Lembcke B

Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study

BACKGROUND Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The short-acting anesthetic propofol offers certain potential advantages for endoscopic procedures, but controlled studies proving its superiority over benzodiazepines for ERCP are lacking. METHODS During a 6-month period 198 consecutive patients undergoing routine ERCP randomly received either midazolam (n = 98) or propofol (n = 99) for sedation. Vital signs (heart rate, blood pressure, oxygen saturation) were continuously monitored and procedure-related parameters, the recovery time and quality (recovery score) as well as the patients cooperation and tolerance of the procedure (visual analog scales) were prospectively assessed. RESULTS Patients receiving propofol or midazolam were well matched with respect to demographic and clinical data, ERCP findings, and the performance of associated procedures. Propofol caused a more rapid onset of sedation than midazolam (p < 0.01). Clinically relevant changes in vital signs were observed at comparable frequencies with temporary oxygen desaturation occurring (< 85 %) in 6 patients in the propofol group and 4 patients receiving midazolam (not significant). However, an episode of apnea had to be managed by mask ventilation via an ambu bag (lasting 8 minutes) in one of the patients receiving propofol sedation. Mean recovery times as well as the recovery scores were significantly shorter with propofol (p < 0. 01). Propofol provided significantly better patient cooperation than midazolam ( p < 0.01), but procedure tolerability was rated the same by both groups of patients (not significant). CONCLUSIONS Intravenous sedation with propofol for ERCP is (1) more effective than sedation with midazolam, (2) safe under adequate patient monitoring, and (3) associated with a faster postprocedure recovery.

Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

To evaluate the technical feasibility, safety, and short‐term efficacy of botulinum toxin injection for pancreatic sphincter of Oddi dysfunction and to analyse whether the symptomatic response to botulinum toxin might be a predictor of outcome for endoscopic sphincterotomy.

Sonographic findings of the hepatobiliary-pancreatic system in adult patients with cystic fibrosis

Sonography of the liver, biliary system, and pancreas in adult patients with cystic fibrosis is by far less systematically documented than in pediatric patients with cystic fibrosis. In this prospective study, duplex sonographic findings of the liver, biliary system, and pancreas in adult patients with cystic fibrosis were compared with those of healthy control subjects.

Simple and rapid method for determination of short-chain fatty acids in biological materials by high-performance liquid chromatography with ultraviolet detection

A new and versatile method for the identification and quantification of short-chain fatty acids, such as formic, acetic, propionic, butyric, isobutyric, valeric, isovaleric and mercaptoacetic acids, in biological specimens by high-performance liquid chromatography is described. After sample purification by vacuum transfer and concentration by alkaline freeze-drying, the acids were measured without any further preparative step, using a sulphonated polystyrene-divinylbenzene column as stationary phase. Ultraviolet detection of the native acids was done at 214 nm. Peak resolution and reproducibility were as good as with gas chromatography. Many examples of the application of this method to a variety of biological specimens and fluids both from the rats and humans are described.

Influence of cisapride on antroduodenal motor function in healthy subjects and diabetics with autonomic neuropathy

Antroduodenal manometry was used to assess motility in 10 healthy volunteers and 15 diabetics with cardiac autonomic neuropathy whilst they received 20 mg cisapride orally or an apparently identical placebo. Interdigestive motility was recorded after an overnight fast and for 2 hours following a 500 kcal liquid meal. Active treatment did not influence the number or duration of interdigestive motility cycles in either group although antroduodenal co‐ordination in both the fasting and the fed state was enhanced by cisapride (P < 0.05). In diabetics the postprandial antral motility index was increased by cisapride, whereas in healthy subjects antral and duodenal motility indices were increased both fasting and in the fed state (P < 0.05).

Risk of Gastrointestinal Bleeding Associated with Helicobacter pylori Infection in Patients with Hemophilia or von Willebrand’s Syndrome

Many episodes of bleeding in the upper gastrointestinal tract are caused by Helicobacter pylori infection. Because these episodes present a life‐threatening complication in patients with bleeding disorders, we prospectively investigated the prevalence of H. pylori infection in patients with hemophilia A or B and with the von Willebrand syndrome.

