The European Diploma of Gastroenterology: progress towards harmonization of standards

The European Diploma of Gastroenterology has now been established by the European Board of Gastroenterology (EBG) and has been awarded to several individual doctors and to training centres. The EBG is a working party of the Gastroenterology Section of the European Union of Medical Specialists. The Diploma can be awarded to individual doctors who have been recognized as specialists in their own countries; trained in approved centres; and satisfied the training criteria of the EBG. The Diploma can also be awarded as a recognition of training competence to hospitals that meet the requirements of the EBG. Hospitals seeking recognition will be visited by members of the EBG and must show evidence that they can provide adequate clinical and technical experience to trainee gastroenterologists.

Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients

BACKGROUND AND STUDY AIMS

Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction.

PATIENTS AND METHODS

In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals.

RESULTS

Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting.

CONCLUSION

Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.

Electronic video endoscopy: preliminary results of imaging modification

This study represents a preliminary trial of the quantification of colorimetric modification of the esophageal mucosa, permitting the opening up of a video-electronic and computer classification of lesions of esophagitis.

Glucagon-(1-21)-peptide. Study of its action on sphincter of Oddi function by endoscopic manometry

The amino acid sequence (1-21) of glucagon has been shown to have full spasmolytic action in animal studies but no metabolic effect. The motor activity of the sphincter of Oddi was measured during ERCP with manometric recordings of sphincter pressure. Then glucagon-(1-21)-peptide was given as a bolus intravenous injection; serial blood samples were taken to determine glucagon-like immunoreactivity. The spasmolytic effect of glucagon-(1-21)-peptide began 15 sec after injection and lasted up to 22 min at the higher doses. The basal pressure of the sphincter of Oddi was decreased by 31-56% after administration of glucagon-(1-21)-peptide. Phasic sphincter of Oddi pressure and wave frequency were also affected. In conclusion, glucagon-(1-21)-peptide has a relaxing effect on the human sphincter of Oddi and might emerge as an alternative to glucagon or other spasmolytic drugs for obtaining selective relaxation of the biliary tract.

Experimental study of biliary endoprosthesis efficiency

Insertion of biliary prosthesis permits palliative drainage; unfortunately, cholangitis and clotting induced a large amount of side effects. We set up an experimental model with a view to testing in vitro efficiency of available stents, then we designed a new prosthesis with improved mechanical performance.