Nonerosive reflux disease (NERD) is commonly diagnosed in patients with symptoms of reflux. The aim of the present study was to determine whether high-definition endoscopy (HD) plus equipped with the iScan function or chromoendoscopy with Lugol's solution might permit the differentiation of NERD patients from those without reflux symptoms, proven by targeted biopsies of endoscopic lesions. A total of 100 patients without regular intake of proton pump inhibitors and with a normal conventional upper endoscopy were prospectively divided into NERD patients and controls. A second upper endoscopy was performed using HD+ with additional iScan function and then Lugol's solution was applied. Biopsy specimens were taken from the gastroesophageal junction in all patients. A total of 65 patients with reflux symptoms and 27 controls were included. HD(+) endoscopy with iScan revealed subtle mucosal breaks in 52 patients; the subsequent biopsies confirmed esophagitis in all cases. After Lugol's solution, 58 patients showed mucosal breaks. Sensitivity for the iScan procedure was 82.5%, whereas that for Lugol's solution was 92.06%. Excellent positive predictive values of 100% and 98.3%, respectively, were noted. The present study suggests that the majority of patients with NERD and typical symptoms of reflux disease can be identified by iScan or Lugol's chromoendoscopy as minimal erosive reﬂux disease (ERD) patients.
The prognosis for patients with malignancies of the gastrointestinal-tract is strictly dependent on early detection of premalignant and malignant lesions. However, small, flat or depressed neoplastic lesions remain difficult to detect with these technologies thereby limiting their value for polyp and cancer screening. At the same time computer and chip technologies have undergone major technological changes which have greatly improved endoscopic diagnostic investigation. New imaging modalities and techniques are very notable aspects of modern endoscopy. Chromoendoscopy or filter-aided colonoscopy (virtual chromoendoscopy) with high definition endoscopes is able to enhance the detection and characterization of lesions. Finally, confocal laser endomicroscopy provides histological confirmation of the presence of neoplastic changes. The developing techniques around colonoscopy such as the retro-viewing colonoscope, the balloon-colonoscope or the 330-degrees-viewing colonoscope try to enhance the efficacy by reducing the adenoma miss rate in right-sided, non-polypoid lesions. Colon capsule endoscopy is limited to identifying cancer and not necessarily small adenomas. Preliminary attempts have been made to introduce this technique in clinical routine.
When young people discuss organ donation in their families or when they seek information themselves, the acceptance of organ donation greatly improves. Our data suggest that education on organ donation can double the number of carriers of an organ donor card among students.
More than half of the pupils between 14 years and 20 years of age support the concept of organ transplantation as therapeutic option. Nevertheless the proportion of organ card holders is small among these students. These regional results identify an information deficit in young people in Germany as one of the main causes for inadequate acceptance of organ donation. Therefore, information and structured education should be intensified in German schools as possible measure to increase the number of future organ donor card holders in Germany.
For many specific and nonspecific gastrointestinal symptoms, endoscopic diagnostic procedures play an important role. Gastroscopy and colonoscopy are easily available diagnostic and interventional procedures with low risk. The technical development of gastrointestinal endoscopy has led to an improvement in diagnostics and therapy. In addition to frequent and expected findings, incidental findings may occur. The incidental findings can distinguish rare diseases of unexpected diagnoses. Rare diagnoses usually require an individualized therapy. Unexpected diagnoses can take place during (not properly detected) or after an endoscopy (overlooked or newly appeared) occur. This overview deals with the question of how to minimize unexpected diagnoses and how to diagnose and treat incidental findings.
Die moderne Medizin ist gepr?gt durch die Entwicklung der Computer- und Chiptechnologie mit den damit verbundenen neuen M?glichkeiten der Bildgebung. Einen f?hrenden Stellenwert in der Gastroenterologie nimmt hierbei die Entwicklung neuer bildgebender Verfahren in der Endoskopie ein. Hauptziel der Endoskopie ist die fr?he Erkennung maligner Ver?nderungen, um diese rechtzeitig noch vor Auftreten einer Metastasierung endoskopisch zu resezieren. Die Diagnostik pr?- und fr?hmaligner Ver?nderungen im Gastrointestinaltrakt bestimmt dabei unmittelbar die Prognose der betroffenen Patienten. Dazu stehen heute neben der Chromoendoskopie neue Techniken und Verfahren wie die High-Definition-Endoskopie oder die virtuelle Chromoendoskopie zur Verf?gung. Alternativ versuchen sich neue Methoden wie die Autofluoreszenz oder die Spektroskopie als neue Verfahren zu etablieren, andere Techniken wie die konfokale Endomikroskopie haben bereits den Weg in die endoskopische Untersuchung als In-vivo-Histologie bereits erfolgreich gefunden. Verfahren wie die molekulare Bildgebung werden ex vivo bereits erfolgreich eingewendet und stehen kurz vor ihrem Durchbruch, auch in der Routine Anwendung zu finden.
Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body.
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