On the efficacy of ready-made-up commercially available salicylazosulphapyridine enemas in the treatment of proctitis, proctosigmoiditis and ulcerative colitis involving rectum, sigmoid and descending colon.

To investigate efficacy and possible side effects, double-blind studies were carried out using 3% salicylazosulphapyridine enemas and appropriate placebo enemas. In a first study involving peranal therapy along, the success rate was 73%; in a second study employing a combination of oral and peranal medication, the success rate was 75%. This shows that the efficacy of the peranal form of administration is comparable to that obtained with oral medication. No side effects were observed throughout the period of observation of this study.

[Clinical experiences with a new method of laser coagulation in gastrointestinal hemorrhages]. / Esperienze cliniche con un nuovo metodo di laser-coagulazione nelle emorragie gastrointestinali.

Endoscopic laser-coagulation was used 94 times in 14 patients to stop gastro-intestinal bleeding or coagulate potential bleeding sources during non-bleeding intervals. Lasting haemostasis was achieved in three cases of incomplete gastric erosion, one of gastric ulcer, one of duodenal ulcer and one of bleeding after antral rugectomy. It failed to stop severe arterial bleeding in a case of gastric carcinoma. Lasting haemostasis was achieved in six haemangiomas of the colon, one case of angiomatosis of the antrum with 62 individual sites, two of angiodysplasia of the colon, 17 lesions in Osler's disease of the oesophagus (2 cases), stomach (10) and duodenum (5). The procedure was performed in the course of diagnostic endoscopy with an argon-ion laser developed by the authors, which has a density of 0.7-1.3 W/mm2. No complications have been observed so far.

[Removing adenomas reduces colon carcinoma risk up to 90%. Effective cancer prevention with the endoscope]. / Adenomentfernung reduziert Kolonkarzinom--Risiko um bis zu 90%. Effektive Krebsprävention mit dem Endoskop.

Endoscopic polypectomy is considered the method of choice for the diagnosis and treatment of colorectal polyps. 70-80% of all colorectal polyps are adenomas, which are precursors of colorectal carcinoma. The endoscopic detection and rigorous removal of colorectal polyps is an effective means of preventing colorectal carcinoma, since the incidence of the latter can be reduced by 90%. If technically possible, a snare should be used to remove all polyps larger than 5 mm in diameter. Tiny polyps may be removed with forceps. The removed polyp must be send for histological work-up and the results obtained used to plan the further steps or post-polypectomy surveillance. In defined cases (removal with adequate clearance, well-differentiated carcinoma, low risk situation), endoscopic polypectomy of adenomas with invasive carcinoma (pT1 carcinoma) is now the only treatment needed. Further surgical resection is not necessary. Surveillance is as for surgically removed colorectal carcinoma.

[Prevention and early detection of colorectal cancer]. / Kolonkarzinom--Prävention.

With 60000 new cases and approximately 31000 deaths annually the colorectal carcinoma is the second most frequent cause of death due to a tumour in Germany. In over 90% of all colorectal carcinomas the precursors (adenomas) are well known. Moreover the early carcinoma of the colorectum (pT1-carcinoma) has an exceptional benign prognosis. To detect those precursors and early stages effective methods of primary, secondary and tertiary prevention are available.

[Endoscopy in the diagnosis and therapy of surgical diseases. Colonoscopic diagnosis (author's transl)]. / Die Endoskopie in Diagnostik und Therapie chirurgischer Erkrankungen. Coloskopische Diagnostick.

Fibroscopes and the techniques of introducing them are now so highly developed that, except for an impassable stenosis, the entire colon can be inspected in every case and the adjacent small intestine in 90% of the cases. Indisputable advantages as compared with indirect methods such as radiology are the direct inspection of the mucosa, the possibility of reliably differentiating between pathological findings and residual stool, the detection of minute lesions that escape radiological examination, and the possibility of removing tissue samples (forceps biopsy, big-particle biopsy, polypectomy). Thus it is possible for the first time to confirm diagnosis morphologically prior to surgery.

Evaluation of a new three-dimensional magnetic imaging system for use during colonoscopy.

