- Email: [email protected]
OC1.05.5 IN SYSTEMIC SCLEROSIS MULTICHANNEL INTRALUMINAL IMPEDANCE SHOWS A BETTER CORRELATION WITH PULMONARY AND SKIN INVOLVEMENT THAN ESOPHAGEAL MANOMETRY
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195 for persistent symptoms. Among the seven patients who had esophagitis (Grade A/B) at the index endoscopy, only three were negative for lesions at the 6-mo control; whereas other two previuously negative patients, showed esophagitis at the follow-up. QOL-RAD scores improved in all but two patients (who were submitted to surgery), with a median value at baseline of 42 (range 22-73), and of 8 (1-23) at 6 –mo follow-up. No statistically significant differences were found (table). Table 1. PH-MII impedance data (median, range) at baseline and at 6 monthsfollow up
Esophageal total reflux exposure (%) Esophageal total acid exposure (%) Total acid reflux events (no.) Total non acid reflux events (no.)
Pre-Esophyx
Post-Esophyx
2.4 (1.1-13.5) 2 (0.1-12.6)
2.5 (0.8-20.8) 2.35 (0.2-20.3)
49 (3-78) 19 (2-79)
45 (3-119) 18 (9-62)
Conclusions: Although ELF procedure provides an anatomical approach similar to the laparoscopic antireflux surgery, physiological data do not yet support the novel device as an effective alternative modality in GERD patients. Despite the fact that symptoms of reflux and quality of life improved in the majority of the patients at 6 month follow-up, no significant differences were seen in terms of acid exposure at the pH-MII. # A. Oesophagus 1. GERD
OC1.05.4 RELATIONSHIP BETWEEN INEFFECTIVE ESOPHAGEAL MOTILITY AND VOLUME CLEARANCE IN GERD, AS ASSESSED BY SIMULTANEOUS INTRALUMINAL IMPEDANCE-MANOMETRY AND FLUOROSCOPY M. Ribolsi 2 , F.I. Habib 1 , L. Occhigrossi 3 , C. Cohen 3 , M. Cicala 2 1 Dipartimento
di Scienze Cliniche, Università Sapienza, Roma; di Malattie Digestive, Università Campus Bio Medico, Roma; 3 Eurel srl, Lainate, Milano
2 Dipartimento
Background and aim: Ineffective esophageal motility (IEM), defined as the presence, in =3/10 swallows, of low amplitude (<30 mmHg) or simultaneous contractions at 5 and/or 10 cm above the LOS, has been reported in GERD patients and may impair the clearance of gastric refluxate. The relationship between wave amplitude of esophageal contractions and volume clearance is still debated. Material and methods: In order to assess the impact of peristaltic wave amplitude on esophageal volume clearance, concurrent manometry, intraluminal impedance and videofluoroscopy were prospectively performed in 15 GERD patients, following a three-week pharmacological washout. Boluses (5-10ml) of 70% barium w-v were swallowed at =20 sec. intervals (8-10 swallows/patient), with patients lying on their right side. Multi-channel impedance manometry (MMS SOLAR GI-CIMP, Holland) with video acquisition was used. The perfusion MUI-DENTSLEEVE catheter had 8 pressure channels (6 esophageal pressure channels, the distal three, at 5, 10 and 15 cm above LES, placed in between the impedance measuring segments) and 3 impedance measuring segments. Results: Out of the 15 patients, 11 presented delayed barium clearance at fluoroscopy (bolus transit = 15 seconds in at least 3/8 swallows, mean 34.4 sec., range 16-48 sec., barium residue in about 80% of delayed bolus transit episodes). Intraluminal impedance showed a good correlation with fluoroscopic findings. According to the criteria of IEM, esophageal manometry was within the normal range in all except one patient, who presented IEM and delayed bolus transit. Conclusions: Delayed esophageal clearance and retention of barium frequently occur in the presence of normal peristaltic contractions. Fluoroscopy and impedance demonstrate to correlate fairly in the assessment of bolus transit in GERD. The wave amplitude threshold and current criteria for IEM together with the small number of esophageal
S19
measured segments in conventional manometry may account for its low sensitivity and for the lack of agreement between esophageal motility and volume clearance. # A. Oesophagus 1. GERD
