[Gastric diagnosis, indications for radiological and endoscopic examinations considering gastrointestinal hemorrhage (author's transl)].
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Biomedical subjects
Publications and source records attributed to K U Schentke.
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The examinations contain the findings of the endoscopic retrograde cholangiopancreaticography in 600 patients, the date of a controlled comparative study intravenous cholangiotomography versus endoscopic retrograde cholangiography in 45 patients undergoing endoscopic retrograde cholangiopancreaticography and the results of the percutaneous transhepatic cholangiography in 54 patients. In anicteric patients and after subsidence of the clinical symptoms the optimum use of the intravenous cholegraphy with tomography is to be demanded. It is able multiply to clarify the diagnosis. The terminal part of the choledochus deserves particular consideration. In obstructive jaundice the percutaneous transhepatic cholangiography is essentially more successful and simpler than the endoscopic retrograde cholangiography.
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The diagnostic potentialities in cholestasis and cholangitis could be considerably improved by endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatal cholangiography (PTC) with a thin needle (0.7 mm). First ERCP was performed, enabling us to establish pathological findings in 62 per cent of the 233 examinations in the period 1975--1977. Gallstones were most often found-in 65 cases (28%). Second to be found was the suptapapillary stenosis of the bile ducts and obstruction of the bile ducts--42 cases (18% of the examined), caused by surgical interventions, tumours of the bile ducts and processes in the region of the head of the pancreas. When ERCP fails to provide sufficient data or is ineffective - PTC is performed. Correct diagnosis was made in 15 cases out of 23 examinations, in six - partial data were obtained and in two - the examination failed.
A short survey is given on description and evaluation of progress and developmental trend of laparoscopy. Important technical improvements are the cold light via the glass fibre light conductor, optics of high value, the colour photography with electronic flash-light, colour films and colour television, new accessory instruments and belongings. Now as ever hepatomegaly and splenomegaly, jaundice, ascites, portal hypertension, suspicion of cirrhosis and metastases are regarded as main indications. The laparoscopy deserves a greater consideration in unclear abdominal symptoms, in gynaecological diseases, for the proof of the affection of liver and spleen in lymphogranulomatosis, sarcoidosis, tuberculosis (with aimed liver biopsy). The endoscopic retrograde cholangiopancreatography in the differential diagnosis of the jaundice competes with the laparoscopy, but it is not able to supersede it. The laparoscopic judgment of the pancreas and the importance of visible changes of the fine structed. Among the contraindications of the laparoscopy the hiatal hernia has lost its significance.
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