BACKGROUND AND STUDY AIMS: A prototype magnetic imaging system (Scope Guide, Olympus Optical Co., Ltd.) provides a new facility for continuous viewing on a monitor of the position of the colonoscope during examination, without exposing patients or medical staff to radiation. The aim of this prospective study was to compare this magnetic imaging system with routine colonoscopy, including fluoroscopy. The study parameters were the detection of loops, the location of the endoscope tip at defined positions, the insertion time, and the premedication rate. MATERIALS AND METHODS: In the first part of the study, 133 consecutive patients were examined - 64 using an integrated three-dimensional colonoscope and 69 with the three-dimensional probe inserted into the biopsy channel of a routine video colonoscope. Fluoroscopy was used in all investigations for comparison at defined anatomical points and loops, and pathological findings and defined anatomic structures were documented using a laser printer both for three-dimensional colonoscopy and fluoroscopy. In the second part of the study, 25 further patients underwent colonoscopy with a modified prototype, now exclusively using the integrated three-dimensional colonoscope. RESULTS: The total time for insertion and the premedication rate did not differ from those of routine colonoscopies with fluoroscopy available. Precise detection of loops was observed in the first study in 79 - 100 % of cases in comparison with fluoroscopy. Precise localization of the endoscopic tip improved from 30 % in the first part of the study to 80 % in part 2. CONCLUSION: Using magnetic three-dimensional imaging systems, the position of the colonoscope, the detection and observation of loops during straightening, and localization of pathological findings can be accurately achieved. Modification of the prototype led to satisfactory improvement in all parameters tested.

[The electro-hydro-thermal probe. Clinical results and possible use of modified electrocoagulation in the gastrointestinal tract]. / Elektro-Hydro-Thermo-Sonde. Klinische Ergebnisse und Einsatzmöglichkeiten der modifizierten Elektrokoagulation im Gastrointestinaltrakt.

Electrocoagulation with simultaneous water infusion (electro-hydro-thermal probe) was applied in 58 patients. In 43 there had been active bleeding which was stopped in over 90%. The use of this probe thus proved to be of clinical importance for endoscopic arrest of bleeding. Non-bleeding lesions, most of them vascular changes, were coagulated in 15 patients, removing a potential source of bleeding. There were no complications.

[Colonoscopy in children and juveniles (author's transl)]. / Koloskopie bei Kindern und Jugendlichen.

Colonoscopy, as an established endoscopic procedure in adults, is thought to be of great value in children and juveniles as well. The main indications for its use are intestinal hemorrhage, polypectomy, diarrhoea of uncertain origin, uncertain x-ray findings as well as the confirmation of a diagnosis made by biopsy. The choice of instruments used, preparations prior to the examination and premedication are dependent upon the child's age. 32 children, aged between 1--14 years, and 41 juveniles between 15 and 18 years were examined. Most common diagnoses were Crohn's disease (29), polyps (7) and ulcerative colitis (4). Others were unspecific colitis (3), follicular hyperplasia of the terminal ileum (2), lymphangiectasia (2), one hemangioma and one rectal ulcer. In 24 patients endoscopy revealed nothing pathological within the colon. Examinations should be performed only by skilled endoscopists with special experience of the problems of colonoscopy in children.

Endoscopic treatment of precanceroses and early gastric carcinoma.

A plea is made for individual age-adjusted endoscopic therapy of precancerous lesions and, under certain conditions, of early gastric carcinoma. True adenoma and borderline lesion have to be resected, if technically feasible, by snare ectomy. Tumour remnants or local recurrences can be destroyed by argon laser application. In poor-risk patients with a well-differentiated mucosal carcinoma situated close to the cardia, the risk of dying from metastases left behind after endoscopic resection seems less than that of fundectoma or gastrectomy. Endoscopic polypectomy was successfully practised in 6 patients with early gastric carcinoma with no tumor recurrence.

Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry.

In April, 1978, we carried out a survey covering 27 hospitals, in which colonoscopy is performed on a routine basis. With respect to the size of the hospital, the equipment available and the level of training of the examiner, this selection may be regarded as representative. A total of 35,892 colonoscopies, 7,365 polypectomies, 58 electrocoagulations and 14 rugectomies were analysed with respect to the nature, localization and treatment of any complications that arose. The rate of complications seen in diagnostic colonoscopy was 0.008% for bleeding and 0.14% for perforation, the mortality rate being 0.02%. As expected, the complication rate for colonoscopic polypectomy was higher. Bleedings were reported in 2.24%, perforations in 0.34% and deaths in 0.1% of the examinations. Of particular importance would seem to be the possibilities of preventing complications. It was shown on the basis of the survey that a good, standardized training of the endoscopist, the strict observance of the contraindications, the non-use of analgesics and general anaesthesia, fluoroscopic control of "difficult" colons and the use of the best instruments and aids presently available, reduce the complication rate to a minimum.