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INTRODUCTION: Double balloon enteroscopy (DBE) is one of the newest among endoscopic techniques used in diagnosis of the digestive tract diseases--particularly in small bowel's lesions. MATERIALS AND METHODS: The retrospective analysis of patients' data from 2008 to 2012 in the Department of Digestive Tract Diseases, UM was made. Case histories were analised and evaluated for sex, age, clinical symptoms, results of additional examinations and indications. The course of the examination, its result, complications and role in final diagnosis were also checked. RESULTS: During the analysed period DBE was attempted 71 times DBE among 42 patients (17 women and 25 men; the age was 44.5 years ± 17.5 years). The most frequent indication for DBE was occult gastrointestinal bleeding--34 patients (80.9%). Among the other patients, the clinical image suggested Crohn's disease (4 cases--9.5%), suspicion of small bowel's neoplasm (2 patients--4.8%), familiar adenomatous polyposis with a need to make polypectomy (1 case--2.4%) and state after bariatric surgery to extract moved gastric balloon (1 patient--2.4%). Small bowel's lesions were detected in 21 patients (50%)--8 polyps, 8--aphthaes and inflammatory changes, 3--vascular lesions, 2--smoothing villi. In four cases the polypectomy was made. The anaesthetic complications appeared with two patients (4,8%). Complications being a result of performed DBE was observed in one case (2.4%). CONCLUSIONS: Double balloon enteroscopy is safe endoscopic procedure and it plays a key role in diagnosis of patients with gastrointestinal bleeding.

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This paper presents an in-depth study of several approaches to exploratory analysis of wireless capsule endoscopy images (WCE). It is demonstrated that versatile texture and color based descriptors of image regions corresponding to various anomalies of the gastrointestinal tract allows their accurate detection of pathologies in a sequence of WCE frames. Moreover, through classification of single pixels described by texture features of their neighborhood, the images can be segmented into homogeneous areas well matched to the image content. For both, detection and segmentation tasks the same procedure is applied which consists of features calculation, relevant feature subset selection and classification stages. This general three-stage framework is realized using various recognition strategies. In particular, the performance of the developed Vector Supported Convex Hull classification algorithm is compared against Support Vector Machines run in configuration with two different feature selection methods.

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The benign lesions of esophagus constitutes small part of all esophageal tumors and among them giant esophageal polyps are exceptionally rarely reported. The authors present the uncommon case of pedunculated giant fibrovascular polyp (lenght 12cm and diameter 2cm) in the esophagus in a 79-years-old woman who was admitted to our department because of hoarseness, throat discomfort during swallowing and endoral tumor regurgitation during cough. The polyp was removed by minimally invasive approach by endoscopic procedure which was particularly important in our patient because of her advanced age. No recurrence was observed during follow-up.

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The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.

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BACKGROUND/AIMS: Analysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid. METHODS: The study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed. RESULTS: CEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8-4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9-693 ng/ml; p < 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p < 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level>45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%). CONCLUSION: Molecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy.

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BACKGROUND/AIMS: Pancreatic pseudocysts are frequent complication of chronic pancreatitis with incidence rate from 20 to 40%. The aim of our study was to establish a possible correlation between clinical features and outcome of pseudocysts complicating chronic pancreatitis. METHODOLOGY: We included in the study 37 patients with chronic pancreatitis and pancreatic pseudocysts treated at the Department of Digestive Tract Diseases of Lodz Medical University between 2003-2008. For each patients the following parameters were recorded: number and location of pseudocysts, diameter, kind of treatment, recurrence rate and time of hospitalisation. RESULTS: The mean size of pancreatic pseudocysts was 7.8 cm (range 2-16 cm). Spontaneous regression was observed in 7 pseudocysts (18.9%), persistence without symptoms and without size enlargement in 9 patients (24.3%). Twenty one (56.8%) pseudocysts required therapeutic intervention: endoscopic procedures (27.1%), surgical treatment (18,.9%) or percutaneous drainage (10.8%). Mean pseudocyst size for conservative treated patients was 4.2 compared to 9.6 for patients with interventional treatment (p < 0.05). The overall recurrence rate was 33.3%. The mean hospital stay of patients treated endoscopically was significantly shorter than those treated surgically (p < 0.01) and shorter than those of percutaneous drainage (p < 0.01). CONCLUSION: Pseudocysts treatment in chronic pancreatitis may be effectively achieved by both endoscopic and surgical means. Nonetheless, the endoscopic drainage, with lower hospitalization period, should be considered for initial therapy in each appropriate patients.

