[Diagnosis of a high-grade B-cell lymphoma of the small bowel by means of wireless capsule endoscopy]. / Diagnostik eines hochmalignen B-Zell-Lymphoms des Dünndarms mit der Kapselendoskopie.

Wireless capsule endoscopy is a new diagnostic procedure to detect diseases of the small bowel, in particular in patients with obscure gastrointestinal bleeding. We report on a 76-year-old patient who presented at our hospital with signs of gastrointestinal bleeding and hypochromic anaemia. Bidirectional endoscopy, push enteroscopy, angiography as well as small bowel barium enema rendered no pathologic findings. Wireless capsule endoscopy demonstrated a polypous space in the cantral area of the small bowel. Subsequent intraoperative endoscopy revealed a subtotal stenosing tumour of the upper jejunum which was resected. Based on the histology a high-grade B-Cell lymphoma was diagnosed. The postoperative staging examinations did not indicate any further extranodal involvement.

[Magnetic Resonance Imaging in diagnosis and follow-up of Crohn's Disease--Is conventional enteroclysis still necessary?]. / Die Magnetresonanztomographie in der Diagnostik und Verlaufsbeobachtung des Morbus Crohn - Ist das konventionelle Enteroklysma noch erforderlich?

UNLABELLED: A non-invasive diagnostic modality for differential diagnosis and detection of complications in inflammatory bowel disease (IBD) is desirable as alternative to invasive and troublesome endoscopy and conventional radiological methods. METHODS: 51 patients suspicious of inflammatory bowel disease (bloody diarrhoea, symptoms of stenosis, abdominal pain) were investigated consecutively according to a standardised protocol by magnetic resonance tomography (MRI). Also, endoscopy was performed dependent on clinical presentation. MRI findings were compared to clinical follow-up, percutaneous ultrasonography (US), endoscopy, and surgical findings. RESULTS: MRI confirmed diagnosis of Crohn's disease (CD) in more than 90 % of cases. In case of distinct lesions, all of these were detected by MRI in the small bowel and colon. Discreet inflammatory lesions were not seen regularly. Numerous findings in endoscopically inaccessible bowel segments were described by MRI, extraintestinal lesions (conglomerate, abscess, fistulae) were detected accurately. Altogether, MRI was superior to abdominal ultrasonography. CONCLUSION: In patients with distinct inflammatory bowel disease, and in detection of complications (abscess, fistulae), MRI appears as versatile, non-invasive and accurate diagnostic instrument with therapeutical consequence. Endoscopy remains method of first choice for detection of discreet lesions and for histopathological diagnosis.

[Endoscopy of the small intestine without tube or enema? A video capsule makes it possible]. / Dünndarmendoskopie ohne Schlauch und Klysma? Eine Videokapsel macht's möglich.

The diagnosis of unclear bleeding in the small bowel remains a gastroenterological problem. To date, the diagnostic approach routinely employed has been roentgen Sellink. With such newer techniques as magnetic resonance tomography (MRT) substantially more diagnostic information can now be obtained. A recent new development is capsule endoscopy, which is intended for use when conventional endoscopic examinations fail to identify the source of bleeding. Using this new option in the Ludwigshafen Klinikum the small bowel lesions were discovered in 81% of the 26 patients in whom they had been previously remained undetected. At present, the patients have to bear the cost of this examination themselves.