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The complications of gastrointestinal (GI) endoscopy have become very rare, due to technical advances but also the use of good practices by all gastroenterologists. The overall rate of complications is 1 percent per year for more than 2 millions of lower and upper GI endoscopies, all indications included. The most common complication, though with a frequency inferior to 1/1,000 per year, is still perforation during colonoscopy, most often induced by a fragile intestine or a healing abdomen. Other complications are often the consequence of diathesis or comorbidities, especially if this procedure is performed under anesthesia. Thus in patients with severe cardiovascular or respiratory diseases, or simply depending on the age of patients, risks should be carefully assessed so that the endoscopic procedure can be adapted or even postponed. Being aware of and especially taking into account any risk factor before performing a diagnostic endoscopic examination should thus allow gastroenterologists to avoid complications.

One side effect of the immunomodulatory effect of interferon is the possible triggering or exacerbation of systemic or cutaneous sarcoidosis. We report two new cases and offer an exhaustive review of the literature. A 39-year-old man with type C chronic active hepatitis developed new respiratory symptoms and pulmonary infiltrates with hilar and mediastinal adenopathy after 7 months of treatment with pegylated interferon. The evolution was favourable after stopping treatment. The second patient developed cutaneous lesions after 6 months of treatment. Resolution occurred after the discontinuation of the treatment. In these two cases ribavirin was stopped before the first signs of sarcoidosis.

From January to December 1991, the portal venous system was evaluated by Doppler ultrasonography in 72 patients with liver cirrhosis. The objectives of this study were to evaluate the prevalence of spontaneous reversal of blood flow in the portal vein and to assess the relationship between Doppler ultrasound investigation and clinical, biochemical, endoscopic (70 patients), and endosonographic (44 patients) features. Reversed flow was quite frequent (alternating: 17%, permanent: 22%) and its prevalence did not differ in relation to age, sex, serum gammaglobulin concentration and Child-Pugh class. In patients with reversed portal venous flow, the prevalence of hepatic encephalopathy was higher (39% vs 13.5%, P < 0.05), but the prevalence of esophageal or gastric varices was not related to that pattern. Endosonography detected gastric wall abnormalities in a higher proportion of patients with reversed portal flow than in patients without it (P < 0.05). This study suggests that reversal of flow in the portal vein could play a role in the development of the gastric wall abnormalities in liver cirrhosis, which are detected by endosonography but not by endoscopy.

Non-alcoholic steatosis of the liver is a common condition. It usually consists of triglyceride drop deposits in macro- or microvacuoles of the hepatocytes and may result from various disturbances of lipid metabolism, notably accumulation of fatty acids in the liver and decrease in the secretion or synthesis of lipoproteins. The causes of steatosis are numerous. It is important to distinguish between severe steatosis (acute steatosis of pregnancy, toxic steatosis, Reye's syndrome), where most of the deposits are in microvacuoles, and incidental or moderate steatosis of nutritional or hormonal origin, or developed during idiopathic enterocolitis or various liver diseases. Treatment, sometimes intensive, essentially depends upon the cause of steatosis.

Ultrasonography allowed to diagnose in emergency an acute intraperitoneal bleeding complicating a percutaneous needle liver biopsy in a woman suffering from diffuse steatosis and to demonstrate the mechanism of bleeding by the visualization of the probable injury of a sus-hepatic vein.

This study was carried out in order to assess the value of ultrasonography in the diagnosis of cirrhosis. One hundred patients were studied within 2 weeks of the histological diagnosis of the liver disease (cirrhosis 49, acute or chronic hepatitis: 23, fatty liver: 16, normal liver: 12). Ultrasonic patterns were classified by a second examiner according to 5 hepatic criteria (volume, outline, echogenicity, attenuation of the ultrasound beam, enlargement of caudate lobe) and 3 extrahepatic criteria (dilatation of the portal vein, ascites, splenomegaly), leading to a ultrasonic diagnosis. Cirrhosis was diagnosed in 36 out of 49 patients (73 p. 100) by the echographist whereas clinical and biological data lead to diagnosis in only 27 out of these 49 patients (P = 0.057). Hepatocellular carcinoma was diagnosed only in 2 out of 5 patients. Splenomegaly (0.60) and caudate lobe enlargement (0.59) were the signs whose predictive value was the best for this group of patients. The ratio thickness of caudate lobe/global hepatic thickness (as measured on a sagittal cut through the inferior vena cava) allowed for easy assessment of caudate lobe size. The mean value of this ratio was significantly different (P less than 0.001) in the cirrhotic group (0.38 +/- 0.07) when compared to the non-cirrhotic one (0.28 +/- 0.06). Ratios greater than 0.35 were not seen in subjects with normal livers, nor were ratios greater than 0.40 seen in non-cirrhotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)