[Is the prognosis of patients with variceal hemorrhage determined by the severity of the underlying disease?]. / Ist die Prognose der Patienten mit Varizenblutung durch den Schweregrad der Grundkrankheit determiniert?

This retrospective analysis includes all patients in whom endoscopic sclerotherapy was initiated because of bleeding oesophageal varices during the years 1984 to 1986. Of the total of 107 patients (77 men, 30 women, mean age 56 years) a majority of 71 (66.3%) had alcoholic liver disease as the underlying cause of portal hypertension. Varices were injected with ethoxysclerol 1% in weekly sessions if possible until they were completely eradicated. Initially 27 patients (25.2%) were classified as Child's class A, 52 (48.5%) as Child's class B and 27 as Child's class C. At the time of analysis 46 patients (42.9%) had died. 17 patients died of uncontrolled variceal haemorrhage one of them after a completed course of sclerotherapy, 15 died in hepatic coma. The cumulative survival rate after one year was 63.8% overall, 84.7% for patients in Child's class A, 75.4% for patients in Child's class B and 21.3% for patients in Child's class C. The one year survival rate for the 50 patients who failed to complete a course of sclerotherapy was 26.9%. The one year survival rate for alcoholics as a group (63%) was the same as for non-alcoholics (64.2%). 40 patients had non-fatal episodes of bleeding, 15 of whom bled after completion of a course of endoscopic sclerotherapy (median delay 174 days after completion of sclerotherapy). We conclude from our results that the outcome after sclerotherapy for oesophageal varices is determined mainly by the severity of the underlying liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopic treatment of choledocholithiasis]. / Die endoskopische Behandlung der Choledocholithiasis.

Since its introduction 10 years ago, endoscopic removal of gallstones from the common bile duct has become a widely accepted method. The procedure is successful in approximately 90% of cases. Complications occur in 5-10%, with a reported mortality of 1-2%. Endoscopic removal of gallstones from the common bile duct appears to be the method of choice in the treatment of patients with previous cholecystectomy. Other important indications are acute cholangitis and biliary pancreatitis.

[Endoscopic insertion of endoprostheses in malignant extrahepatic bile duct stenoses]. / Endoskopische Einlage von Endoprothesen bei malignen extrahepatischen Gallengangstenosen.

In the vast majority of patients with malignant biliary strictures endoscopic insertion of biliary endoprostheses leads to good palliation with decline of the jaundice and disappearence of the pruritus. The prostheses are positioned immediately after diagnostic endoscopic retrograde cholangiopancreatography, thus causing only minor additional discomfort for the patients. The insertion technique is difficult, but success rates between 70 and 90% are achieved by experienced endoscopists. Complications occur in 10 to 20% and mortality is 2-3%. Thus, endoscopically inserted endoprostheses have become a good alternative to the percutaneous transhepatic procedure and in many cases even to palliative surgical biliary drainage.

Palliative intubation of malignant esophagogastric obstruction.

Our experience with endoprosthesis placement in 400 patients with obstructing esophagogastric or pulmonary malignancy includes patients with bronchoesophageal fistulas, carcinoma of the cardia, tumor recurrence after Billroth I and Billroth II surgery, tumor recurrence after proximal and total gastric resection, and patients with total involvement of the stomach. We employed an introducer and tubes that were designed and adapted to solve specific problems of dilatation and intubation. Adequate tube functioning was obtained in 95% of the patients, despite the fact that we treated some who had been previously considered to be unsuitable candidates. Complications were severe bleeding (1%), perforation (7%), early migration (15%), late migration (8%), obstruction (6%), and pressure necrosis (3%). The mortality rate due to the procedure was 4%. In general, marked improvement of the quality of life was obtained. Mean survival time was 113 days.

Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation.

Twenty-one patients with a solitary ulcer of the rectum were treated with instructions for a high-fiber diet and abstention of straining at defecation, since there is evidence that the solitary ulcer syndrome is caused by chronic mechanical and ischemic trauma, by hard stools, and intussusception of the mucosa. In 15 patients disappearance of symptoms and complete ulcer healing was obtained in an average period of 10.5 months (range 2.5-21 months). In the other six patients the lesions remained unchanged. The results demonstrate that softening of stools and normalization of defecation habits should be the mainstay in the treatment of this otherwise chronic disorder with poor healing tendency.

Comparison of beclomethasone dipropionate and prednisolone 21-phosphate enemas in the treatment of ulcerative proctitis.

In a double-blind randomized clinical trial 18 patients with exacerbations of distal ulcerative colitis were treated for 4 weeks with enemas containing either prednisolone 21-phosphate 30 mg (PP) or beclomethasone dipropionate 1 mg (BDP) a surface-active corticosteroid. All 8 patients treated with PP showed clinical and endoscopic improvement in contrast with only 4 of 10 patients treated with BDP. Endocrinologic evaluation showed a significant decrease in morning plasma cortisol, in cortisol increase after synacthen, and in urinary free cortisol excretion after PP therapy, but no changes in these variables after BDP therapy. We conclude that PP enemas are more active in the treatment of ulcerative proctitis, but they cause a suppression of the adrenal cortex, in contrast to BDP.