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UNLABELLED: Cholangiocarcinomas have been often met in daily practice. Biliar tract neoplasmas are the most important group in adenomas and papillomas. There is the medical and social problem with cancer patients because they call doctor too late when cancer changes reach a high level and only paliative procedures are recommended. In the most cases the prothesis implanted by ERCP and surgical digestive bypasses are applied. AIM OF THE STUDY: was to evaluate some therapeutic methods in paliative treatment applied in patients with biliary tract cancer. MATERIAL AND METHODS: From 01.2003 to 12.2007 (5 years experience) in 4 departments of general surgery and departments of digestive tract diseases the medical treatment of 430 patients with biliary tract cancer was analyzed. All patients were divided into 3 groups: G1--prosthesis by ERCP; G2--percutaneously, transhepatic drainage of biliary tract; G3--surgical digestive bypass. RESULTS: G1 techniques were applied in 75 patients, G2 in 14 cases and G3 in 74 cases. In the last group of patients the following procedures have been performed: triple bypass (TB) in 45 cases (62%), choledochoduodenostomy (ChD) in 7 cases (9%), gastroenterostomy (GE) in 10 patients (13%) and laparotomy with Kehr drainage in 12 patients (16%). The number of complications in G1 group was observed in 31%, in G2--42%, and in G3--63%. 30 days death rate was 14% in G1, 28% in G2 and 18% in G3. Over 12 months survival rate was in G1, 3 months in G2 and 15 months in G3. Differences are statistically sagnificant (p < 0.05). CONCLUSIONS: From all applied methods of paliative treatment the best results were noticed in surgical digestive bypass and implantation of prosthesis by ERCP. After surgical treatment survival rate was higher, but the number of complications was higher in relation to another methods.

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INTRODUCTION: Biliary and pancreatic diseases, especially choledocholithiasis and neoplastic diseases, are commonly seen in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure performed more and more frequently also in elderly patients. OBJECTIVES: The aim of this study was to evaluate the utility and safety of ERCP in patients > 80 years of age. PATIENTS AND METHODS: We retrospectively analyzed 821 ERCP performed in the Department of Gastrointestinal Diseases, Medical University of Lódz in the years 2005-2007. We compared age, sex, clinical symptoms, laboratory findings, ERCP efficacy and safety in patients > 80 years of age versus younger subjects. RESULTS: ERCP was performed in 96 patients > 80 years of age (11.7%). ERCP-related complications occured in 48 (5.8%) patients, including 44 (6.1%) younger and 4 (4.2%) older subjects (p > 0.05). Acute pancreatitis was observed in 34 patients (32 [4.4%] younger and 2 [2.1%] older patients; p > 0.05). In 12 patients gastrointestinal hemorrhage and in 2 patients perforation were diagnosed. There was no statistical difference between the number of complications in the 2 compared patient groups. A mean length of hospital stay was similar in both groups, 4.8 days in the younger, and 5.7 days in older patients (p > 0.05). CONCLUSIONS: ERCP is a safe and effective method for diagnosis and treatment of both elderly and younger patients.

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BACKGROUND: Renal transplant patients are at high risk for bacterial, viral and fungal infections. The infections occur characteristically within well-defined risk periods after transplantation, but their clinical presentation is frequently atypical. Candida albicans is the normal part of body flora but in immunocompromized patient this pathogen may lead to severe opportunistic diseases. CASE REPORT: A case of esophageal candidosis due to Candida albicans in a 56-year-old female patient, who was one year after kidney transplantation, is reported. The clinical manifestations of gastrointestinal candidosis were atypical and the patient was initially suspected of having a malignancy. She developed several complications of esophageal candidiasis such as ulceration, bleeding and esophageal obstruction secondary to stricture and mycetoma formation. Eventually the patient achieved clinical and mycological recovery after the prolonged treatment with systemic antimycotics. CONCLUSIONS: The fungal infections may occur in different periods after transplantation, have atypical manifestations and require systemic long-term therapy.

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Esophageal carcinoma is one of the most common cancers in the world and has an increasing incidence in Western civilisation and poor prognosis. In most cases palliative treatment is the only kind of therapy, which can be applied. In the Department of Digestive Tract Diseases, Medical University, Lodz, Poland, we have used PDT in two cases of palliative therapy of advanced esophageal cancer in cervical location of esophagus. We find PDT very promising, minimally invasive, safe and easy technique to perform for esophageal cancer of cervical localization.