[How safe is sedation in gastrointestinal endoscopy? A multicentre analysis of 388,404 endoscopies and analysis of data from prospective registries of complications managed by members of the Working Group of Leading Hospital Gastroenterologists (ALGK)]. / Wie sicher ist die Sedierung in der gastrointestinalen Endoskopie? Eine multizentrische Auswertung von 388 404 Endoskopien und Auswertung der Daten aus prospektiv geführten Komplikationsregistern von Mitgliedern der Arbeitsgemeinschaft leitender Gastroenterologen im Krankenhaus (ALGK).

BACKGROUND: Gastrointestinal endoscopies are increasingly being carried out with sedation. All of the drugs used for sedation are associated with a certain risk of complications. Data currently available on sedation-associated morbidity and mortality rates are limited and in most cases have substantial methodological limitations. The aim of this study was to record severe sedation-associated complications in a large number of gastrointestinal endoscopies. METHODS: Data on severe sedation-associated complications were collected on a multicentre basis from prospectively recorded registries of complications in the participating hospitals (median documentation period 27 months, range 9 - 129 months). RESULTS: Data for 388,404 endoscopies from 15 departments were included in the study. Severe sedation-associated complications occurred in 57 patients (0.01 %). Forty-one percent of the complications and 50 % of all complications with a fatal outcome (10/20 patients) occurred during emergency endoscopies. In addition, it was found that 95 % of the complications and 100 % of all fatal complications affected patients in ASA class ≥ 3. CONCLUSIONS: Including nearly 400,000 endoscopies, this study represents the largest prospective, multicenter record of the complications of sedation worldwide. The analysis shows that sedation is carried out safely in gastrointestinal endoscopy. The morbidity and mortality rates are much lower than previously reported in the literature in similar groups of patients. Risk factors for the occurrence of serious complications include emergency examinations and patients in ASA class ≥ 3.

[Adenoma of the common bile duct simulating a calculus]. / Adenom des Ductus hepatocholedochus unter dem Bild eines Konkrementes.

We report the case of a 81-year old woman having had a cholecystectomy due to cholelithiasis four years ago. Three years later she suffered from cholangiolithiasis, which was treated by endoscopic revision of the hepatic duct. After another year she had right upper quadrant pain and was admitted to hospital. ERCP revealed an intraluminal filling defect. Suspecting cholangiolithiasis the patient was referred to our hospital for papillotomy and extraction of a "common duct stone". On withdrawal of the basket a tissue mass was removed. The histological examination showed a tubulopapillary adenoma of the common bile duct.

[An unusual course of low-malignancy non-Hodgkin lymphoma of the stomach]. / Ein ungewöhnlicher Verlauf eines niedrigmalignen Non-Hodgkin-Lymphoms des Magens.

We report on a 51-year-old women, who suffered from a low-grade lymphoma of the stomach (MALT-lymphoma) and underwent subtotal gastrectomy in 1991. Two years later she developed a relapse of her MALT-lymphoma. She was treated with two Helicobacter pylori eradication therapies which led to complets remission of the lymphoma. In 1994 she developed a high-grade conchal lymphoma and underwent conchotomy. No moleculargenetic evidence of any relationship between the two lymphomas was found.

[Solitary angiomyolipoma of the liver]. / Das solitäre Angiomyolipom der Leber.

Today in the age of ultrasonography focal hepatic lesions are diagnosed more often, which are difficult to be classified. Metastases are leading numerically among the malignant tumors, hemangiomas among the benign. We report on a rare case of a hemangiomyolipoma of the liver and the diagnostic difficulties. The final diagnosis was made only after hemihepatectomy.

[Intramural pseudodiverticulosis of the esophagus with candidiasis involvement]. / Intramurale Pseudodivertikulose des Osophagus mit Soor-Befall.

We report on a 55 year old female patient suffering from weight loss. On endoscopy we found an Esophageal Intramural Pseudodiverticulosis (EIP) with Candidiasis. This case report wants to discuss this rare benign disease and its diagnostic and therapeutic approach.

Endoscopic and bioptic diagnosis of malignant non-Hodgkin's lymphoma of the stomach.

Experience in the endoscopic and bioptic diagnosis of malignant non-Hodgkin's lymphomas of the stomach in 66 patients is reported all of which were B cell lymphomas originating in the mucosa associated lymphoid tissue (MALT) type. Two types of tumor could be differentiated by their appearance on endoscopy (two patients had both types). An exophytic type (n = 24) was easily recognized as malignancy on endoscopy and the diagnosis confirmed by endoscopic biopsy (mean of 1.2 endoscopic-bioptic examinations). It could be classified according to the Palmer classification; 50% were low-grade malignancies and 50% high-grade malignancies. Resection (n = 17) showed wall penetration beyond the muscularis propria in 70%. An infiltrative type (n = 44) was difficult to diagnose by means of endoscopy and biopsy (mean of 2.9 endoscopic-bioptic examinations); in one case a histological diagnosis could only be established on surgery. A classification system is suggested for this type (I--elevated, II--flat, III--cavitated). Most of these lymphomas were low-grade malignancies (77%), and limited to the mucosa and submucosa (79% of 34 resected cases). It is concluded that attention should be paid especially to the infiltrative type of gastric lymphoma which is difficult to diagnose and to differentiate from other gastric conditions such as ulcers and erosions, but which is most often found at an early stage and has a better prognosis. Complete tumor resection (R0) was achieved in 49 of 51 patients undergoing surgery (96%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pedicled polypoid carcinosarcoma: a very rare esophageal tumor]. / Das gestielt polypoide Karzinosarkom: ein sehr seltener Osophagustumor.

Neoplasms of the esophagus normally appear either as a exophytic-polypoid form, or as an infiltrating carcinoma or as an ulcerating tumor. We report on a 86 year old man suffering from the rare case of a pedicle polypoid tumor of the esophagus histologically diagnosed as a carcinosarcoma. We discuss the histological problems and our diagnostic and therapeutic proceeding.

Short Barrett: prevalence and risk factors.

BACKGROUND: The incidence of adenocarcinoma at the gastro-oesophageal junction is on the increase. These carcinomas are usually diagnosed too late and thus have a poor prognosis. Only early diagnosis can improve the situation. Classical Barrett oesophagus (length, >3 cm) is a known precancerous condition. There is also specialized columnar epithelium (SCE) in the grossly unremarkable gastro-oesophageal transitional zone (short Barrett). METHODS: To determine the frequency of SCE, 370 patients were investigated by gastroscopy (OGD) consecutively between September 1995 and February 1996. RESULTS: Classical Barrett oesophagus was found to have an incidence of 4.6%. In contrast, microscopic evidence of SCE was observed in 13.6% of the cases. Patients with short Barrett presented with reflux symptoms (odds ratio (OR), 4.7), irregular zona serrata ('tongues') in the cardia (OR, 2.8), and reflux oesophagitis significantly more frequently. Patients with reflux symptoms and concomitant 'tongues', however, had an OR of 13.16. Careful history-taking, together with a subtle histologic work-up of the gastro-oesophageal transitional zone can improve the rate of detecting patients with short Barrett. CONCLUSION: Patients with reflux symptoms and irregular zona serrata should be selectively biopsied at the gastro-oesophageal junction, even when the latter presents a grossly normal appearance, with the aim of detecting patients at risk of developing a Barrett carcinoma.