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Polyps occur significantly less frequently in the upper gastrointestinal tract compared to the lower gastrointestinal tract. They are usually incidental findings at esophagogastroduodenoscopy. A distinction is made between epithelial lesions and subepithelial tumors. Endoscopic screening is not recommended in Germany (exception: hereditary risk groups). Polyps are sometimes symptomatic, generally in the case of advanced tumor size. In this case, or in the case of potential for malignant transformation, resection is necessary and can usually be performed endoscopically. Surgical resections are rarely necessary. Epithelial lesions are removed by means of endoscopic mucosal resection (EMR). For subepithelial tumors, advanced procedures such as endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), or endoscopic full-thickness resection are available. These procedures should primarily be performed at centers with appropriate expertise. Endoscopic follow-up is primarily determined by the tumor entity and the resection status.

Introduction Risk stratification in upper gastrointestinal bleeding (UGIB) currently relies on clinical parameters and risk scores. HemoPill® acute (Ovesco Endoscopy, Tuebingen, Germany) is a pill-shaped, orally administered sensor capsule for real-time blood detection. The aim of this study was to evaluate the system in clinical routine. Material and methods Sixty-one consecutive patients in whom the HemoPill® had been used at 12 international hospitals between July 2019 and March 2020 were retrospectively analysed. Indications for application were the clinical suspicion of UGIB, small bowel bleeding, of rebleeding after hemostasis. Primary endpoints were technical success and bleeding detection/exclusion. Secondary endpoints included adverse events and change of clinical course. Results The capsule was used in 45 (73%) patients with UGIB, in 12 (20%) patients with small bowel bleeding and in four (7%) patients for exclusion of rebleeding. Technical success was 98%. 35/60 (58%) cases were capsule-positive and among these, endoscopy showed bleeding in 20/35 (57%) cases. None of the 25 capsule-negative patients rebled. Emergency endoscopy could be avoided in 18/25 (72%) cases. Serious adverse events did not occur. Conclusion HemoPill®-based blood detection is feasible and safe. Negative capsule results might 'downgrade' the need for urgent endoscopy.

Polyps occur significantly less frequently in the upper gastrointestinal tract compared to the lower gastrointestinal tract. They are usually incidental findings at esophagogastroduodenoscopy. A distinction is made between epithelial lesions and subepithelial tumors. Endoscopic screening is not recommended in Germany (exception: hereditary risk groups). Polyps are sometimes symptomatic, generally in the case of advanced tumor size. In this case, or in the case of potential for malignant transformation, resection is necessary and can usually be performed endoscopically. Surgical resections are rarely necessary. Epithelial lesions are removed by means of endoscopic mucosal resection (EMR). For subepithelial tumors, advanced procedures such as endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), or endoscopic full-thickness resection are available. These procedures should primarily be performed at centers with appropriate expertise. Endoscopic follow-up is primarily determined by the tumor entity and the resection status.Im Vergleich zum unteren Gastrointestinaltrakt kommen Polypen im oberen Gastrointestinaltrakt deutlich seltener vor. Sie fallen meist als Zufallsbefund im Rahmen einer Ösophagogastroduodenoskopie auf. Epitheliale Läsionen werden von subepithelialen Tumoren unterschieden. Eine endoskopische Vorsorge ist in Deutschland nicht empfohlen (Ausnahme: hereditäre Risikogruppen). In manchen Fällen sind Polypen symptomatisch, meist bei fortgeschrittener Tumorgröße. In diesem Fall oder bei potenziell malignen Befunden ist eine Resektion erforderlich, diese kann in aller Regel endoskopisch erfolgen. Chirurgische Resektionen sind selten erforderlich. Epitheliale Läsionen werden mittels endoskopischer Mukosaresektion (EMR) entfernt. Für subepitheliale Tumoren stehen fortgeschrittene Verfahren wie die endoskopische Submukosadissektion (ESD), Tunnelungstechniken („submucosal tunneling endoscopic resection“ [STER]) oder die endoskopische Vollwandresektion zur Verfügung. Diese Verfahren sollten primär an Zentren mit entsprechender Expertise durchgeführt werden. Die endoskopische Nachsorge wird maßgeblich durch die Tumorentität und den Resektionsstatus bestimmt.

