Gut: first published as 10.1136/gut.19.5.A432 on 1 May 1978. Downloaded from Gut, 1978, 19, A432-A458 The British Society of Gastroenterology The Spring Meeting of the BSG, together with the BSDE, took place at Warwick University, Coventry, from 31 March to 1 April. The meeting was largely given up to parallel sessions of scientific communications, abstracts of which appear below. During the proceedings, the President of the BSG, Dr. W. Sircus, presented Dr. D. B. Silk with the Research Medal for 1977-8: Dr. Silk later addressed the Society on 'Peptide transport in the human small intestine'. A varied social programme included a medieval banquet in Warwick Castle. R. FERGUSON AND MICHAEL ATKINSON recently managed three patients who bled ENDOSCOPY (General Hospital, Nottingham) In 43 from an angiomatous lesion of the patients (mean age 67 years) with benign gastric antrum. Each patient presented Disinfection of upper gastrointestinal fibre- oesophageal stricture caused by gastro- with a profound iron deficiency anaemia optic equipment oesophageal reflux, after initial dilatation due to persistent gastrointestinal blood by the Eder Puestow method, active loss. Barium studies of the upper and D. L. CARR-LOCKE AND P. CLAYTON medical measures were instituted. lower gastrointestinal tract failed to (Area Endoscopy Unit and Department of Ten subjects have not required further demonstrate the cause for the bleeding. Microbiology, Leicester General Hospital, dilatation after periods ranging from Gastroscopy in each patient demonstrated Leicester) As there is little information three months to three years, and 27 a striking antral abnormality consisting of available on the bacteriological con- have needed further dilatation. After the linear angioid streaks running longi- tamination of upper gastrointestinal fibre- initial dilatation three patients underwent tudinally towards the pylorus. Endoscopic optic endoscopes and ancillary equip- surgery, two died of unrelated disease, biopsies were essentially normal and http://gut.bmj.com/ ment during routine use and the effect of and one of a perforation of the stricture, angiography in two cases failed to display disinfecting solutions, a detailed evalua- the only death in the 132 dilatations. any abnormality. One patient was unfit tion was made of different cleaning Of the 37 patients followed up, 27 for surgery and subsequently died but the methods using (a) water, (b) an aqueous underwent dilatation over one year ago, remaining two patients were subjected to solution of 1 % cetrimide with 0-1% and of these nine have not required Billroth I antrectomy. At operation chlorhexidine, and (c) activated aqueous dilatation since. Eight patients required there were multiple, linear areas of 2 % glutaraldehyde (Cidex). All over five dilatations, and continuing punctate haemorrhage on the crests of equip- on September 24, 2021 by guest. Protected copyright. ment was found to be heavily contaminat- medical treatment did not diminish the the longitudinal antral mucosal folds. ed after use with a wide variety of organ- frequency of dilatation. Four of the 37 Following surgery, these patients have isms of which 53 % were Gram positive. patients have died ofother conditions, and remained well and free of anaemia. Cleaning of the endoscope and other in two of these adenocarcinoma was Microscopically, there were groups of equipment with water and cetrimide/ found at the site of the fibrous stricture. arteries and veins, larger and more chlorhexidine alone or in combination The use of the Eder Puestow dilators numerous than usual, situated in the was inadequate to produce disinfection, at fibreoptic endoscopy, combined with submucosa of the antral specimens. These but immersion in glutaraldehyde for medical measures to control reflux, offers vessels ran mostly in a longitudinal two minutes consistently produced sterile relatively safe management of benign direction. In places there were thrombosed cultures with our sampling method. As a oesophageal stricture in the elderly. and dilated superficial vessels. result of this study a rapid and simple Remission from dysphagia of over a year The appearances were characteristic method for disinfection has been adopted occurs in one-third of patients. of an angiomatous hamartoma. and will be described in detail. It is especially suitable for busy endoscopy units. A new cause of upper gastrointestinal Bleeding gastric arteriovenous malforma- bleeding tion diagnosed by endoscopy M. H. WHEELER, P. M. SMITH, P. B. COTrON, M. VAN BLANKENSTEIN, J. DEES, AND D. M. D. EVANS, AND B. W. LAWRIE (Welsh F. J. W. TEN KATE Introduced by Dr J. R. National School of Medicine, Cardiff Bennett, Gastro-Intestinal Unit, Hull Outlook with conservative treatment of and