Through the rigorous application of polypectomy, the colon carcinoma rate can be clearly reduced (66%). The term "polyp" comprises epithelial (hyperplastic or neoplastic) and nonepithelial causes. The majority of carcinomas in the colon develop from adenomatous tissue (adenoma-carcinoma sequence). Pedunculated adenomas (90% of all polyps) are removed with the high-frequency diathermy snare. In some cases, flat (sessile) polyps can be elevated by injections placed below them, and then removed with the diathermy snare (strip biopsy). In the event of larger or large-area flat polyps that cannot be removed with the snare, piecemeal resection is applied. The excision alone of adenomas with a stage I carcinoma is carried out only in so-called low-risk situations. Flat neoplasms make particular demands of the endoscopist, since they often appear merely as a reddish area, but may already have invaded the submucosa when diagnosed. For classification and, where indicated, endoscopic resection, the recommendations of the Japanese Society of Gastroenterological Endoscopy are applied.

Zusammenfassung Fragestellung: Ziel der vorliegenden Studie war es, den Langzeitverlauf bei Patienten mit primär konservativ behandelter Sigmadivertikulitis zu erfassen. Patienten und Methodik: In den Jahren 1991–1995 wurden in unserer Klinik 88 Patienten (57 Frauen, 31 Männer, durchschnittliches Alter 65,7 Jahre) mit einer akuten Sigmadivertikulitis primär konservativ behandelt. In einer retrospektiven Analyse wurden das klinische Beschwerdebild sowie die diagnostischen und therapeutischen Maßnahmen 1998 erfasst. Ergebnisse: Bei 76,1% der Patienten (n = 67) verlief die Sigmadivertikulitis unkompliziert. Die Rezidivrate während des Beobachtungszeitraums betrug 42,6% (n = 26). Bei 23,9% der Patienten (n = 21) wies die Sigmadivertikulitis Komplikationen auf. Die Rezidivrate dieser Patientengruppe betrug 75%. 76,2% dieser Patienten (n = 16) wurden im Anschluss an die internistische Therapie operiert. Nicht letale Komplikationen traten bei 14,3% (n = 5) der insgesamt 35 operierten Patienten auf. Zwei Patienten (5,7%) verstarben postoperativ. 93,7% (n = 15) der initial operierten Patienten blieben postoperativ beschwerdefrei. Schlussfolgerung: Bei komplizierter Sigmadivertikulitis besteht die Indikation zur operativen Therapie. Eine konservative Therapie ist bei unkomplizierten Verläufen der Sigmadivertikulitis gerechtfertigt. In Anbetracht der hohen Rezidivrate kann allerdings individuell bereits nach dem ersten Divertikulitisschub die Indikation zur elektiven Sigmaresektion überprüft werden.

Introduction.The recent introduction of US contrast media has effectively increased the intensity of color and power Doppler signals in the study of focal liver diseases.Aim.Aim of our study has been to evaluate diagnostic confidence of US with contrast agents in focal liver lesions.Patients and methods.42 patients (17 M; 25 F; mean age: 57 years) affected by 68 focal liver lesions (25 hepatocellular carcinoma, 14 metastasis, 11 focal nodular hyperplasia, and 18 hemangiomas) have been submitted to Power Doppler ultrasonography, without and with contrast media (CM).The CM (SH U 508 A, Levovist) has been injected intravenously, at 2 mlIsec.Before and after CM administration, the following parameters have been evaluated: I) signal intensity; 2) diagnostic confidence.All the examination have been video-recordered, Both these parameters were expressed on a visu-analogic scale (0-10).The study has been performed with a high resolution equipment (Toshiba Sonolayer SSH-140A with a 3.75 MHz convex probe).

The purpose of the present study was to investigate prospectively the value of manometry, non-invasive techniques and endoscopic sphincterotomy in biliary type II and III patients with suspected sphincter of Oddi dysfunction.All patients (n = 31) had undergone a cholecystectomy from 1 to 45 years before entry into the study, and had a history of biliary-type pain ranging from 4 to 156 months. In a primary diagnostic work-up, including ERCP, other causes of gastrointestinal disease were excluded. The width of the common bile duct, pain induced by the injection of contrast medium into the common bile duct, delayed contrast drainage and the results of a morphine-neostigmine test were analysed. Manometric measurements of basal sphincter of Oddi pressure were performed. Twenty-three patients with an elevated basal pressure (> 40 mmHg) underwent endoscopic sphincterotomy.During the follow-up period (8-62 months) 83% of the patients became symptom free or experienced an improvement. Basal sphincter of Oddi pressure and long-term clinical outcome of patients correlated to different degrees with the results of non-invasive techniques.Our data suggest that endoscopic sphincterotomy may be an effective therapeutic modality in group II and III patients with sphincter of Oddi dysfunction in whom other gastrointestinal disorders have previously been excluded.

In 240 patients with predefined indications, the validity of ultrasound imaging as a primary diagnostic procedure was examined prospectively. Ultrasonography revealed normal intestinal findings in 150 patients and pathological lesions in 90 subjects. All patients underwent subsequent endoscopic, radiological, or surgical examination. In 7 patients with Crohn's disease and in 2 patients with radiation colitis, the ultrasound findings were false-negative. In the other 9 cases, ultrasonography suggested false-positive results. Ultrasonographic examination of the small intestine and large bowel had a very high overall validity, with a sensitivity of 90% and specificity of 94%.