Comparability of localization data in transnasal and transoral esophagogastroduodenoscopy.

BACKGROUND: Esophagogastroduodenoscopy is an often-used and safe diagnostic method in gastroenterology. Transnasal esophagogastroduodenoscopy is now an established addition to the endoscopic instrumentarium. Although the two examination methods can be used alongside each other, there is a lack of studies on the comparability of the localization data obtained with the transoral and transnasal methods. METHODS: In 135 adult patients presenting for routine outpatient esophagogastroduodenoscopy, transoral esophagogastroduodenoscopy (TOG) was carried out after transnasal esophagogastroduodenoscopy (TNG), and the distance from the naris or incisors, respectively, to the esophagogastric junction was measured. RESULTS: The data for 135 patients were analyzed. With the transoral access route, the distance from the upper incisors to the cardia was a mean of 40.5 cm (SD ± 3.4 cm). In the transnasal examinations, the mean distance between the naris and the cardia was 45.6 cm (SD ± 3.5 cm). The correlation analysis showed a very close correlation between the peroral and transnasal data, with a correlation coefficient of r = 0.925. On the basis of the regression line calculated using these data, the formula TNG (cm) = 1.1 × TOG (cm) was developed. Using this formula, localization details obtained with one method can be converted into those for the other method. CONCLUSIONS: There is a strong correlation between the localization details obtained with the transnasal and transoral examination methods. The formula for converting localization details from one method to the other, presented here for the first time, is practicable for everyday use and allows rapid conversion.

A new approach to endoscopic treatment of tumors of the esophagogastric junction with individually designed self-expanding metal stents.

The incidence of adenocarcinoma of the esophago-gastric junction is constantly increasing. Curative treatment is no longer possible at the time of diagnosis in more than 50% of patients with esophageal carcinoma, and palliative treatment focusing on eliminating dysphagia is required. Endoscopic therapy with stent implantation is an established method of achieving this. It can be carried out quickly, with a low rate of early complications, and leads to fast symptomatic improvement, assessed using the dysphagia score. The relatively high rate of late complications such as stent migration, hemorrhage, and gastroesophageal mucosal prolapse has led to recent debate on the role of metal stents in palliative therapy. We present here a new type of stent design for transcardial application, which is intended to prevent bleeding due to mechanical mucosal lesions caused by the distal end of the stent extending into the stomach. The further intention of this case report is to force the discussion on individually designed nitinol stents in special anatomic conditions.

[Characterization of proteinuria in patients with ulcerative colitis and therapy with aminosalicylates]. / Charakterisierung der Proteinurie bei Patienten mit Colitis ulcerosa unter der Behandlung mit Aminosalicylaten.

BACKGROUND AND PURPOSE: Patients with ulcerative colitis have a higher rate of tubular nephropathies. Data concerning the cause of these lesions is rare and inconsistent, the occurrence may be part of the disease itself or a side effect of 5-aminosalicylates (5-ASA). This study investigated proteinuria and eosinophiluria in patients with moderate ulcerative colitis under treatment with 5-ASA. PATIENTS AND METHODS: Urine specimens (microelectrophoresis and eosinophiluria) of 34 patients with acute onset of moderate ulcerative colitis who were treated only with 5-ASA as active drug were analyzed. RESULTS: Data of 27 patients could be evaluated. Twelve patients had tubular proteinuria previous to treatment. By the end of the study, urine specimens normalized in six, in further six the proteinuria remained unaltered, two patients developed proteinuria under treatment. In 14 patients, proteinuria was not detectable at any time. Eosinophiluria was found in none of the specimens. CONCLUSION: Under treatment with 5-ASA no toxic or allergic nephropathy developed. One initially pathologic urine specimen normalized under treatment coming along with remission of the intestinal symptoms and histological findings. This indicates an association between the activity of the ulcerative colitis and might be caused by renal excretion of pro-inflammatory cytokines.