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The new technique of double balloon endoscopy (DBE) has made possible not only accessing but also therapeutic interventions throughout the small bowel without the need for laparotomy or laparoscopy. Nowadays almost all types of therapeutic endoscopic interventions can be performed during DBE. Recently, a single balloon enteroscopy system with only one balloon at the tip of the overtube was proposed for small bowel enteroscopy, but only preliminary results on the clinical effectiveness of this system are available so far.

Background Double-balloon enterocopy (DBE) is still under evaluation, including its yield and safety aspects. Objective Our purpose was to consider the relationship between DBE and hyperamylasemia. Design Single-center prospective study. Setting Tertiary referral hospital, conducted from March to October 2006. Patients Thirty-five oral DBEs were carried out in 31 patients (17 men, 14 women). Serum amylase, lipase, C-reactive protein (CRP), and urine amylase were taken before the procedure and 4 and 24 hours after the investigation. Abdominal pain was evaluated with a 3-step scale. Main Outcome Measurements Only 1 patient had acute pancreatitis after DBE. Results An elevation of amylase levels after the procedure was found in 51.4% and abdominal pain or nausea or vomiting in 34.3%, but 8.6% of these patients had no hyperamylasemia after DBE. CRP was determined in 25 procedures and the serum lipase level in 14 of these 25 DBEs; elevation of both factors after the procedure was found in 36%. The CRP level was elevated in 60% after the procedure. We found a positive correlation between abdominal pain and serum lipase level ( r = 0.72, P = .0032) and negative correlation between abdominal pain and age ( r = –0.445, P = .0076). Significant hyperamylasemia seems to be associated with longer duration of DBE (borderline statistically significant, P = .045; 95% CI for difference of means 0.985-82.306). Limitations Nonblinded nonrandomized study. Conclusions Hyperamylasemia after DBE seems to be rather common, mainly in the longest examinations. Although association of significant hyperamylasemia and acute pancreatitis is possible, it is not obligatory.

The negative initial endoscopy investigations (gastroscopy and colonoscopy) are the basic conditions for the obscure gastrointestinal (GI) bleeding diagnosis. The bleeding source is mostly localized in the small bowel; in spite of this, there is still a large group of patients with upper GI lesions missed during initial gastroscopy. Therefore, the capsule endoscopy indicated as the first-line method can be valuable for the gastric and duodenal investigation, too. Some cases of missed upper GI lesions diagnosed by means of capsule endoscopy indicated for obscure GI bleeding are demonstrated. This article is part of an expert video encyclopedia.

Endoscopy-assisted injection of India ink is a useful method for facilitating surgical and endoscopic identification of gastrointestinal lesions. It is important, especially in cases of nonpalpable lesions and before laparoscopy. Injection of submucosa with saline bleb and needle insertion at an oblique angle will prevent intraperitoneal application of the marker. Multiple injections, circumferentially in the colon, have been suggested to optimize operative localization. Microabscesses after the application of India ink were described, use of commercial suspension of presterilized and prediluted carbon particles has not been associated with any complications. This article is part of an expert video encyclopedia.

Objective The causal mechanism of acute pancreatitis after oral double balloon enteroscopy (DBE) is still uncertain. The most probable cause seems to be a mechanical straining of the endoscope with an over-tube on the pancreas. Hyperamylasemia and hyperlipasemia after DBE are frequent and usually asymptomatic. They do not represent the immediate risk factor of acute pancreatitis. The aim of this prospective study was to investigate several laboratory markers to predict patients in a higher risk of hyperamylasemia and hyperlipasemia and/or possible DBE-associated acute pancreatitis. Methods A total 38 patients (18 men and 20 women, mean age 51 years) with 44 DBEs and 30 matched healthy controls with no endoscopy entered the study. Following laboratory markers were investigated before, 4 hours and 24 hours after DBE and once in controls: serum hs-CRP, prokalcitonin, total S100 protein, cathepsin B, SPINK1, lactoferrin, E-selectin, alfa-1-antitrypsin, malondialdehyde, amylase and lipase. The mean time of DBE was 80 min. (range 20 210 min.), the mean number of push-and-pull cycles was 14 (range 1 41). We have not recorded any DBEassociated acute pancreatitis in this series. Results Serum amylase and lipase rose significantly with the maximum 4 hours after DBE, with increased abnormal values in 31/44 (70%) of serum amylase and 29/44 (66%) of serum lipase (p < 0.001 and p < 0.001). Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients' values before DBE (p = 0.018 and p = 0.031). There was a statistically significant, but clinically irrelevant, difference in malondialdehyde between males and females 4 hours after DBE (0.33±0.20 vs. 0.20±0.13 μmol/L; p = 0.012). No other gender-associated difference was recorded. There was a trend for an association between number of push-and-pull cycles in DBE and procalcitonin (r = -0.384; p = 0.011) and urine amylase (r = 0.313; p = 0.043) 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin (r = 0.358; p = 0.021), cathepsin (r = 0.362; p = 0.020) and hs-CRP (r = 0.358; p = 0.021); and between E-selectin and malondialdehyde (r = 0.364; p = 0.019) 4 hours after DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. Conclusions Our current results support our previous hypothesis that endoscope-induced mechanical straining during DBE is the most important factor responsible for the increase of amylase and lipase or even for progression to acute pancreatitis. We found no laboratory predictive markers that would identify in advance those patients in a higher risk. This study was supported by the research grant MH CZ NT11524-5/2010 and by the programme PRVOUK 37-08.