Eine 46-jahrige Patientin stellte sich mit akuten rechtsseitigen Oberbauchschmerzen vor. In der Osophagogastroduodenoskopie wurde eine Duodenalstenose im Bereich der Pars horizontalis duodeni festgestellt. Die Computertomographie des Abdomens, Endosonographie, Doppler‑/Duplexsonographie und Angiographie ergaben in der Zusammenschau ein Aneurysma eines Asts der A. pancreaticoduodenalis inferior innerhalb eines Umgehungskreislaufs von der A. mesenterica superior zur A. hepatica propria. Die Umgehung hatte sich aufgrund eines Verschlusses des Truncus coeliacus gebildet. Die symptomatische Duodenalstenose wurde durch ein lokales Hamatom nach stattgehabter Aneurysmaruptur verursacht. Nach erfolgreichem Coiling des zufuhrenden Gefases zum Aneurysma war das Hamatom in Verlaufskontrollen regredient und die Patientin beschwerdefrei.

This study investigated the interconnection between student’s achievements in prerequisite courses with their subsequent achievement in mechanics. Eighty-five preservice physics students’ achievement in four prerequisite courses for mechanics, namely Basic Physics I, Basic Physics II, Mathematics Physics I, and Mathematics Physics II, were analyzed statistically to determine the relationships and effects of prior achievement to sub-sequent learning achievement. Results suggested that students’ achievement in mechanics was significantly re-lated to students’ achievement in prerequisite courses. The effects of each course on student’s achievement in mechanics were estimated and discussed.

A 46-year-old woman presented with acute abdominal pain in the right upper quadrant. Esophagogastroduodenoscopy revealed a duodenal stenosis within the horizontal part of the duodenum. Based on the findings of abdominal computed tomography (CT), endosonography, Doppler duplex sonography and angiography, the diagnosis of an aneurysm of a branch of the inferior pancreaticoduodenal artery was established. This arterial branch was part of a collateral circulation between the superior mesenteric artery and the proper hepatic artery caused by obturation of the celiac artery. The symptomatic duodenal stenosis was the result of a local hematoma due to prior rupture of an aneurysm. After successful coiling of the afferent vessels to the aneurysm follow-up examinations showed progredient resorption of the hematoma and the patient was free of complaints.

Background: This study was designed to compare cisplatin/docetaxel with oxaliplatin/docetaxel in patients with advanced and metastatic non-small lung cancer as a first-line treatment. Methods: Patients were randomly assigned to receive either cisplatin 75 mg m−2 and docetaxel 75 mg m−2 every 3 weeks or oxaliplatin 85 mg m−2 and docetaxel 50 mg m−2 every 2 weeks. The primary end point was response rate, and secondary end points were toxicity, time to progression and overall survival. Results: A total of 88 patients (median age: 65 (39–86) years; stage IV: 93%) were randomly assigned. Response rate (complete and partial response) was 47% (95% CI: 33–61%) in the cisplatin/docetaxel arm and 28% (95% CI: 17–43%) in the oxaliplatin/docetaxel arm (P=0.118). There was no significant difference in time to progression (6.3 vs 4.9 months, P=0.111) and median overall survival (11.6 vs 7.0 months, P=0.102) with cisplatin/docetaxel vs oxaliplatin/docetaxel, although slight trends favouring cisplatin were seen. Oxaliplatin/docetaxel was associated with significantly less (any grade) renal toxicity (56% vs 11%), any grade fatigue (81% vs 59%), complete alopecia (76% vs 27%), any grade leukopenia (84% vs 61%) and grade 3/4 leukopenia (44% vs 14%) and neutropenia (56% vs 27%). Conclusion: Oxaliplatin/docetaxel has activity in metastatic non-small cell lung cancer, but it seems to be inferior to cisplatin/docetaxel.

