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«Esculape» est un systeme de gestion de donnees etabli a l’usage d’unites d’endoscopie digestive travaillant avec un systeme informatique en reseau ou avec un ordinateur personnel de type MS-DOS. Ce systeme permet les activites suivantes: compiler le rapport du diagnostic, des investigations et procedes operatoires des voies digestives superieures — inferieures — bilio-pancreatiques, y compris la laparoscopie, de stocker les donnees d’endoscopie et les donnees cliniques et de les recuperer, de produire automatiquement le rapport, de saisir et de stocker les images en cours d’examen endoscopique et de les traiter simultanement, de fournir l’analyse statistiques des donnees enregistrees, enfin d’enregistrer et de decoder les observations histologiques relatives aux patients. L’elaboration du rapport est simplifiee grâce a l’utilisation de fenetres (windows), de menus a options et de la methode automatique «POP-UP». La terminologie se refere a la 3e edition du systeme OMED et les donnees histologiques sont enregistrees selon les codes SNOMED. Des que toutes les donnees ont ete introduites, un rapport est produit en langage codifie. La production du rapport s’effectue a une vitesse moyenne d’une minute. Actuellement, 170 centres italiens utilisent le programme et 42 % d’entre-eux l’emploient de facon quotidienne pour toutes leurs activites endoscopiques. Le programme est relie au gestionnaire de fichier et d’images ES IMAGE, qui utilise un disque dur de type WORM pour l’archivage des resultats d’examens d’endoscopie digitale ou de radiologie.

Endoscopic sphincterotomy (ES) is particulary difficult in patients with previous Billroth II gastrectomy, when a reverse approach to enter and cut the papilla must be used. A further method using a diathermic needle type cutter has been proposed by us in Billroth II patients in 1984. Now we have developed a modified technique, positioning a naso biliary tube in the common bile duct before starting ES. So the sphincterotomy can be performed by a diathermic needle using the catheter as a guide. In this way the risk of perforation of the posterior duodenal wall and of pancreatitis are avoided because the cutting direction and the depth of the section are well controlled maintaining the diathermic needle upward respect to the position of the catheter. Over the last 10 years 2082 ERCP and 1557 ES have been carried out in our Endoscopic Unit. Of these 98 ES have been performed in Billroth II patients. Technical implications and results are described.

It has been suggested that pre-procedural oral simethicone improves visibility in upper GI tract endoscopy. We examined three-hundred-thirty patients referred for upper endoscopy who were randomized and were required to swallow a placebo solution or one of three liquid simethicone solutions 15 min prior to the examination. These solutions contained 65 mg, 65 mg and 195 mg of drug dissolved in 90 ml, 30 ml and 90 ml of water, respectively. Patients treated with both dosages of simethicone revealed significantly less foam and bubbles in both the stomach and the duodenum compared to placebo. Only the 90 ml volume adequately cleared both locations. The reduction of examination time could be found both in patients with an intact stomach and in patients with or without gastric bile reflux, but was most striking in patients with previous gastric resection (examination time being reduced by almost 50% and the need of adjunctive lavage being reduced about 20 fold compared to placebo). In conclusion, pre-procedural oral simethicone should be routinely considered in patients with previous gastric resection. The utility of the drug is less evident in patients with normal gastric anatomy.

Many changes and advances have been achieved in the last years, so that emergency endoscopy has now a definite role also in the diagnosis and treatment of diseases in childhood. In order to determinate main indications to endoscopic examination, and which are the most useful diagnostic and therapeutic measures that should be performed, we examined the records of 202 patients (aged 1 day-14 years) undergone emergency endoscopy from June 1979 to January 1990. Patients were referred to endoscopy because of foreign bodies or caustic ingestion, hematemesis, and in one patient a suspected intussusception. We didn't record any complication. Our study shows that emergency endoscopy has a definite role also in pediatric age and gives a diagnostic and therapeutic gain in the management of many diseases.

Early diagnosis of esophageal perforation is critical. We believe that the treatment of each case must be individualized. The management of perforation in our series has been "conservative" in two cases, for small perforations; and "operative", suture closure and drainage, in the remainder, for a large perforation with contamination of the mediastinum.

Endoscopy plays an important role in the treatment of complications of biliary stones [3]. An indication for endoscopic sphincterotomy (ES) may also occur in early complications after biliary surgery [23]. The indications for ES in our endoscopy unit over the past 10 years are presented in Table 1; those for patients with choledocholithiasis are listed in Table 2. Indications for emergency endoscopic sphincterotomy are urgent medical conditions that require a prompt, life-saving treatment. Indications for EES in our series are presented in Table 3.

La dysphagie sideropenique, denommee syndrome de Plummer-Vinson ou de Patterson-Kelly, est une affection non exceptionnelle, meme en Italie.

The authors analyze a retrospective study of 850 patients who underwent endoscopic sphincterotomy (ES). One group of patients (705) routinely had nasobiliary drainage following ES as a prophylactic measure to prevent complications, while 145 patients were not drained. Complications, mortality and the need for emergency surgery were compared in both groups. In the drained group, the complication rate was 2% vs 10.3% in the nondrained group (P less than 0.001), and mortality was 0.4% vs 2.7% (P = 0.03). Emergency surgery was required in 0.1% in the drained patients versus 3.4% in the nondrained group (P = 0.01). Based on these data within the limits of a retrospective study, the authors strongly support the routine use of nasobiliary drainage to prevent complications, which usually occur within the first 24 h, and also to facilitate the immediate treatment of the complications. This procedure is also highly recommended when ES is performed by inexperienced endoscopists and with a technically demanding ES, which is frequently followed by complications.

Adenomatosis coli (or familial polyposis of the large bowel) and related syndromes are relatively rare diseases characterized by an autosomal dominant mode of inheritance. In these diseases, the entire colorectal mucosa is covered by hundreds (often innumerable) polyps of various dimensions. In addition, several extracolonic abnormalities have been reported. In the present study, we describe the clinical features of eight families from northern Italy fulfilling the diagnostic criteria of adenomatosis coli. Information was available on 123 unaffected and 30 affected family members. The most relevant findings of the study can be summarized as follows. 1) Gene frequency was calculated to be between 1:7,300 and 1:19,000. Segregation ratio in affected branches was 0.57, with a gene penetrance of nearly 60% and a male:female ratio of 1.73. 2) Extracolonic manifestations were present in all families and in 15 of 30 affected patients, the most frequent being cutaneous cysts and retinal lesions. No case fulfilling the classical criteria of Gardner syndrome was observed. 3) When the diagnosis of adenomatosis followed the appearance of symptoms, colorectal cancer had usually already developed, whereas no malignant changes were observed in individuals diagnosed in the asymptomatic stage. When colectomy with ileorectal anastomosis was the treatment of choice, polyps tended to recur in the rectal stump, and long-term endoscopic follow-up was necessary. In conclusion, adenomatosis coli may account for a definite proportion of colorectal neoplasms observed in the general population. Taking into consideration the genetic base of the disease, it follows that individuals at risk should be closely monitored for several years. Moreover, clinical investigations should not be limited to the large bowel, but should be extended to the skin, upper digestive tract, fundus oculi, bones, and probably other organs.