OC1.05.5 IN SYSTEMIC SCLEROSIS MULTICHANNEL INTRALUMINAL IMPEDANCE SHOWS A BETTER CORRELATION WITH PULMONARY AND SKIN INVOLVEMENT THAN ESOPHAGEAL MANOMETRY F. De Iorio ∗ ,1 , C. Cusumano 1 , L. Peraro 1 , D. Biasi 2 , T. Viaro 1 , P. Caramaschi 2 , A. Rostello 1 , L.M. Bambara 1 , I. Vantini 1 , L. Benini 1 1 Istituto
Gastroenterologia, Verona; 2 U.O. Reumatologia, Verona
Background and aim: Esophageal dysmotility occurs in 50–90% of systemic sclerosis (SSc) patients, and has been reported to reflect the severity of systemic involvment. No data are available in SSc on relationship between the impairment of bolus transit, as measured by multichannel intraluminal impedance (MCII) and the involvment of other organs (heart, lung and skin). Material and methods: Our aim of was to compare, in SSc, esophageal motility, as measured by manometry) and bolus transit (evaluated by MCII) and their relationship with systemic involvement. Consecutive outpatients from the Rheumathologic Unit underwent computerised manometric and MCII evaluation (10 swallows of saline and 10 of fruit gel; Solar System, MMS-Eurel, Milan). Manometry was considered normal if >70% of contractions were peristaltic and with distal amplitude >30 mmHg; MCII when >80% liquid and >70% viscous swallows showed a complete transit. The Medsger and Rodnan scores were used to quantify lung, heart, and skin involvements. The ANOVA and Kruskal-Wallis tests were used to compare the number of effective swallows in patients with different scores of systemic involvement; the chi-square test to evaluate the diagnostic efficiency of MCII and manometry for systemic involvement. Results: Twenty-six patients (22 F), aged 57,4 (range 27-80) and with disease duration of 6,8 (range 1-20) years were studied. Manometry and MCII were abnormal in 42 and 49% of patients respectively. Some swallows were followed by a normal transit even in patients
S20
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
with complete aperistalsis. A more severe esophageal involvement was observed both by manometry and MCII in diffuse than in limited disease (p<0,05), without any relationship with its duration. MCII but not manometry alterations correlated with Rodnan skin score (p<0.01) and lung involvement (Medsger score and CO diffusion test; p<0.05). Conclusions: Multichannel impedance is a sensitive test of GI involvement in scleroderma. Esophageal involvement may be present in very early stages and does not appear to increase with the duration of the disease. MCII reflects a systemic involvement better than manometry (which is more severely affected by the atrophy of the circular muscolar layer often found in SSC). # A. Oesophagus 1. GERD
OC1.05.6 DOUBLE-DOSE THERAPY WITH ESOMEPRAZOLE IS MORE EFFECTIVE THAN PANTOPRAZOLE TO MODIFY TISSUTAL HOMEOSTASIS IN PATIENTS WITH BARRETT ESOPHAGUS. A RANDOMIZED STUDY
Table 2. The results of immunohistochemistry in group with pantoprazole 40 therapy KI-67 T0 T1 0 1 2 3
7 11 11 10
8 13 11 7
p
0.932 N.S.
COX-2 T0 T1 10 12 10 8
11 12 9 7
p
0.792 N.S.
TUNEL T0 T1 10 10 9 10
9 8 11 11
p
0.859 N.S.
modification was statistically significant (see table 1). The mean acid exposure was 0.8% in group A and 1.2% in groupB. Conclusions: Esomeprazole could induce a stabilization of cellular omeostasis in patients with Barrett esophagus probably for greater esophageal acid exposure control. # A. Oesophagus 4. Barrett
OC1.06.1
N. de Bortoli ∗ ,2 , S. Maltinti 1 , E. Ciancia 2 , G. Leonardi 1 , M. Bellini 1 , F. Costa 1 , M.G. Mumolo 1 , A. Ricchiuti 1 , S. Marchi 1
PUSH AND PULL ENTEROSCOPY USING SINGLEBALLOON ENTEROSCOPE SYSTEM: TECHNIQUE, FEASIBILITY AND PRELIMINARY RESULTS
Gastroenterologia Universitaria, Università di Pisa, Pisa; 2 U.O. Anatomia Patologia 2, A.U.O.P., Pisa
M.E. Riccioni ∗ ,1 , R. Urgesi 2 , E.C. Nista 1 , C. Spada 1 , M. Mutignani 1 , G. Costamagna 1
