Endoscopic sphincterotomy in patients with Billroth II gastrectomy.

We attempted endoscopic sphincterotomy in 35 patients previously subjected to Billroth II gastrectomy, and succeeded in 23 of them. It is often difficult to pass the instrument along the afferent loop and the sphincterotomy incision is seldom placed in an optimal position. Although we had complications in only 2 patpients, it is likely that spincterotomy carries a higher risk in Billroth II gastrectomy patients. It should therefore be reserved for patients who are at high risk for surgery.

[Endoscopic papillotomy for acute pancreatitis caused by biliary disease (author's transl)]. / Endoskopische Papillotomie bei akuter, biliär bedingter Pandreatitis.

In 15 patients with acute pancreatitis caused by biliary disease endoscopic sphincterotomy was performed after diagnostic ERCP. All patients had a history of symptoms pointing to long-standing biliary disease, such as typical right-sided upper abdominal pain, signs of biliary stasis, and jaundice. An impacted solitary ampullar stone was demonstrated in eight patients while in seven several stones were found in the biliary tract. In one patient pancreaticogram also revealed a gall-stone which had slipped in Wirsung's duct. After endoscopic sphincterotomy and extraction of stone rapid and marked improvement occurred in all 15 patients and the biochemical abnormalities were restored towards normal. All patients became pain-free immediately after the procedure. The markedly raised levels of serum-alpha-amylase (mean of 21 700 U/l immediately before the procedure) fell tonormal values within 48 hours (400--3000 U/l). Endoscopic sphincterotomy is thus an alternative to early operation in acute pancreatitis of biliary origin.

[Endoscopic transpapillary bile duct drainage in malignant obstructive jaundice]. / Endoskopische transpapilläre Gallengangsdrainage bei tumorbedingtem Verschlussikterus.

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.8 months. The initially high rate of complications, mainly due to cholangitis, with a mortality rate of 9.3% could be reduced drastically after use of a duodenoscope with a 3.7 mm bore instrumentation canal enabling insertion of well-draining wide-lumen endoprostheses. Drainage should only be used in non-resectable tumours, general inoperability or for preoperative relief of biliary ducts in jaundice and prospective curative surgical intervention. As results improve with mounting experience it may be expected that endoscopic biliary duct drainage will replace palliative surgery, especially in elderly patients at risk.

[Treatment of duodenal ulcer with synthetic depot secretin - a double-blind study]. / Die Behandlung des Ulcus duodeni mit synthetischem Depot-Sekretin - eine Doppelblindstudie.

63 inpatients with duodenal ulcer disease were treated with either depot-secretin or placebo. Two different secretin-regimens were used. In group I 18 patients were given secretin twice daily. 11 ulcers from a total of 19 ulcers healed within 3 weeks. In group II 23 patients were given secretin once daily. 21 out of 28 ulcers healed within 3 weeks. In the placebo-treated group 24 ulcers were observed in 22 patients. Of these 15 healed within 3 weeks. There was no statistical difference in the healing rate between the 3 groups. However, depot-secretin significantly improved typical symptoms. Analgetics were used less frequently. Serious side effects did not occur.