Daniel Teubner

Acute gastrointestinal bleeding - a new approach to clinical and endoscopic management.

Overt or occult gastrointestinal bleeding is a frequently observed condition in routine gastroenterological practice. Occult gastrointestinal bleeding is usually a purely incidental finding, based on the discovery of iron deficiency anemia in the laboratory or blood in stool (a positive Hemoccult test). However, overt bleeding accompanied by the clinical features of tarry stool, hematemesis, or hematochezia may be a life-threatening condition, calling for immediate emergency management. In contrast to traumatology, algorithms of emergency and intensive medicine are not sufficiently validated yet for acute life-threatening bleeding. The purpose of this review was to present all established and new endoscopic hemostasis techniques and to evaluate their efficacy, as well as to provide the treating endoscopist with practical advice on how he/she could incorporate these procedures into acute medical management. The recommendations are based on inspection of the study results in the recent published literature, as well as emergency medicine algorithms in traumatology.

Competition in Colon Cancer Screening? What Is the Role of Colonoscopy?

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the Western world. The incidence could be reduced if this cancer were to be diagnosed at an early stage of disease. A competition has started between the existing screening methods to be the most efficient in detecting premalignant conditions. This review illustrates the current state of screening techniques for CRC. Method: Pubmed was searched for meta-analyses and prospective studies on screening for CRC, with an emphasis on colonography, computed tomographic colonography (CTC), magnetic resonance colonography (MRC), stool DNA testing, and colon capsule endoscopy, and critical appraisal of the research was done by the reviewers. Results: The imaging techniques (CTC and MRC) had similar detection rates for bigger lesions (≥10 mm) as colonoscopy. High-definition colonoscopy showed better efficiency with smaller lesions. The techniques developing around colonoscopy such as the retro-viewing colonoscope, the balloon colonoscope, or the 330-degree viewing colonoscope try to enhance efficacy by reducing the adenoma miss rate in right-sided, non-polypoid lesions. Colon capsule endoscopy and the stool detection systems are limited to identifying cancer but not necessarily adenomas. Conclusion: Colonoscopy is the preferred CRC screening strategy and the undisputed gold standard in terms of efficacy.

Endoscopic Bleeding Control

Gastrointestinal bleeding (GIB) can occur at different locations and different intensities throughout the intestine. Gastrointestinal bleeding is subdivided based on the location (upper, lower, middle GIB). The upper GI tract comprises the esophagus, stomach, and duodenum (up to the papilla of Vateri). Middle GIB relates to that part of the GI tract located below the papilla Vateri up to the terminal ileum. Lower GIB is defined as a bleeding within the colon and rectum.

Rare gastroenterologic finding as a cause of hypochromic microcytic anemia

CASE HISTORY A 66-year-old woman suffering from skin paleness and weakness presented an increasing hypochromic, microcytic anemia. Diagnostic: In an ambulant setting a capsule endoscopy of the small intestine was carried out because of multiple polyps of the colon (colonoscopy) in addition to non-invasive (Hämoccult-Test) and invasive (gastroscopy) diagnostic. The patient was then admitted to hospital to clarify a suspicious ulcer of the small bowl. According to biopsies taken via balloon enteroscopy, an adenocarcinoma of the small intestine was diagnosed. THERAPY AND CLINICAL COURSE After staging and exploratory laparotomy, histology findings showed an advanced tumour stage. A palliative chemotherapy, analogue to colon cancer treatment, was conducted. CONCLUSION Small bowel diagnostics should be carried out if the aetiology of an anemia is not certain with an existing polyposis of the colon. Individuals with personal or family history of cumulative colorectal adenomas should undergo assessment for an adenomatous polyposis syndrom.