1 U.O.
Background and aim: Barrett’s esophagus (BE) is the most important risk factor for adenocarcinoma. Few and unclear data are available about the effect of maintaining therapy with PPI in patients with BE. The aim of the study is to evaluate the effect of two different approach with double dose of pantoprazole 40 or esomeprazole 40 in two groups of randomised patients with BE using proliferation markers (Ki-67 and Cox-2) and tissutal apoptosis level (TUNEL) after 18 month of continuing therapy. Material and methods: From gennary 2006 to november 2007 were diagnosed 77 patients (49 M, 28 F; mean age 58.7±12.3) with BE. All patients underwent multiple endoscopic biopsy specimens as ACG guidelines. All patients were randomised in two different schedules of therapy: (group A) 39 patients (24M and 15F mean age 56.3±11.2 yrs) started esomeprazole 40mg bid and (group B) 38 patients (25M and 13F mean age 59.8±13.6yrs) started pantoprazole 40 mg bid. All patients underwent a second endoscopy with multiple biopsies and a pH-metric test after 18 months. Immunohistochemistry was performed on tissue sections incubating samples with anti-COX2 or anti-Ki-67 primary antibody. Moreover apoptosis was quantified on tissue samples using the DeadEnd TM Colorimetric TUNEL System. The staining of all markers were scored as scale of 0–3 based on the percentage of specific strong epithelial cell staining: grade 0, no or < 5% specific staining; grade 1, >5% to <35%; grade 2, >35% to <65% of the cells; grade 3, >65% of the cells. Statistical analysis was performed by t-test and results were considered significant when p value <0.05. Results: After 18 months of therapy all patients was complied with follow-up. In first endoscopy esophagitis was present in 24.7% of patients (19/77) and in second one and half-year later endoscopy was absent in all patients. In Group A we observe an important reduction in proliferation markers (Ki-67 and COX-2) and a significative increase of apoptosis (p<0.05). In Group B we recorded only a partial regression in proliferation markers and a little increase in apoptosis but no
Table 1. The results of immunohistochemistry in group with esomeprazole 40 therapy KI-67 T0 T1 0 1 2 3
6 8 12 12
14 12 7 5
p
0.040
COX-2 T0 T1 6 9 12 11
15 12 6 5
p
0.036
TUNEL T0 T1 12 11 9 6
6 6 10 16
p
0.045
1 Policlinico
Universitario “A. Gemelli”, Roma; 2 Ospedale Bel Colle,
Viterbo Background and aim: Several endoscopic techniques have been developed in recent years including capsule endoscopy (CE) and double balloon enteroscope. Recently another a new method was also developed: the single-balloon enteroscope (SBE–Olympus, Tokyo, Japan). The SBE consists of a high-resolution videoendoscope and a flexible overtube. A latex free silicone balloon is attached at the tip of the overtube and is inflated and deflated with air from a pressure-controlled pump system. The tip of the enteroscope has a broad bending capability due to its extreme flexibility allowing anchorage to the small bowel without balloon. By using these method to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops. Material and methods: Between July 2006 and November 2007, 37 SBE procedures (34 oral and 3 anal approaches) were performed under general anesthesia on 34 patients. Starting insertion route of SBE was chosen according to the estimated location of the suspected lesions based on the clinical presentation and on the findings of previous investigations such as CE performed in 26 patients. Indications were acute recurrent or chronic OGIB (N=18), chronic abdominal pain and or chronic diarrhea (N=5), suspected tumors (N=3), suspected Crohn’s disease (N=2), suspected refractory celiac disease (N=2), polyposis syndromes (N=4): 3 Peutz-Jeghers and 1 Familial Adenomatous Polyposis respectively. Results: In 2 patients the SBE was not carried out for technical problems. A definite bleeding source was found and treated in 16 patients: APC was used in 13 patients with multiple angiodysplasias and in 1 with a bleeding jejunal polyp. In one patient the bleeding source was a capillary hemangioma-angiomatosis of the jejunum, treated with sclerotherapy using polidocanol and in another one a Dieulafoy’s lesion treated with APC and epinephrine injection. In patients with Peutz-Jeghers syndrome and FAP multiple resections of small-bowel polyps were carried out. In another 2 cases SBE plus histology led to the diagnosis of idiopathic eosinophilic enteritis and of melanoma metastases, respectively. SBE was diagnostic for celiac disease in 1 patient and for GIST and Crohn’s disease in 2 cases respectively. No complication occurred. Conclusions: According to our prelimirary experience, SBE seems to be safe and useful highly effective in the diagnosis and therapy of several small bowel diseases. # Q. Diagnostic endoscopy 3. Enteroscopy
Esophageal total reflux exposure (%) Esophageal total acid exposure (%) Total acid reflux events (no.) Total non acid reflux events (no.)
