Ulrich Damian

Computer-assisted colonoscopy (the NeoGuide Endoscopy System): results of the first human clinical trial ("PACE study").

OBJECTIVES:Unsedated colonoscopy is an uncomfortable procedure for most patients. Discomfort during colonoscopy is largely related to looping of the colonoscope, which displaces the colon from its native configuration and stretches attachments to the mesentery. A novel computer-assisted colonoscope utilizes a fully articulated, computer-controlled insertion tube. On manual insertion of the colonoscope, the position and angle of the scopes tip are encoded into a computer algorithm. As the colonoscope is advanced, the computer directs each successive segment to take the same shape that the tip had at a given insertion depth. The insertion tube thus changes its shape at different insertion depths in a “follow-the-leader” manner.METHODS:This initial clinical trial with this novel colonoscopy system was designed as a prospective, nonrandomized, unblinded, feasibility study. Three physicians of varying levels of experience participated in the study.RESULTS:Eleven consecutive patients (seven men, four women, age range 19–80) meeting inclusion criteria for screening or diagnostic colonoscopy were enrolled in the study. The cecum was reached in 10 consecutive patients (100%). Findings included diverticular disease in two cases and multiple colonic polyps in two cases. Postprocedure assessment at discharge, 48 h, and 30 days revealed no complications or adverse effects. Physician satisfaction and patient acceptance of this new technique were high.CONCLUSIONS:In this limited, first of its kind feasibility study, the computer-assisted colonoscope was shown to perform colonoscopy safely and effectively. The colonoscopes unique design limited loop formation during colonoscopy. Large-scale clinical trials are indicated.

Indikation zur chirurgischen Therapie der Sigmadivertikulitis aus der Sicht des Gastroenterologen

During the last decades, the prevalence and incidence of diverticular disease have increased dramatically, especially in the western industrialized countries. The changes in living and nutritional habits are considered to be responsible for this development. Diverticulitis can be associated with gentle symptoms, but in complicated cases it is potentially fatal. Conservative therapy consists of fasting and antibiotic therapy. To avoid a recurrence of diverticulitis a high fiber diet is recommended. Data for a medical treatment for prevention of recurrence is discussed controversially, so currently a common recommendation is not possible. Elective sigma resection should be accomplished after an episode of severe complicated diverticulitis and in immunosuppressed patients, who have had an attack before. In young patients diverticulitis has a more aggressive course with a higher rate of recurrence, so an earlier surgical approach might be considered. Elective resection after healed second attack of uncomplicated diverticulitis is discussed controversially, and the benefit of its application should be assessed in consideration of the individual case. Thus, treatment of diverticulitis requires close interdisciplinary cooperation.

Frequency of Small Bowel Polyps in Patients with Duodenal Adenoma But Without Familial Adenomatous Polyposis

Frequency of Small Bowel Polyps in Patients with Duodenal Adenoma But Without Familial Adenomatous Polyposis Dirk Hartmann, Phillip Erben, Dieter Schilling, Ulrich Damian, Juergen F. Riemann Background: Duodenal adenomas are extremly common in patients with familial adenomatous polyposis. However, it is uncertain wether patients with duodenal adenomas without familial adenomatous polyposis are at greater risk for small bowel neoplasia and, therefore should routinely undergo surveillance small bowel examination. The aim of this study was to determine whether there is a correlation between non-papillary duodenal adenoma without familial adenomatous polyposis and small bowel neoplasia. Methods: 14 (8 women, 6 men, 67 G 10 years) patients with non-papillary duodenal adenomas without familial adenomatous polyposis were prospectively evaluated. All patients underwent wireless capsule endoscopy. We compared the results of this group with an ageand sex-matched cohort of patients undergoing capsule endoscopy for suspected small bowel disease. Results: Capsule endoscopy was carried out without complications in all cases. At capsule endoscopy, polyps were found in 4 (26%) patients in the study group and no polyp was found in the control group. All detected polyps was very small with no macroscopic view of malignancy. Other pathological findings were angiodysplasias in two patients in the study group. In the control group capsule endoscopy found angiodysplasia in 5 patients and inflammatory lesions in 2 patients. In none of the patients with small bowel polyps detected by capsule endoscopy, management was altered due to polyp formation. Conclusion: Based on the results of this prospective study, the frequency of small bowel polyps in patients with duodenal adenomas without familial adenomatous polyposis appears to be increased compared with a control group undergoing capsule endoscopy for other reasons. In none of the patients management was altered. Follow-up data of these patients will be needed. Abstracts