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

Aufgrund der speziellen Tumoreigenschaften und der steigenden Inzidenz in den westlichen Landern gibt es zukunftig in der Diagnostik und Therapie von Cholangiokarzinomen noch viele Herausforderungen. Jungste Fortschritte in der Bildgebung und den endoskopischen Techniken zeigen vielversprechende Erfolge. Hauptansatz der aktuellen Forschung und der laufenden Studien ist die Verbesserung auf folgenden Feldern: Tumorfruhdiagnostik, histologische Sicherung, Resektabilitatsprufung und adaquate Angebote zur Lebensverlangerung in der Palliativsituation. Dieser Artikel gibt einen kritischen Uberblick der fur die Cholangiokarzinome aktuell zur Verfugung stehenden diagnostischen und therapeutischen Mittel.

BACKGROUND AND AIM Natural-orifice transluminal endoscopic surgery (NOTES) is an emerging transluminal technique in which interventions are carried out by entering the abdominal cavity via a natural orifice such as the stomach. Infection is a potential risk of the procedure, and the potential pathogens are different from those encountered with skin incisions. Currently, available data regarding prophylactic anti-infective treatment are limited. We compared the effectiveness of topical antimicrobial lavage of mouth and stomach and proton pump inhibitor therapy with gastric cleansing with sterile saline solution in preventing NOTES-related contamination and infection. METHODS A randomized survival swine study was performed. Eight pigs underwent preparation with intravenously administered proton pump inhibitors, mouth and gastric lavage (chlorhexidine), and gastric irrigation (diluted neomycin), plus single-shot intravenous antibiotics. Control group (n = 8) underwent gastric cleansing with sterile saline solution. Peritoneal biopsy, multiple smears, and dilutions for cultures were taken and incubated. The swine were sacrificed after 14 days. Bacterial load was expressed in colony-forming units (CFU). RESULTS One pig died due to gallbladder perforation after 3 days, 2/15 swine presented minor clinical signs of infection in the 14-day follow-up (all 3 pigs were in the control group). Mean C-reactive protein levels were 5.7 +/- 2.4 g/dL (therapy group) and 12.2 +/- 3.8 g/dL (control) ( P = 0.17). Bacterial growth was seen in 1/8 swine (therapy group) and 6/8 swine (control group) ( P = 0.002). Bacterial load was 282 CFU/mL (therapy) vs. 3.2 x 10 (5) CFU/mL (control) ( P = 0.023) in the follow-up. CONCLUSION The use of intravenous antibiotics in addition to topical antimicrobial lavage of mouth and stomach and treatment with proton pump inhibitors decreased the peritoneal bacterial load to almost zero and this was associated with a significantly lower peritoneal infection rate compared with saline-only lavage.

BACKGROUND AND STUDY AIM: Endoscopic mucosal resection (EMR) is a minimally invasive method for en bloc removal of superficial gastrointestinal lesions. The aim of this study was to evaluate the feasibility of a novel grasp-and-snare EMR technique. METHODS: In 10 domestic pigs, gastric lesions of approximately 3 cm were marked using electrocautery. EMR was performed using a double-channel endoscope. A novel tissue anchor was used through one channel, and a monofilament snare through the other. After submucosal injection, a circumferential mucosal incision was created. The tissue-anchoring device was then advanced through the open snare and anchored into the submucosal layer. The tissue-anchoring device was partly retracted into the endoscope and the snare was positioned into the circular incision. The snare was subsequently closed and the specimen resected by applying high-frequency electrocautery. RESULTS: Mean time to perform EMR was 32.4 minutes (range 22 - 41 minutes, SD 6.3). EMR yielded specimens that ranged in area from 2.7 cm (minor axis) by 2.8 cm (major axis) to 4.0 cm by 4.2 cm (mean area 9.36 cm 2 ; range 5.94 - 13.19 cm 2 ; SD ± 2.50). Complete en bloc resection including all electrocautery markings was achieved in 9/10 cases. In one case, resection was achieved in two steps. One gastric wall perforation occurred. No other adverse events were observed. CONCLUSIONS: Grasp-and-snare EMR is feasible in an animal model. The technique can be performed efficiently compared with standard methods. To avoid perforation, caution is needed to ensure that tissue anchor needles are placed within and not deeper than the submucosal layer prior to tissue retraction.

