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When endoscopic therapy is used for the treatment of patients with painful chronic pancreatitis, extracorporeal shock wave lithotripsy (ESWL) can be proposed as a first-line approach when obstructive ductal stone(s) induce upstream dilation of the main pancreatic duct. Stone fragmentation by ESWL is followed by endoscopic ductal drainage using pancreatic sphincterotomy, fragmented stone(s) extraction, and pancreatic stenting in case of ductal stricture. After completion of endoscopic pancreatic ductal drainage, long-term clinical benefit can be expected for two thirds of the patients. Best clinical results are associated with absence or cessation of smoking and with early treatment in the course of chronic pancreatitis, while alcohol abuse increases the risks of diabetes, steatorrhea and mortality.The complications of chronic pancreatitis are mainly the development of pseudocyst secondary to the downstream ductal obstruction, and biliary obstruction caused by fibrotic changes in the head of the pancreas. Successful endoscopic pseudocyst drainage is currently obtained in most patients, and carries a low complication rate. Biliary stenting is a safe and effective technique for the short-term treatment of symptomatic bile duct stricture due to chronic pancreatitis, but permanent resolution is obtained in only 25% of cases.In conclusion, endoscopic management is now considered to be the preferred interventional treatment of chronic pancreatitis, for patients selected on the basis of the anatomical changes caused by the disease. This treatment is generally safe, minimally invasive, often effective for years, does not prevent further surgery, and can be repeated.

Background & Aims: This study aimed to compare the accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing acute pancreatitis (AP) and to explore the correlation between MRI findings and clinical outcome. Methods: Patients with AP were investigated by contrast-enhanced CT and MRI on admission and 7 and 30 days thereafter. MRI was performed with intravenous secretin and contrast medium. Balthazar's grading system was used to measure CT and MRI severity indices (CTSI and MRSI, respectively). Results: Thirty-nine patients (median age, 47 years; range, 15-86) were studied. AP was of biliary etiology in 19 patients (49%). On admission, AP was assessed clinically as severe in 7 patients (18%). A strong correlation was demonstrated between CTSI and MRSI on admission and 7 days later. MRSI on admission correlated with the following: the Ranson score, C-reactive protein levels 48 hours after admission, duration of hospitalization, and clinical outcome regarding morbidity, including local and systemic complications. Considering the Ranson score as the gold standard, MRI detected severe AP with 83% (58-96, 95% CI) sensitivity, 91% (68-98) specificity vs. 78% (52-93) and 86% (63-96) for CT. Magnetic resonance cholangiopancreatography after IV secretin injection showed pancreatic duct leakage in 3 patients (8%). Conclusions: MRI is a reliable method of staging AP severity, has predictive value for the prognosis of the disease, and has fewer contraindications than CT. It can also detect pancreatic duct disruption, which may occur early in the course of AP.

Summary: Real-time ultrasonography (US) of the gastric antrum after ingestion of a mixed solid-liquid meal was performed in 60 patients (median age, 8.2 years; range, 3–17) being investigated for symptoms suggesting upper intestinal dysfunction (vomiting, regurgitation, abdominal pain, early saticty, and anorexia) and in 13 controls (median age, 5 years; range, 3–15). The diagnostic work-up allowed identification of 14 patients with esophagitis (group A) and 26 with Helicobacter pylori(HP) gastritis (group B); median age in group A was 9 years (range, 3–15) and in group B was 9.5 years (range, 3–17). Group A patients had significantly more prolonged gastric-emptying times (median, 180 min; range, 110–270) than did controls (median, 150 min; range, 110–180; p < 0.01); however, group A times were not significantly longer than those of group B patients (median, 160 min; range, 90–265). In the remaining 20 patients (group C; median age, 7.1 years; range, 3–15) without a specific diagnosis, markedly delayed gastric emptying was detected (median, 237 min; range, 165–270; p < 0.01 vs. group B patients and vs. controls; p < 0.05 vs. group A patients); in this group, Gl manometry revealed findings of deranged motility of the gut. Distension of the antral area (percentage of increase vs. baseline values) 60 and 90 min after feeding was higher in group C (60 min: median, 185; range, 70–614; 90 min: median, 175; range, 60–400) than in both controls (60 min: median, 80; range 26–148; 90 min: median 90; range 20–253; p < 0.01) and HP patients (60 min: median, 120; range, 35–311; 90 min: median, 98; range, 23–400; p < 0.05); there was no significant difference versus esophagitis patients. The latter differed from controls only for the 60-min postfeeding antral distension (p < 0.01), whereas HP patients did not differ from controls. In group C patients, symptomatic dyspeptic score correlated with both 60− and 90-min fed antral distension (r = 0.61 and r = 0.64, respectively; p < 0.05), but no correlation was found with gastric-emptying time. In group A patients, histologic score of esophagitis correlated with 60-min postfeeding antral distension (r = 0.56; p < 0.05), whereas poor correlation was found with 90-min postfeeding antral distension and with gastric-emptying time. However, the latter significantly correlated with 90-min fed antral distension in esophagitis patients (r = 0.70; p < 0.01). We conclude that US imaging of the antral area of the stomach reveals abnormalities of gastric motility in most children referred for dyspeptic symptoms; this technique should be included among the investigative tools in the diagnostic approach to these patients.

