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Zusammenfassung ! Hintergrund: Elektive Ösophagogastroduodeno-skopien (EGD) werden oft ohne Sedierung durchgeführt. Transorale (TO) und transnasale (TN) EGD haben unterschiedlichen Patientenkomfort und Komplikationen. Patienten und Methoden: In einer kontrollierten, randomisierten, klinischen Studie wurde die TN-EGD mit der TO-EGD ohne Sedierung verglichen, und zwar Gruppe 1 (93 Patienten, TN-EGD mit dünnem Endoskop) mit Gruppe 2 (90 Patienten, TO-EGD mit Standardendoskop). Gruppe 3 (Kontrolle) enthielt 118 Patienten, die früher eine TO-EGD hatten und nun eine TN-EGD bekamen. Arztbewertete Untersuchungszeit und Komplikationen sowie patientenbewertete Nebenwirkungen und Vorlieben wurden verglichen. Ergebnisse: Zwischen Gruppe 1 und 2 gab es keinen signifikanten Unterschied in der Untersuchungszeit. Übelkeit (p = 0,047) und Epistaxis (p < 0,001) waren signifikant häufiger bei der TN-EGD. Die Konversionsrate von TN-zu TO-EGD war mit 4.3 % niedrig. Die TN-EGD wurde besser toleriert (p < 0,001), der Würgereiz war geringer (p < 0,001). Für eine erneute EGD bevorzugen Patienten, die beide Techniken kennen (Gruppe 3), die TN-EGD (80 %). Alle Gruppen wünschen für zukünftige Untersuchungen keine Sedierung (90 %/90 %/89 %). Resultate: Epistaxis nach einer TN-EGD kann meist konservativ behandelt werden. Die TN-EGD ist der TO-EGD überlegen in Bezug auf Wür-gereiz und Akzeptanz der Untersuchung. Patienten, die beide Methoden kennen, bevorzugen die TN-EGD. Die TN-EGD ohne Sedierung wird für den Patientenkomfort empfohlen.Abstract ! Background and Study Aims: Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications. Patients and Methods: For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD. Results: Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN-to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/ 89 %). Conclusions: Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.Downloaded ...

BackgroundMassive upper gastrointestinal hemorrhage can be the dominant symptom of decompensated liver cirrhosis, varices and ulcerations in the upper gastrointestinal tract. Postoperative complications are known to lead to these bleedings. Commonly, emergency endoscopy will be performed. Here we report of a patient with extensive bleeding caused by an aneurysma spurium of the arteria hepatica dextra induced by a laparoscopic cholecystectomy. The condition was diagnosed by the Doppler ultrasound scan of the liver.Case presentationInitially the source of the gastrointestinal bleeding was caused by an ulcus Dieulafoy in the jejunum which was stopped by clipping. Continous bleeding was observed and traced to a rare complication of a laparoscopic cholecystectomy due to a gallbladder empyema. After surgical intervention the patient developed an aneurysma spurium of the arteria hepatica dextra which was in communication with the small bowel. The successful treatment was performed by embolizing the aneurysma.ConclusionThe reasons for gastrointestinal bleedings are manifold. This case presents a seldom cause of a gastrointestinal bleeding due to an aneurysma of the hepatic arteria. The successful embolization was performed to ultimately stop the bleeding.

BackgroundThe reprocessing of medical endoscopes is carried out using automatic cleaning and disinfection machines. The documentation and archiving of records of properly conducted reprocessing procedures is the last and increasingly important part of the reprocessing cycle for flexible endoscopes.MethodsThis report describes a new computer program designed to monitor and document the automatic reprocessing of flexible endoscopes and accessories in fully automatic washer-disinfectors; it does not contain nor compensate the manual cleaning step. The program implements national standards for the monitoring of hygiene in flexible endoscopes and the guidelines for the reprocessing of medical products. No FDA approval has been obtained up to now. The advantages of this newly developed computer program are firstly that it simplifies the documentation procedures of medical endoscopes and that it could be used universally with any washer-disinfector and that it is independent of the various interfaces and software products provided by the individual suppliers of washer-disinfectors.ResultsThe computer program presented here has been tested on a total of four washer-disinfectors in more than 6000 medical examinations within 9 months.ConclusionsWe present for the first time an electronic documentation system for automated washer-disinfectors for medical devices e.g. flexible endoscopes which can be used on any washer-disinfectors that documents the procedures involved in the automatic cleaning process and can be easily connected to most hospital documentation systems.

We report on a 78‐year‐old female patient who suffered from end‐stage renal disease (ESRD) and received intermittent hemodialysis for 9 years. In the late progression of ESRD, she developed very painful ulcerations on both legs. The ulcerations were diagnosed as an early stage of calciphylaxis. In line with the high mortality of this disease, she lived only 5 months after initial diagnosis. Up to now, the pathology of calciphylaxis has been poorly understood. Hence no truly successful treatment regime has been available. Treatment should focus on the patient's pain, a major manifestation of the illness. This case report looks at a rare and seldom seen illness in patients with end‐stage renal disease.