Die extraintestinale Manifestation einer Infektion mit Enterobius vermicularis ist eine Rarität. Bei einem 50-jährigen Mann mit Unterbauchschmerzen wurde computertomographisch die Verdachtsdiagnose eines hepatisch metastasierten Sigmakarzinoms gestellt. Nach endoskopischem Ausschluss eines Tumors und ausgeprägtem Befall mit Enterobius vermicularis wurde eine Laparoskopie durchgeführt. Es fanden sich parasitäre Granulome mit Madenwürmern in der Leber. Bei Nachweis einer Phlebitis mit Thrombose der V. mesenterica inferior ist ein hämatogener Migrationsweg zu postulieren.

We report three cases of severe olmesartanassociated chronic diarrhea with weight loss and malassimilation syndrome. Histologically, a sprue-like enteropathy was diagnosed in each case, while serological tests for celiac disease were negative. After stopping the medication, symptoms improved within a few days. Histologically, remission was documented after 3 months. Olmesartan-associatedenteropathy is an underestimated entity and an important differential diagnosis in patients with chronic diarrhea.

Das Magenkarzinom stellt die weltweit fünfthäufigste Krebserkrankung und die dritthäufigste krebsbedingte Todesursache dar. Die klinischen Symptome sind unspezifisch, sodass die Diagnose oft erst im fortgeschrittenen Stadium gestellt wird. Bei frühen Magenneoplasien (fMN) infiltriert der Tumor maximal die Submukosa, die Wahrscheinlichkeit eines Lymphknotenbefalls ist sehr gering. Mittels endoskopischer Resektion (ER) ist eine kurative Therapie der fMN möglich. Neben vielen anderen ist die atrophische Gastritis ein wichtiger Risikofaktor für die Entwicklung eines Magenkarzinoms. Eine Vorsorgegastroskopie bei nachgewiesener atrophischer Gastritis zur Karzinomfrüherkennung wird aktuell jedoch nicht empfohlen. Wenige Erkenntnisse gibt es bislang bezüglich der Entstehung metachroner Magenneoplasien nach ER bei Patienten mit atrophischer Gastritis.

BACKGROUND Although rare, atrioesophageal fistula is a serious and often lethal complication of radiofrequency catheter ablation in patients with atrial fibrillation (AF). Consequently, esophago-gastroduodenoscopy after AF catheter ablation has been suggested to detect thermal esophageal lesions.OBJECTIVE To report the incidence of thermal lesions and other incidental gastrointestinal (GI) abnormalities in patients with AF after radiofrequency catheter ablation.METHODS Four hundred twenty-five (mean age 59 +/- 10 years; 64% men) consecutive patients with symptomatic AF who underwent left atrial radiofrequency catheter ablation were scheduled for upper GI endoscopy 1-3 days after the procedure. Patients were asymptomatic for GI diseases, that is, exhibiting no dysphagia, heart burn, or abdominal pain.RESULTS Pathological GI findings were observed in 328 (77%) patients and included gastral erosions (22%), esophageal erythema (21%), gastroparesis (17%), hiatal hernia (16%), reflux esophagitis (12%), thermal esophageal lesion (11%), and suspected Barrett's esophagus (5%). Biopsies were performed in 70 (17%) patients, showing gastritis (84%), Helicobacter pylori colonization (17%) and mucosa-associated lymphoid tissue (17%), esophagitis (9%), and Barrett's esophagus (4%). Further diagnostic workup or treatment was initiated in 105 (25%) patients.CONCLUSIONS Upper GI pathologies are observed frequently in asymptomatic patients. Half of all patients have a requirement for treatment. Among the findings, thermal esophageal lesions and gastroparesis can be attributed to AF catheter ablation. The high incidence of gastroparesis is a novel finding that deserves further investigation.

A 32-year-old woman was referred to our emergency department because of abdominal pain and vomiting. She had received a gastric balloon in an outpatient clinic 5 years previously to treat obesity, but had not attended follow-up appointments. Emergency computed tomography showed a partially deflated gastric balloon (●" Fig.1, arrow) in the mid part of the jejunum with proximal dilatation of the small bowel loops consistent with ileus. To remove the gastric balloon from the jejunum, the patient was offered peroral double-balloon enteroscopy under conscious sedation. The gastric balloon was found at an insertion depth of 180cm (●" Fig.2a). To empty themethylene-bluecontaining salineoutof thegastric balloon, a standard injection needle was used to perforate the silicone wall (●" Fig.2b). The deflated gastric balloon was folded up using a large polypectomy snare and was removed (●" Fig.2c). The symptoms resolved quickly and the patient was discharged the next day. Insertion of gastric balloons is performed as a temporary measure for weight loss [1]. If a gastric balloon remains longer than scheduled, it may deflate spontaneously and cause obstruction by entering the bowel. Similar cases have been treated by surgery [2–5]. However, double-balloon enteroscopy seems a promising method to treat bowel obstruction caused by partially deflated gastric balloons.

Esophageal intramural pseudodiverticulosis is a rare disease that may lead to esophageal stenosis and dysphagia. The aim of the study was to evaluate the endoscopic diagnosis, treatment and clinical course of intramural pseudodiverticulosis. We retrospectively studied endoscopic criteria of intramural pseudodiverticulitis, associated diseases, and the clinical course, particularly in patients with dysphagia because of esophageal stenosis in a period from 2002 to 2012. In 23 patients, the diagnosis was made according to endoscopic criteria. As risk factors, alcohol and tobacco consumption were present in all patients. Concomitant candida infection was present in six (26%) patients. In 12 (52%) patients esophageal stenosis was present, which was localized in the upper half of the esophagus. In 11 patients bougienage has been performed with excellent improvement of the dysphagia score from 3.7 to 1.3 (P = 0.002). However, dysphagia was recurrent in four patients with need for repeated bougienage. About half of the patients with intramural pseudodiverticulosis present with stenosis of the esophagus at the time of diagnosis. In patients with proximal esophageal stenosis and a typical risk constellation, intramural pseudodiverticulosis should be suspected. Treatment of stenosis with bougienage is effective to resolve dysphagia, but repeated bougienage may be necessary.

Tumorpatienten mit psychischer Komorbidität leiden unter vermehrten Lebensqualitätseinbußen und haben oft psychoonkologischen Behandlungsbedarf.

Einleitung: Die Radiofrequenzablation bei Patienten mit linksatrialen Arrhythmien kann aufgrund der Nähe zum linken Vorhof thermische Schäden im Ösophagus verursachen. Gefürchtet ist die selten auftretende atrioösophageale Fistel, welche regelhaft letal verläuft.

We report a case of a 45-year-old man who complained of progressive vision loss in his right eye. Visual acuity was 20/300 in the right eye and 20/25 in the left eye. Bilateral uveitis intermedia R > L was diagnosed and treated with systemic and local steroids. An internal checkup was also done, and duodenal biopsy identified Whipple's disease. Despite specific antibiotic therapy, the patient's follow-up examination showed increased inflammatory activity R > L and bilateral cataracta complicata. Cataract surgery and pars plana vitrectomy with removal of epiretinal membranes were done. Histologic analysis of the vitreous and epiretinal membranes showed periodic acid-Schiff-positive macrophages, pathognomonic for Whipple's disease. Whipple's disease is a rare but severe disease with multiple manifestations and should be considered a differential diagnosis in uveitis.