L. Degen

The effect of cholecystokinin in controlling appetite and food intake in humans

The present review of the satiating effect of cholecystokinin in humans has revealed that cholecystokinin is a physiological satiety factor in humans. The results demonstrate the efficacy of the satiating actions of exogenous and endogenous CCK in humans. The therapeutic potential of CCK analogues cannot be estimated until further studies are performed that demonstrate the efficacy of CCK analogues for decreasing body weight, and the safety of CCK when administered repetitively for prolonged periods.

Ileocecal reservoir reconstruction with physiologic function after total mesorectal cancer excision

BACKGROUND/AIMSnAfter proctectomy for low rectal cancer and straight coloanal reconstruction, the main causes for increased daily stool frequency, urgency, and incontinence are the limited capacity and distensibility of the anastomosed colic segment in the pelvis. The authors postulated that a pedunculated (preserving the nerve) ileocecal interpositional graft (cecum-reservoir) placed between the sigmoid colon and the anal canal would greatly reduce these inconveniences.nnnMETHODSnThe authors evaluated the safety, defecation quality, and anorectal physiology of such a neorectum in 20 consecutive patients with rectal carcinoma between 5 and 10 cm above the anal verge who underwent total mesorectal excision.nnnRESULTSnNo perioperative morbidity related to the technique and no mortality was observed in these 20 patients. Six months after the operation, 16 patients showed excellent and 4 patients good defecation quality, with maximal tolerable volumes, compliance, and mean colonic transit times comparable to age- and gender-matched healthy volunteers. In addition, anal resting pressure was decreased, squeeze pressure was maintained, and the rectoanal inhibitory reflex remained positive in 80%.nnnCONCLUSIONSnThe cecum-reservoir as a neorectum, using an intact neurovascular colonic segment, is a safe technique, providing excellent defecation quality. It enables a nearly normal physiologic anorectal function, which is already seen 6 months postoperatively.

Clinical outcome and quality of life after gastric and distal esophagus replacement with an ileocolon interposition.

Mainly because of the loss of reservoir function, loss of sphincter function, and exclusion of the duodenal route, patients who undergo gastrectomy suffer from many adverse effects postoperatively. The ileocecal interpositional graft is an attractive method to use as a gastric substitute after gastrectomy and distal esophagectomy. A pedunculated ileocecal graft is placed between the esophagus and the duodenum. The cecum acts as a reservoir while the ileocecal valve protects against enteroesophageal reflux. The duodenal passage is also preserved. Fourteen patients underwent this operation. The technique-related morbidity was low and the quality of life was good. During a mean follow-up of 6 months, no evidence of severe dumping syndrome or reflux esophagitis was observed. Further prospective randomized studies are warranted to compare this technique with the standard methods of gastric reconstruction.

Ileocecal segment transposition does not alter whole gut transit in humans.

OBJECTIVESnWe have recently described a reservoir for rectal replacement after total mesorectal excision for rectal carcinoma. The ileocecal segment with its intact extrinsic nerve and blood supply is placed between the ascending colon and the anal canal. This reconstruction has been shown to provide good defecation quality and anorectal function. Whether gastric emptying and small as well as large bowel transit are affected by this transposition remains unclear. Our aim was to quantify whole gut transit in such patients and compare it with that of a matched group of controls.nnnMETHODSnGastric emptying rates and small intestinal and colonic transit times were assessed scintigraphically in 12 patients aged 46 to 87 years with ileocecal reservoir reconstruction after total mesorectal excision and compared to a sex-matched group of asymptomatic healthy volunteers of similar age. Gastric emptying rates and small intestinal and colonic transit times were calculated as described previously. Data were compared using Wilcoxons signed rank test for gastric emptying rates and small bowel transit or by analysis of variance for colonic transit; p < 0.05 was considered significant.nnnRESULTSnGastric time for half of the meal (T50) was 161 +/- 16 minutes for patients and 201 +/- 22 for the controls. Small bowel transit time was 150 +/- 15 minutes for patients and 177 +/- 22 for the controls. Geometric center at 6 hours was 1.53 +/- 0.13 for patients and 1.27 +/- 0.16 for the controls. Geometric center at 24 hours was 2.96 +/- 0.23 for patients and 2.57 +/- 0.25 for the controls. Data are mean +/- SEM.nnnSUMMARYnGastric emptying rates and small bowel transit and colonic transit times (expressed as geometric center at 6 and 24 hours) were similar in patients with ileocecal reservoir reconstruction and in a sex- and age-matched group of healthy controls. We conclude that the transposition of an ileocecal segment with intact extrinsic neurovascular supply between the sigmoid colon and the anal canal does not alter whole gut transit, not even in any of the presumably key regions.

