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Wir berichten über einen Patienten mit extrakutanem Befall bei Pyoderma gangraenosum. Der Patient stellte sich initial mit multiplen sterilen Hautabszessen vor, bei der weiterführenden Diagnostik zeigten sich dann auch Prostata-, Herz- und Nierenabszesse. Ein extrakutaner Befall beim Pyoderma gangraenosum ist sehr selten. Die Diagnosestellung gelang erst nach aufwendigem Ausschluss relevanter Differenzialdiagnosen bei immer wieder fehlendem Keimnachweis sowie schließlich nach einem empirischen Therapieversuch mit Prednisolon. Nach Steroidgabe kam es zu einer raschen Besserung. Unter Reduktion der Steroide kam es jedoch immer wieder zu einem Rezidiv, auch bei kombinierter Immunsuppression mit Methotrexat oder Azathioprin. Erst mit dem Tumor-Nekrose-Faktor-α-Blocker Infliximab konnte eine dauerhafte Remission erzielt werden. We report a case of an extracutaneus involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneus involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor-α-inhibitor infliximab was permanent remission achieved.

Endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett´s adenocarcinoma (EBAC). Endoscopic submucosal dissection (ESD) is a new endoscopic technique, which allows—in contrast to EMR—endoscopic en-bloc resection of neoplastic lesions greater than 2 cm with complete histological evaluation of the resected specimen. In contrast to Western countries, Barrett´s esophagus is less common in Asia indicating the low volume of published data of ESD in EBAC in Japanese series. Therefore, the aim of the present study is to describe the results of ESD in patients with EBAC performed in a German tertiary referral center. Between November 2009 and April 2014 ESDs were performed in 22 patients with histologically proven EBAC. Data were given for the en-bloc, the R0, the R0 en-bloc, and the curative resection rate as well as for the complication and the local recurrence rate. ESD was technically possible in all of the 22 patients. 20 of the resected EBAC were mucosal carcinomas, whereas in two patients the tumor showed submucosal invasion. The en-bloc, R0, R0 en-bloc, and curative resection rates were 95.5, 81.8, 81.8 %, and77.3 %, resp. Complication rate was 27.3 % (perforation n= 1, bleeding n= 2, stenosis n= 3). In case of curative tumor resection, only one local tumor recurrence (5.9 %) occurred after a medium follow-up of 1.6 years. Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD, especially in case of curative resections in the definite and less invasive therapy of EBAC. Attention should be drawn toward subsquamous extension of EBAC requiring a sufficient safety margin as an obligate condition for curative R0 resections. Due to the required learning curve and the management of potential complications, ESD should be restricted to greater endoscopic centers.

Background: This study assessed the feasibility of high-resolution magnetic resonance imaging of the pancreas by means of an endoscopically inserted endoluminal magnetic resonance receiver coil. Method: A 0.032-inch diameter internal magnetic resonance imaging receiver coil was endoscopically inserted into the pancreatic duct in 4 pigs through the accessory channel of a standard duodenoscope to obtain high-resolution magnetic resonance images by using T1- and T2-weighted sequences. Results: The pig anatomy precluded the usual transoral approach; however, transgastric access allowed endoscopic transpapillary insertion of a receiver coil into the pancreatic duct in all animals without the need for sphincterotomy. The small swine pancreas could then be visualized by magnetic resonance imaging with a 0.3 x 0.3-mm in-plane resolution. Conclusion: High-resolution pancreas magnetic resonance imaging is feasible by using an endoscopically inserted endoluminal receiver coil. The smaller stomach and larger pancreatic duct diameter in humans will facilitate clinical application of the imaging procedure.