The diagnositc value of ultrasonic tomography of the upper abdominal organs is sometimes limited by bones and gas. Endoscopic ultrasonography (EUST) combines the advantages of the direct visualization of the upper GI tube and the ultrasonic imaging of adjacent organs. The ultrasonic probe consists of a 5 MHz array that generates a good resolution at the acustical focus, the endoscope is a conventional Olympus gastroscope type GFB3. The ultrasonic transducer is firmly attached to the distal end of the endoscope. Combined examinations are performed in 18 patients with biliary, pancreatic and hepatic disorders or postoperative changes. EUST may be of value not only for gastrointestinal but also for retroperitoneal, cardiac, and mediastinal diseases.

Background and Aims: Malfunctions of enteric neurons are believed to play an important role in the pathophysiology of irritable bowel syndrome (IBS). Our aim was to investigate whether neuronal activity in biopsies from IBS patients is altered in comparison to healthy controls (HC).Methods: Activity of human submucous neurons in response to electrical nerve stimulation and local application of nicotine or a mixture of histamine, serotonin, tryptase, and TNF-α (IBS-cocktail) was recorded in biopsies from 17 HC and 35 IBS patients with the calcium-sensitive-dye Fluo-4 AM. The concentrations of the mediators resembeled those found in biopsy supernatants or blood. Neuronal activity in guinea-pig submucous neurons was studied with the voltage-sensitive-dye di-8-ANEPPS.Results: Activity in submucous ganglia in response to nicotine or electrical nerve stimulation was not different between HC and IBS patients (P = 0.097 or P = 0.448). However, the neuronal response after application of the IBS-cocktail was significantly decreased (P = 0.039) independent of whether diarrhea (n = 12), constipation (n = 5) or bloating (n = 5) was the predominant symptom. In agreement with this we found that responses of submucous ganglia conditioned by overnight incubation with IBS mucosal biopsy supernatant to spritz application of this supernatant was significantly reduced (P = 0.019) when compared to incubation with HC supernatant.Conclusion: We demonstrated for the first time reduced neuronal responses in mucosal IBS biopsies to an IBS mediator cocktail. While excitability to classical stimuli of enteric neurons was comparable to HC, the activation by the IBS-cocktail was decreased. This was very likely due to desensitization to mediators constantly released by mucosal and immune cells in the gut wall of IBS patients.

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Specially designed longstanding nasobiliary tubes allow to reflect upon some well established therapeutic rules. The safe, decompressing effect of the tube leads to prompt relief of obstructive suppurative cholangitis. Therefore emergency of laparotomy can be avoided in high risk patients. Large common bile duct stones until now have required a large papillotomy with increased frequency of complications. The attempt to dissolve those stones with Capmul is justified on an account of a 50% success rate. Either a very small EPT or even non is necessary in order to insert the tube.

In an evaluation of endoscopic-radiological cholangiopancreaticographies (ERCP), in addition to variations in the form of the papilla of Vater, peripapillary diverticula were found on 34 and papillae with several orifices on 19 occasions. The most frequently found pancreatic anomaly at 2.70/o (18 cases) was the non-fusion of the original double "anlage" of the pancreatic duct systems. Accessory pancreatic duct, annular pancreas, ancillary pancreas, cystic fibrosis, choledochus cyst, accessory bile duct, deep hepatic bifurcation and anomalies of the gallbladder are demonstrated. Knowledge of the atypical forms and the anomalies involving papilla, pancreas and common bile duct system, is important, even though they occur in only small percentage of cases, in order to avoid misinterpretations. Key-Words: Anomalies of biliary ducts, anomalies of pancreas, ERCP, retrograde cholangiography, retrograde pancreaticography. Variationen und Anomalien von Papilla Vateri, Pankreas und Gallengangsystem Bei Auswertung von 911 endoskopisch-radiologischen Cholangiopankreatikographien (ERCP) fanden sich neben Formvarianten der Papilla Vateri 34mal peripapilläre Divertikel und 19 Papillen mit mehreren Orifizien. Die häufigste Pankreasatypie stellt mit insgesamt 2,7°/o (18 Fälle) die Nichtvereinigung der urspriinglich doppelt angelegten Pankreasgangsysteme dar. Akzessorischer Pankreasgang, Pancreas annulare, Nebenpankreas, Mukoviszidose, Choledochuszyste, akzessorischer Gallengang, tiefe Hepatikusgabel und Anomalien der Gallenblase werden demonstriert. Die Kenntnis von Atypien und Anomalien an Papille, Pankreas und Gallenwegssystem ist wichtig, auch wenn sie nur in einem geringen Prozentsatz vorkommen, um Fehldeutungen zu vermeiden. Downloaded by: University of British Columbia. Copyrighted material.

Over a period of 8 years 351 upper gastrointestinal endoscopies and 72 coloscopies were performed in infants, children and juvenile patients. Development of special pediatric instruments provides increasing application even to the youngest patients. Fiberendoscopy is a safe and sensitive diagnostic tool also in the pediatric age group; furthermore the therapeutic possibilities of operative endoscopy can be used without disadvantage.

Ligation of Wirsung's duct or obstruction with a glue may be an alternative to pancreatectomy in patients with intractable pain due to chronic relapsing pancreatitis. In 10 patients obstruction of Wirsung's duct was performed via endoscopic retrograde instillation of an alcoholic aminoacid solution into the ductal system. All patients became free of symptoms within one week; no complications were seen. Long-term follow-up data, however, suggest that clinical improvement may be persistent in only about 50 per cent of the patients. Further data are necessary before endoscopic obstruction of Wirsung's duct can be recommended as a conservative method in the treatment of chronic pancreatitis.

In a total of 409 patients with inflammatory disease of the colon information provided by colonoscopy with biopsy and barium contrast enema was compared. In 156 of these patients the cndoscopic diagnosis was ulcerative colitis, the results of biopsy showed agreement in 111 of 141 patients (78.2 °/o). Radiological confirmation of ulcerative colitis diagnosed endoscopically (n = 122) was possible in 49.2 °/o (n 60) in respect of diagnosis, and in 21.3 °/o (n = 26) with regard to the localization of the disease. In 89 patients with ulcerative colitis demonstrated by colonoscopy and biopsy, an agreement in respect of diagnosis was found in 55.1 °/o (n = 49) and with regard to the extent of the disease, in 27 0/o (n = 24). Crohn's disease of the colon was diagnosed in 206 patients at colonoscopy. On the basis of biopsy, granulomas were demonstrated in up to 26.9 °/o. In 125 patients with Crohn's disease verified at colonoscopy, the double-contrast barium enema revealed the diagnosis in 56.8 s/o (n = 71). The two methods disagreed with respect to the extent of the disease in 72.8 °/o (n = 91) of the cases. Despite the proven greater accuracy of endoscopy plus biopsy, the double contrast enema technique remains a diagnostic procedure, the possibilities of which should be made use of, in particular within the framework of initial examinations. Normal X-ray film of the colon, however, does not exclude the presence of inflammatory changes in the colon. Colonoscopy with biopsy provides additional information in a high percentage of the patients.