Summary: Real-time ultrasonography (US) of the gastric antrum after ingestion of a mixed solid-liquid meal was performed in 60 patients (median age, 8.2 years; range, 3–17) being investigated for symptoms suggesting upper intestinal dysfunction (vomiting, regurgitation, abdominal pain, early saticty, and anorexia) and in 13 controls (median age, 5 years; range, 3–15). The diagnostic work-up allowed identification of 14 patients with esophagitis (group A) and 26 with Helicobacter pylori(HP) gastritis (group B); median age in group A was 9 years (range, 3–15) and in group B was 9.5 years (range, 3–17). Group A patients had significantly more prolonged gastric-emptying times (median, 180 min; range, 110–270) than did controls (median, 150 min; range, 110–180; p < 0.01); however, group A times were not significantly longer than those of group B patients (median, 160 min; range, 90–265). In the remaining 20 patients (group C; median age, 7.1 years; range, 3–15) without a specific diagnosis, markedly delayed gastric emptying was detected (median, 237 min; range, 165–270; p < 0.01 vs. group B patients and vs. controls; p < 0.05 vs. group A patients); in this group, Gl manometry revealed findings of deranged motility of the gut. Distension of the antral area (percentage of increase vs. baseline values) 60 and 90 min after feeding was higher in group C (60 min: median, 185%; range, 70–614%; 90 min: median, 175%; range, 60–400%) than in both controls (60 min: median, 80%; range 26–148%; 90 min: median 90%; range 20–253%; p < 0.01) and HP patients (60 min: median, 120%; range, 35–311%; 90 min: median, 98%; range, 23–400%; p < 0.05); there was no significant difference versus esophagitis patients. The latter differed from controls only for the 60-min postfeeding antral distension (p < 0.01), whereas HP patients did not differ from controls. In group C patients, symptomatic dyspeptic score correlated with both 60- and 90-min fed antral distension (r = 0.61 and r = 0.64, respectively; p < 0.05), but no correlation was found with gastric-emptying time. In group A patients, histologic score of esophagitis correlated with 60-min postfeeding antral distension (r = 0.56; p < 0.05), whereas poor correlation was found with 90-min postfeeding antral distension and with gastric-emptying time. However, the latter significantly correlated with 90-min fed antral distension in esophagitis patients (r = 0.70; p < 0.01). We conclude that US imaging of the antral area of the stomach reveals abnormalities of gastric motility in most children referred for dyspeptic symptoms; this technique should be included among the investigative tools in the diagnostic approach to these patients.

Zusammenfassung Das Thiazolgelbverfahren wurde zur Bestimmung des Magnesiums in Nickel und Nickelverbindungen herangezogen und ein neues Verfahren zur Trennung des Magnesiums von Nickel, Eisen und Mangan beschrieben. Die störende Wirkung des Eisens und Mangans wird durch Absorptionskurven veranschaulicht.