A new intraluminal electrical impedance procedure for high‐resolution measurements and the quantitative assessment of gastrointestinal motility is examined in healthy volunteers by cineradiography and manometry. The peristalsis in the oesophagus, stomach and small bowel is recorded with a combined impedance‐pressure catheter. Additionally, investigations with a flexible 16‐channel impedance catheter with a closed surface and a diameter of 3 mm are carried out in the oesophagus and small intestine. The 16 measuring segments with a length of 2 cm each record the contractile patterns from a 32‐cm‐long organ section without a gap. The correctness of the physical approach is validated by concurrent impedance and cineradiography recordings of the oesophageal peristalsis. The comparative studies confirm a close relation between the pressure and the impedance changes in the oesophagus and small intestine. The time analysis of the impedance tracings offers information about the bolus transit and the change of the wall compliance along the organ. Regions of high or low compliance of the muscular wall can be recognized. From the impedance tracings the direction of the contraction waves as well as their velocities, lengths, beginnings and ends can be determined. Moreover, the beginning and end of the bolus, and from them the momentary bolus length, can be characterized for any instant during the bolus transit.
Generally accepted standards for the therapy of advanced gastric carcinomas do not exist. In cases where the therapeutic strategy is surgical exploration, no preoperative staging is necessary. In cases with differentiated treatment strategies, the accuracy of EUS is not sufficient for the selection of patients for endoscopic resection. Its accuracy for submucosal cancer invasion and for the detection of lymph node metastases needs to be further enhanced. If only multimodal therapy is considered, EUS staging seems to be absolutely mandatory. Patients classified preoperatively as T1 to T3 can be operated on primarily with sufficient security. In patients where radical resection of the tumor seems doubtful, we recommend that a diagnostic laparoscopy be performed to confirm the diagnosis.
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