Diagnostik und Differenzialdiagnostik der Divertikelkrankheit sowie Wertigkeit der Sonografie

Die Diagnose der akuten Divertikulitis stutzt sich auf die Trias: 1. akuter umschriebener Schmerzen im Kolonverlauf (meist, aber nicht immer im linken unteren Quadranten), 2. Nachweis entzundlicher Veranderungen im klinischen Bild (Temperatur) und Labor (CRP > Leukozyten) sowie 3. typische Veranderungen in der Schnittbildgebung. Dabei weist die qualifizierte Sonografie Vorteile gegenuber der CT auf; letztere hat dagegen Vorteile beim Vorliegen eines Ileus oder tief im kleinen Becken liegender Befunde. Die Koloskopie ist fur die Divertikulitisdiagnose nicht erforderlich, kann aber in der Differenzialdiagnose zur SCAD (segmentare Kolitis assoziiert mit Divertikeln) eine wichtige Rolle spielen und nach Abklingen der Divertikulitis zum Ausschluss eines Karzinoms und seiner Vorstufen indiziert sein. Ein Vorteil der Sonografie ist die hohe Detailauflosung, die die geforderte neue CDD-Klassifikation der Leitlinie ebenso erleichtert wie die Differenzialdiagnose der Divertikulitis gegenuber anderen (extra)intestinalen Erkrankungen.

Divertikelkrankheit – Klinisches Bild und Therapie

Diverticulosis, diverticular disease and diverticulitis have come into focus again because new aspects concerning diagnosis, risk factors and treatment arose only recently which prompted a new Guideline released by the DGVS and DGAV summarising the current evidence. Along with the guidelines essentials for medical practice a diagnosis of diverticulitis is considered unsatisfactory unless a cross-sectional imaging method (either ultrasonography [US] or computed tomography [CT] ) has proven that the clinical findings and inflammation (CRP considered superior to WBC and temperature) are due to diverticular inflammation. For reasons of practicability and considering relevant legislation for radiation exposure protection, US is the primary - and usually effectual - diagnostic method of choice as it is equipotent to CT. While US offers better resolution and enables precise imaging exactly at the location of pain as well as reiterative application, the latter implies advantages in the case of a deep abscess or diverticulitis in difficult locations (e. g. the small pelvis). Clinical evidence and laboratory and imaging findings allow for distinguishing a large number of differential diagnoses and also form the basis of a new classification (classification of diverticular disease, CDD) which comprises all forms of diverticular disease, from diverticulosis to bleeding and to the different facettes of diverticulitis. This classification -which should be applied in any patient with the diagnosis of diverticular disease- is independent of specific diagnostic preferences and applicable both to conservative and operative treatment options. While the number of recurrent episodes is no longer a significant indicator for surgery in diverticulitis, severity and / or complications determine treatment options along with the patients preferences. According to first data, conservative treatment may waive antibiotics under certain circumstances, however they are indispensible in complicated disease or patients bearing risk factors. Spasmoanalgetics and supportive fluid supply are individually necessary, and avoidance of potentially aggravating medications (e. g. NSAIDS) appears advisable, but many suggestions (nil by mouth, bed rest, laxatives) come along without an adaequate body of evidence. Similarly medical advice concerning prevention and secondary prophylaxis relies mainly on epidemiological plausibility. Because minor perforations (CDD type 2 a) as well as recurrent episodes of uncomplicated diverticulitis and even some abscesses > 1 cm (CDD type 2 b) respond favourably to medical treatment, the timely indication for surgery in these cases requires precise classification along with a close surveillance in trustful cooperation between the gastroenterologist and the surgeon.

Ziele der vorliegenden Untersuchung

Im Rahmen der vorliegenden Arbeit wurden Moglichkeiten pharmakologischer Beeinflussung der Kohlenhydrat-Assimilation unter dem Gesichtspunkt einer Resorptionsverzogerung als Therapieprinzip untersucht.

Ergebnisse der Experimente und Studien

Die α-Amylase-Inhibitoren Trestatin (Ro 9-0154) und Tendamistat (HOE 467) fuhrten im Tierexperiment (Pirson u. Buchschacher, 1981; Regitz et al., 1981) sowie in klinischen Prufungen zu einer Hemmung der Kohlenhydratassimilation nach Starkeingestion (Eichler et al., 1984; Meyer et al., 1983a u. 1984a,b). Eine Hemmung der Blutglukose- und Insulinanstiege nach oraler Gabe von Glukose oder Saccharose (Trestatin) bzw. von Glukose oder Maltose (Tendamistat) wurde dagegen nicht beobachtet (Eichler et al., 1984; Regitz et al., 1981).