Detailed esophageal function and morphological analysis shows high prevalence of gastroesophageal reflux disease and Barrett's esophagus in patients with cervical inlet patch.

Although the pathogenesis of cervical inlet patch (CIP) is not fully understood, most authors consider it as a congenital abnormality, whereas others surmise it to be related to gastroesophageal reflux disease (GERD). We aimed to evaluate esophageal function and the prevalence of GERD and Barrett's esophagus in patients with CIP. GERD is defined by the presence of erosive esophagitis or an abnormal pH monitoring. Seventy-one consecutive patients with endoscopic and histological evidence of CIP were prospectively evaluated. Esophageal symptom analysis, 24-hour simultaneous biliary reflux and double-channel pH-monitoring, and esophageal manometry were carried out in 65/71 (92%) patients and in 25 matched controls. Six patients were not suitable for testing and were, therefore, excluded. The histological evaluation of the heterotopic islands showed cardia and/or oxyntic mucosa in 64/65 (98%) patients and specialized intestinal metaplasia (SIM) in one patient (2%). The cardia and/or oxyntic mucosa was accompanied by focally appearing pancreatic acinar metaplasia and pancreatic ductal metaplasia in 7/64 (11%) and in 1/64 (2%), superficial mucous glands in 6/64 (9%), and SIM in 2/64 (3%) cases. In total, SIM was present in three patients (5%), and one of them had low-grade dysplasia. At the gastroesophageal junction, 28 (43%) patients had columnar metaplasia, including nine (14%) patients with SIM. Erosive esophagitis was present in 37 (57%) cases. Thirty-two patients (49%) had abnormal acid reflux in the distal and 25 (38%) in the proximal esophagus. Abnormal biliary reflux was present in 25 (38%) cases. On the basis of endoscopic and pH studies, GERD was established in 44/65 (68%) patients. Typical reflux symptoms were common (33/65, 51%). The combined 24-hour biliary and double-channel pH-monitoring detected significantly more significant acidic reflux at both measurement points and significantly longer bile exposure time in the distal esophagus in patients with CIP. Acid secretion in the CIP was detected in three (5%) cases. Esophageal manometry revealed decreased LES pressure and prolonged relaxation with decreased peristaltic wave amplitude, and an increased number of simultaneous contractions in the esophageal body. The detailed evaluation of the esophageal morphology and function in subjects with CIP showed a high prevalence of GERD and Barrett's esophagus. Further studies are needed to evaluate whether combined acidic and biliary reflux is able to promote similar histomorphological changes in the CIP, as it is shown distally in patients with Barrett's esophagus.

Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members.

BACKGROUND/AIMS: Sedation rates may vary among countries, depending on patients' and endoscopists' preferences. The aim of this survey was to investigate the rate of using premedication for routine diagnostic upper gastrointestinal (UGI) endoscopy in endoscopy societies, members of the European Society of Gastrointestinal Endoscopy (ESGE). METHODS: We evaluated a multiple-choice questionnaire which was e-mailed to representatives of national endoscopy societies, which are members of the ESGE. The questionnaire had 14 items referring to endoscopy practices in each country and the representatives' endoscopy units. RESULTS: The response rate was 76% (34/45). In 47% of the countries, less than 25% of patients undergo routine diagnostic UGI endoscopy with conscious sedation. In 62% of the responders' endoscopy units, patients are not asked their preference for sedation and do not sign a consent form (59%). Common sedatives in use are midazolam (82%), diazepam (38%) or propofol (47%). Monitoring equipment is not available 'in most of the endoscopy units' in 46% (13/28) of the countries. Though they were available in 91% of the national representatives' endoscopy units, they are rarely (21%) used to monitor unsedated routine diagnostic UGI endoscopy. CONCLUSIONS: In about 50% of ESGE-related countries, less than 25% of patients are sedated for routine diagnostic UGI endoscopy. Major issues to improve include availability of monitoring equipment and the use of a consent form.

[Use of two teflon stents in malignant non-hilar biliary atresia]. / Két teflondrén alkalmazása malignus, nem hilaris epeúti szükületben.

Insertion of biliary stents in cases of malignant biliary obstruction is a widely accepted method to resolve jaundice. The authors applied two 10 French biliary teflon stents to prolong the drain patency in 32 patients with distal malignant obstruction, thought to be inoperable at the time of intervention. Among the followed, inoperable 23 cases 14 patients died for the time of evaluation. The median survival was 150 days, the median drain patency was 99 days. Cholangitis was the cause of death in three patients. Repeated endoscopic interventions were: transient nasobiliary drainage without drain replacement in two patients and four changes of stents in three patients. In the 13 patients, surviving and wearing their drains at least for 100 days the patency of the double drains was 157 days. These results obtained in the long-time survivors support the comparability of the patency of double teflon stent to that of metalstents. In majority of cases the two teflon drains remained patent until the deaths of patients.

[Experience with percutaneous endoscopic gastrostomy in the nutrition of a patient with 3rd and 4th degree facial burns]. / Percutan endoszkópos gastrostomán át táplált III-IV. fokú arcégett beteg kezelésével nyert tapasztalataink.

Recovery after thermal injury depends in great proportion on nutrition. A major problem is accounted in patients with facial burn, because they can not be nourished per vias naturales. Eliminating disadvantages of parenteral nutrition, but utilizing the advantages of enteral nutrition, we have tried a new method of treatment in a patient whose case is presented. On the second day after injury a percutaneous endoscopic gastrostomy was made. On the 7th day after injury and on the 4th day from the beginning of enteral nutrition complete intake of food and liquid was assured through the percutaneous endoscopic gastrostoma. We had no complication related to the gastrostoma. Nutrition through the percutaneous endoscopic gastrostoma at our patient provided a "natural" route to assure liquid, electrolite and energy balance, prevented atrophy of intestinal mucosa and its metabolic and immunologic complications. With the use of percutaneous endoscopic gastrostoma the possible complications of central line catheter were omitted. Our opinion is that percutaneous endoscopic gastrostomy is a safe and effective method for the clinical nutrition of burned patients.