Department of Gastroenterology, The Royal Infirmary, Hull (Department of benign oesophageal strictures Middlesex Hospital, London) We have Internal Medicine II and Department of A432 Gut: first published as 10.1136/gut.19.5.A432 on 1 May 1978. Downloaded from The British Society of Gastroenterology A433 PathologyI, Rotterdam University Hospital, diverticula had gallstones (12/25 of the Department of Diagnostic Radiology, Rotterdam, Holland) Over a five-year 98/42, p < 0-01), and/or previous chol- Leeds General Infirmary) Although period 21 cases of a recognisable vascular ecystectomy (10/38 of 62/755, p < 0-001). chronic pancreatitis is often associated abnormality in the stomach and duodenum In conclusion, the incidence of peri- with biliary disease, little data are avail- have been seen at endoscopy, one in 285 ampullary diverticula was 5%. Where able to indicate how often patients with examinations. These abnormalities present present, they were associated with an biliary disease develop structural changes as red spots with a diameter between 1/4 increased rate of failure of cannulation. in the pancreas. Our experience with and 3/4 cm. On close inspection the spots There was a significant correlation of ERCP over two years has led us to suspect are seen to consist of clusters of blood- duodenal diverticula with gallstones and/ that this is very common. vessels. The average age of the patients or previous cholecystectomy. We found We have therefore reviewed all success- was 75 years (range 50-87 years); in 19 of no evidence that these diverticula were the ful pancreatograms performed during the the 21 cases the patient was being in- cause of biliary or pancreatic obstruction. investigation of patients with biliary vestigated for acute or chronic gastro- disease or jaundice. The pancreatograms intestinal bleeding. Five cases were were assessed independently by two operated on, three had a local excision Endoscopic pancreatography in the experienced observers, without clinical under endoscopic guidance. Histology of diagnosis of pancreatic cancer information, using criteria previously two ofthese resected areas revealed arterio- described by Ashton et al. (1977). Sixty- venous anastomosis, the endoscopically I. T. GILMORE, J. PEMBERTON, AND R. P. H. five pancreatograms were assessed and visible vessels being found to consist of THOMPSON (Gastrointestinal Laboratory, then grouped on clinical grounds as centripetal dilated veins in the submucosa. Rayne Institute, and Department of follows: group I: patients with biliary No recurrent bleeding has been seen in Radiology, St. Thomas' Hospital, London) disease in whom pancreatitis was suspect- the operated cases. This type of arterio- Thirty-two of the 400 patients who under- ed (25); group II: patients with biliary venous malformation, which is easily went endoscopic retrograde cholangio- disease and jaundice in whom pancreatitis recognised by endoscopy, is probably a pancreatography (ERCP) during the last was not suspected (28); group III: controls significant cause of acute and chronic three years were shown to have a pan- known not to have biliary disease and in upper gastrointestinal bleeding in the creatic carcinoma at laparotomy or whom pancreatitis was not suspected (12). elderly. necropsy. Pancreatic carcinoma was diag- Abnormal pancreatograms were found nosed by endoscopy and ERCP in 20. in 12 patients (48%) in group I, in 13 In three the diagnosis was established by patients (47%) in group II but in only one Significance of periampullary duodenal endoscopy and biopsy alone, and in two patient in the control group III (8%). diverticula at ERCP a stricture of the common bile duct was The results confirm a high incidence demonstrated on the endoscopic chol- (48 %) of pancreatic disease associated http://gut.bmj.com/ A. P. KIRK AND J. A. SUMMERFIELD angiogram, while in 15 the pancreato- with biliary disease and show that in half Introduced by Professor Sheila Sherlock gram was abnormal. Pancreatogram these cases (group II) this was an unex- (Medical Unit, Royal Free Hospital, abnormalities included a complete block pected finding. Asymptomatic pancreatitis Pond Street, London) A retrospective (nine) or a localised area of irregular is common in patients with biliary disease. study of periampullary duodenal diverti- narrowing or dilatation (four) in the main cula was performed on 755 ERCP pancreatic duct. A simple method for removal of gallstones examinations carried out at R.F.H. from In four patients the pancreatogram was after endoscopic sphincterotomy 1973-77. Duodenal diverticula were noted normal. In the remaining eight patients on September 24, 2021 by guest. Protected copyright. in 38 (5 %)-22 males and 16 females the pancreatic duct was not filled; in four