Capsule Endoscopy of the Upper Gastrointestinal Tract – The Need for a Second Endoscopy

Background and Aims: Capsule endoscopy (CE) has been recognised as an important investigational tool in the diagnosis of gastrointestinal disease. Studies have shown that CE can identify lesions in the upper gastrointestinal tract as well as in the small intestine. However, contrary to conventional oesophagogastroscopy results, the role of CE findings in the diagnostic algorithm of disorders such as gastrointestinal bleeding has not been well understood. We evaluated the frequency of lesions identified in the oesophagus and the stomach as well as their significance. Methods: We retrospectively evaluated patients who had undergone video CE over the last 2 years at our institution. Indication and findings in the oesophagus and the stomach were analysed and compared to previous oesophagogastroscopy findings. Patients in whom lesions were identified were followed up retrospectively for the significance of these findings. Results: 95 patients were included in the analysis (47 males, 48 females, mean ± SD age of 54.62 ± 19.2 years). The commonest indication for CE was gastrointestinal bleeding (45%), the second commonest anaemia (28%). CE identified significant lesions in the stomach of 11/95 (11.57%) patients. These lesions had been overlooked in 9/95 (9%) of patients by conventional oesophagogastroscopy prior to CE examination (p value < 0.05). Eight of 95 (8%) patients had oesophageal abnormalities detected by CE. The diagnosis changed the treatment of 8/11 (82%) patients with significant lesions. Conclusions: CE has an undefined role in evaluating upper gastrointestinal lesions. Significant lesions missed at oesophagogastroscopy were identified during CE examination. This study underpins the importance of a second conventional endoscopy in the diagnostic algorithm.

Subjective and functional results after replacement of the stomach with an ileocecal segment: a prospective study of 20 patients.

Abstract.Background and aims: The optimal reconstruction procedure after gastrectomy is still a matter of debate. The ileocecal interpositional graft offers an excellent reservoir capacity, the preservation of duodenal passage, and a natural antireflux barrier (ileocecal sphincter). Patients and methods: We prospectively analyzed the quality-of-life outcome in 20 patients undergoing ileocecal interpositional graft (13 subdiaphragmatic reconstruction, 7 intrathoracic reconstruction) after gastrectomy in a University Hospital and a Canton Hospital (mean follow-up 6xa0months), operative and postoperative morbidity, body weight, reflux, and dumping symptoms. In a smaller series of nine patients we performed functional tests such as gastric emptying measurements, glucose tolerance tests, and manometry of the gastric substitute. Results: The mean gastrointestinal quality-of-life index in the subdiaphragmatic reconstruction group 114, and that in the intrathoracic reconstruction group was 106. Mild reflux and dumping symptoms were noted by no patients in the former group and by two of seven patients in the latter. In the smaller series of nine patients gastric emptying time was faster in the intrathoracic group, but no difference in plasma glucose level was found between the two groups. Conclusions: Reconstruction after gastrectomy with an ileocecal interpositional graft achieves good quality of life with an acceptable morbidity. The technique seems to reduce the occurrence of postoperative reflux and dumping symptoms.

Postoperative nutrition of Göttingen minipigs after 2/3 gastric resection: Feeding schedule and hints and pitfalls of postoperative follow-up*

Summary We present a new feeding schedule for the Gottingen minipig after extended gastric resection. Having a clever feeding regime and postoperative care minipigs may survive even in case of extended gastric resection and reconstruction. This enables important survival experiments to be done in regard to new operative techniques in Man. Postoperatively we started immediately to feed the minipigs with soft feed in the form of Hills prescription diet canine/feline a/d. This feed composition consists of highly nutritious proteins and has little crue fibres. This was followed by the standard dry pellet feed KLIBA Minipig 3000. Follow-up over 16 weeks didnt reveal any feeding regime related complications.

Das ileo-coecale Segment als Magenersatz

In der klinischen Praxis wird mehrheitlich eine lange Roux-Y-Rekon-struktion als Magenersatz benutzt. Verschiedene Pouch-Rekonstruktionen mit oder ohne duodenalen Bypass kontrollieren Reflux nur teilweise so. Wie die ileo-coecale Interposition als Rectumersatz zwischen Colon descendens und Analkanal wurde dieses Segment analog erfolgreich bei 14 Patienten zwischen Oesophagus und Duodenum als Magenersatz ohne postoperative Mortalitat eingesetzt. Dysphagie oder Stase des distalen Oesophagus fanden sich nicht, ebenso kein „gas bloat“. Diese kleine Serie zeigt eine ausgezeichnete Kontrolle des alkalischen Reluxes durch die Ileocoecalklappe und eine gute Lebensqualitat gemas Eypasch. Diese Art der Rekonstruktion, welche einfacher ist als verschiedene Pouch-Rekonstruktionen, verdient wohl mehr Aufmerksamkeit. Diese Technik kann unter Umstanden noch verbessert werden, indem die Ileumlange und das Colonvolumen variiert werden.

Rektumersatz mittels Colonreservoir: Gute Lebensqualität dank minimaler Morbidität?

Surgery of rectal cancer aims at providing satisfactory quality of life at an early postoperative stage. Low postoperative morbidity and good defecation quality early after rectal reconstruction by means of a colonic reservoir are essential conditions f o r good quality of life.

Gutartige Erkrankungen von Dickdarm und Rektum

Im folgenden Kapitel werden exemplarisch wichtige benigne Erkrankungen des Dickdarms und Rektums diskutiert. Das Kapitel kann lediglich einen ersten Uberblick bieten. Der interessierte Leser sei bereits an dieser Stelle auf die Spezialkapitel dieses Buches, aber auch auf zusatzliche fokussierte Fachliteratur verwiesen.