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With the increasing technological development of endoscopy in recent years the diagnosis of and endoscopic therapy for duodenal adenomas has gained in importance. Due to its potentially malignant transformation an effective and safe therapy is necessary. The endoscopic resection has been shown to be safe and effective, even in cases of resection of large duodenal adenomas. Several studies have supported this thesis but are based on relatively small numbers of patients. In our clinic we have performed endoscopic resections of 178 duodenal adenomas over a period of 14 years, including sporadic duodenal adenomas as well as adenomas in familial polyposis syndromes. The aim of this retrospective analysis was to determine the acute complications associated with this technique. The rate of severe complications such as major bleeding or perforations was 9%. Further complications were minor bleeding (15.7%), pain needing treatment with analgesia (6.7%), fever (2.8%) and pancreatitis (0.6%). Summing up our experience with the endoscopic resection of adenomas of the small bowel we also consider the endoscopic resection of duodenal adenomas in most cases as a safe and effective alternative to surgical therapy. Because of the potential complications and their management especially in the resection of large adenomas with a size more than 2 cm, the endoscopic resection should be performed on an inpatient basis in experienced centres., (© Georg Thieme Verlag KG Stuttgart · New York.)

The report of a significant increase in plasma VIP concentration (PVC) during endoscopy of the upper gastrointestinal tract prompted us to examine this question under comparable experimental conditions, with simultaneous determination of serum gastrin concentration (SGC). Thirteen patients took part in a study wherein PVC and SGC were determined before, during and after oesophagogastroduodenoscopy (OGD). Before OGD the value for PVC was 30 +/- 2.5 pg/ml (means +/- SEM); during endoscopy it tended to increase slightly, to 35 +/- 3.2 pg/ml immediately after the examination (p greater than 0.05). By contrast with this finding, the SGC increased rapidly and significantly from 47 +/- 4.7 pg/ml prior to the examination to maximal values up to 68 +/- 6 pg/ml on inspection of the fundus (p less than 0,005), and was at a significantly increased level (p less than 0.05), with a value of 61.5 +/- 7.2 pg/ml, as much as thirty minutes after the examination. Sixty minutes after the examination the values had fallen to their original level (47.5 +/- 7.5 pg/ml). The present study shows that OGD has no significant influence on PVC, but that it is possible that stimulation of the VIP-ergic system is accompanied by a trivial increase in PVC. By contrast with this OGD significantly increases the concentration of endocrinally secreted gastrin, an effect which lasts as much as thirty minutes after the examination. The release of gastrin is a result of the combined effect of mechanical stimulation, distension due to insufflation of air and simultaneously induced neural influences. However, these mechanisms exert at most an insignificant influence on PVC - if indeed they have any effect on it at all.

An inquiry in FRG and Switzerland concerning complications in upper G.I. panendoscopy showed a total complication rate of 0.081% and a mortality of 0.007%. This complication rate is diminishing three to four times in comparison to publications ten years ago. The different kind of complications are discussed (perforations, complications of premedication respiratory and cardiovascular complications and infections). It is postulated that in future more attention is given to the problems of complications: treatment of perforations (conservative or surgical), oxygen saturation of blood and transmission of infectious disease, especially AIDS. The major complication is the diagnostic error.