Objectives Epidemiology of uninvestigated dyspepsia was studied in the Czech Republic for the first time in 2001 (1). The aim this current multi-centre prospective study was to evaluate dyspepsia using the samemethods in a representative sample of general unselected population from the same geographical areas 10 years later. Methods A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1,836 subjects (863 males and 973 females; aged 5-98 years) took part in the study and responded to the question on prevalence of dyspepsia. Complete data on variables used in our analysis was available for 1,685 subjects. The proportion of subjects reporting dyspepsia did not differ significantly between the restricted sample and the group excluded from multivariable analyses. Helicobacter pylori (Hp) status was investigated in all subject by means of 13C-urea breath test. Results In subjects aged 5-24 years, when we analyzed determinants of dyspepsia by type (subgroup A: dyspepsia as the only long-lasting symptom vs. subgroup B: dyspepsia as a part of the complex of other complaints or previously recognized diseases), we noted somewhat stronger increase in risk of dyspepsia A with age (OR 1.15 per 1 year of age, 95% CI 1.05-1.26, adjusted for gender) and with current use of antibiotics (OR 3.23 in users vs. non-users, 95% CI 0.87-11.9). In subjects aged 25+ years, when analyzed by type of dyspepsia, a statistically significant negative association of age with dyspepsia of type A became apparent (OR 0.95 per 1 year of age, 95% CI 0.94-0.97) while the association between age and dyspepsia type B was also statistically significant albeit positive (OR 1.02 per 1 year of age, 95% CI 1.01, 1.04). Furthermore, subjects who were single were at lower risk of dyspepsia type B (OR 0.46 in single vs. married, 95% CI 0.21-0.99, adjusted for age and gender). The unexpected protective effect of elementary education appeared also to be stronger for dyspepsia type B (OR for elementary vs. university educated 0.25, 95% CI 0.07-0.86, adjusted for age and gender). Hp negative subjects reported dyspepsia in 4.1% (aged 5-24 years) and 18.1 % (aged 25+ years). In Hp positive subjects, dyspepsia was present in 7.1% (aged 5-24 years; OR 1.45, 95% CI 0.41, 5.16) and 16.3% (aged 25+ years; OR 0.85, 95% CI 0.60, 1.21, adjusted for gender and age). Conclusions Despite the substantial decrease of Hp infection in the Czech Republic over the past 10 years, the prevalence and basic socio-demographic determinants of uninvestigated dyspepsia did not change significantly. Reference: Rejchrt et al. Eur J Gastroenterol Hepatol 2008; 20: 898-905. This study was supported by the research grant MH CZ NT115245/ 2010 and by the programme PRVOUK 3708.

Epidemiology of Helicobacter pylori in the Czech Republic : significant decrease in prevalence within a 10-year period

diagnosis of HPS was confirmed by standard clinical criteria and genetic testing. Data were abstracted for patient demographics, radiologic studies, DBE findings, procedural outcomes, and complications. Results: Twenty-two patients (50% men; 19 PJS; 2 CS; 1JPS) with mean age of 37 14 yrs underwent a total of 34 DBE procedures. Seventeen (77%) patients had prior SB surgeries. There were 4 (18%) patients with a history of SB obstruction, 10 (45%) with prior intussusception, and 5 (23%) with HPS-related SB bleeding. Pre-DBE imaging included CT enterography (n 15), CT enteroclysis (n 5), small bowel follow through (n 1), and MR enterography (n 1). Any SB polyp 1cm in size was targeted for DBE-assisted polypectomy. The estimated location of polyps on imaging studies directed the DBE route of approach (antegrade (A) and/or retrograde (R)). A-DBE (n 20) and R-DBE (n 14) procedures averaged 2.6 0.8 hrs and 2.3 0.8 hrs, respectively (p 0.46). Fluoroscopy was utilized in 70% of A-DBE and 50% of R-DBE procedures. The maximal insertion depth was estimated to be the distal jejunum and proximal ileum in 65% and 35% of ADBE, respectively. R-DBE reached the distal jejunum in 21% of retrograde procedures. A-DBE and R-DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% CI: 66.591.6%). The median size of resected polyps was 2cm (range 1-5cm) and all were hamartomas. Unsuccessful procedures were due to failure to locate the polyp (n 1), failure to advance the enteroscope in the SB (n 2), failure to intubate the terminal ileum (n 2), and poor colon preparation (n 1). Complications occurred in 11.8% of procedures and included abdominal pain requiring overnight hospitalization (n 2), immediate post-polypectomy bleeding requiring clip placement (n 1), and self-limited hematochezia (n 1). Conclusions: DBEassisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To our knowledge, this is the largest single-center experience to report on the performance and safety of DBE-assisted polypectomy in HPS patients.

Background: Small bowel pathology is often difficult to be diagnosed. Enteroscopy is an important diagnostic and/or therapeutic method. Aim of the study is to evaluate significance of push enteroscopy in diagnostics of metastatic involvement of small bowel Methods. Within 5 years (1995- 1999) 458 enteroscopy investigations were done (using push enteroscope Olympus SIF100 with or without overtube). Results. Metastatic involvement of small bowel was found in 8 patients (1.7 %). Two cases of malignant melanoma were found (the first one presenting as melena, the second one as a rapid weight loss). Other cases were as follows: pulmonary cancer metastasis (presenting as melena), teratoma (with microcytic anaemia), gastrinoma (MEN-I syndrome, hypergastrinaemia), carcinoid (melena, no endocrine activity), abdominal carcinomatous lymphadenopathy (with weight loss) and metachronous colon cancer (examined because of ileus). Conclusions: Metastatic involvement of small bowel is a rare condition, usually presenting of melena. Other clinical manifestation (microcytic anaemia, ileus, endocrine tumour activity or accidental finding) are less common.