Die Therapie von nicht-varikosen und varikosenoberen gastrointestinalen Blutungen unterscheidet sich grundlegend.Blutungen aus gastroduodenalen Ulcera sind die haufigsteUrsache fur obere gastrointestinale Blutungen. Die Notfalltherapiebesteht aus der Gabe von intravenosen Protonenpumpeninhibitorenund der endoskopischen Blutstillung. Zusatzlich ist dieH. p.-Eradikation und ggf das Absetzen von NSAR von essentiellerBedeutung. Bei Varizenblutung ist die Gabe von vasoaktiven Substanzen unddie fruhe Antibiotikaprophylaxe essentiell. Zur endoskopsichenBlutstillung werden Gummibandligatur und Injektionsverfahren eingesetzt.Die TIPS-Anlage ist bei endoskopisch nicht beherrschbarer Blutungoder fruher Rezidiv-Blutung Therapie der Wahl. The management of upper non-variceal and variceal hemorrhagediffers substantially. Most common cause auf upper gastrointestinal(GI) hemorrhage are gastroduodenal ulcers. Administration of protonpump inhibitors (PPI) and endoscopic hemostasis are crucial in thetreatment of non-variceal bleeding. In case of Helicobacter pyloriinfection eradication therapy should be undertaken and nonsteroidanti-inflammatory drugs (NSAID) discontinued. Early administrationof vasoactive drugs and antibiotics significantly reduces mortalityfrom variceal hemorrhage. Endoscopic hemostasis is achieved withrubber-band ligation or injection therapy. Placement of transjugularintrahepatic portosystemic shunt (TIPS) is indicated in patientswith uncontrolled hemorrhage or recurrent bleeding despite combinedpharmacological and endoscopic therapy.

BACKGROUND AND STUDY AIMS: Perforation of the colon is considered to be one of the most serious complications of flexible endoscopy. The over-the-scope clip system (OTSC) has previously been shown to close small colonic perforations effectively. The aim of this randomized controlled porcine study was to compare acute closure strengths between the novel 11-mm over-the-scope-clip and surgical closure for large colonic perforations. MATERIAL AND METHODS: In 24 anesthetized domestic pigs, an 18-mm sigmoid perforation was created endoscopically using a needle knife and dilating balloon. The animals were randomly assigned to undergo either open surgical repair (n = 12) or endoscopic closure using the OTSC system (n = 12). Pressurized leak tests were performed during necropsy. RESULTS: Mean time to perform the incision in the sigmoid colon and obtain peritoneal access was 5.5 minutes (range 3 - 12; SD ± 2.5). Mean time for endoscopic closure was 6.8 minutes (range 3 - 14; SD ± 3). At necropsy, all OTSC and surgical closures demonstrated complete sealing of colotomy sites. In one case peritoneum and in a second case adjacent small intestine were found incorporated into the OTSC closure. No other complications occurred. Pressurized leak tests revealed a mean burst pressure of 62.8 mmHg (range 18 - 112; SD 35.7) for OTSC closures and 67.4 mmHg (range 30 - 90; SD 19) for sutured closure. No significant differences in burst pressures were noted between the OTSC closures and surgical repair. CONCLUSION: Closure of acute perforations using the OTSC system is comparable to surgical closure in a nonsurvival porcine model.