Pre-Esophyx
Post-Esophyx
2.4 (1.1-13.5) 2 (0.1-12.6)
2.5 (0.8-20.8) 2.35 (0.2-20.3)
49 (3-78) 19 (2-79)
45 (3-119) 18 (9-62)
Conclusions: Although ELF procedure provides an anatomical approach similar to the laparoscopic antireflux surgery, physiological data do not yet support the novel device as an effective alternative modality in GERD patients. Despite the fact that symptoms of reflux and quality of life improved in the majority of the patients at 6 month follow-up, no significant differences were seen in terms of acid exposure at the pH-MII. # A. Oesophagus 1. GERD
OC1.05.4 RELATIONSHIP BETWEEN INEFFECTIVE ESOPHAGEAL MOTILITY AND VOLUME CLEARANCE IN GERD, AS ASSESSED BY SIMULTANEOUS INTRALUMINAL IMPEDANCE-MANOMETRY AND FLUOROSCOPY M. Ribolsi 2 , F.I. Habib 1 , L. Occhigrossi 3 , C. Cohen 3 , M. Cicala 2 1 Dipartimento
di Scienze Cliniche, Università Sapienza, Roma; di Malattie Digestive, Università Campus Bio Medico, Roma; 3 Eurel srl, Lainate, Milano
2 Dipartimento
Background and aim: Ineffective esophageal motility (IEM), defined as the presence, in =3/10 swallows, of low amplitude (<30 mmHg) or simultaneous contractions at 5 and/or 10 cm above the LOS, has been reported in GERD patients and may impair the clearance of gastric refluxate. The relationship between wave amplitude of esophageal contractions and volume clearance is still debated. Material and methods: In order to assess the impact of peristaltic wave amplitude on esophageal volume clearance, concurrent manometry, intraluminal impedance and videofluoroscopy were prospectively performed in 15 GERD patients, following a three-week pharmacological washout. Boluses (5-10ml) of 70% barium w-v were swallowed at =20 sec. intervals (8-10 swallows/patient), with patients lying on their right side. Multi-channel impedance manometry (MMS SOLAR GI-CIMP, Holland) with video acquisition was used. The perfusion MUI-DENTSLEEVE catheter had 8 pressure channels (6 esophageal pressure channels, the distal three, at 5, 10 and 15 cm above LES, placed in between the impedance measuring segments) and 3 impedance measuring segments. Results: Out of the 15 patients, 11 presented delayed barium clearance at fluoroscopy (bolus transit = 15 seconds in at least 3/8 swallows, mean 34.4 sec., range 16-48 sec., barium residue in about 80% of delayed bolus transit episodes). Intraluminal impedance showed a good correlation with fluoroscopic findings. According to the criteria of IEM, esophageal manometry was within the normal range in all except one patient, who presented IEM and delayed bolus transit. Conclusions: Delayed esophageal clearance and retention of barium frequently occur in the presence of normal peristaltic contractions. Fluoroscopy and impedance demonstrate to correlate fairly in the assessment of bolus transit in GERD. The wave amplitude threshold and current criteria for IEM together with the small number of esophageal
S19
measured segments in conventional manometry may account for its low sensitivity and for the lack of agreement between esophageal motility and volume clearance. # A. Oesophagus 1. GERD
OC1.05.5 IN SYSTEMIC SCLEROSIS MULTICHANNEL INTRALUMINAL IMPEDANCE SHOWS A BETTER CORRELATION WITH PULMONARY AND SKIN INVOLVEMENT THAN ESOPHAGEAL MANOMETRY F. De Iorio ∗ ,1 , C. Cusumano 1 , L. Peraro 1 , D. Biasi 2 , T. Viaro 1 , P. Caramaschi 2 , A. Rostello 1 , L.M. Bambara 1 , I. Vantini 1 , L. Benini 1 1 Istituto
Gastroenterologia, Verona; 2 U.O. Reumatologia, Verona
Background and aim: Esophageal dysmotility occurs in 50–90% of systemic sclerosis (SSc) patients, and has been reported to reflect the severity of systemic involvment. No data are available in SSc on relationship between the impairment of bolus transit, as measured by multichannel intraluminal impedance (MCII) and the involvment of other organs (heart, lung and skin). Material and methods: Our aim of was to compare, in SSc, esophageal motility, as measured by manometry) and bolus transit (evaluated by MCII) and their relationship with systemic involvement. Consecutive outpatients from the Rheumathologic Unit underwent computerised manometric and MCII evaluation (10 swallows of saline and 10 of fruit gel; Solar System, MMS-Eurel, Milan). Manometry was considered normal if >70% of contractions were peristaltic and with distal amplitude >30 mmHg; MCII when >80% liquid and >70% viscous swallows showed a complete transit. The Medsger and Rodnan scores were used to quantify lung, heart, and skin involvements. The ANOVA and Kruskal-Wallis tests were used to compare the number of effective swallows in patients with different scores of systemic involvement; the chi-square test to evaluate the diagnostic efficiency of MCII and manometry for systemic involvement. Results: Twenty-six patients (22 F), aged 57,4 (range 27-80) and with disease duration of 6,8 (range 1-20) years were studied. Manometry and MCII were abnormal in 42 and 49% of patients respectively. Some swallows were followed by a normal transit even in patients
S20
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
with complete aperistalsis. A more severe esophageal involvement was observed both by manometry and MCII in diffuse than in limited disease (p<0,05), without any relationship with its duration. MCII but not manometry alterations correlated with Rodnan skin score (p<0.01) and lung involvement (Medsger score and CO diffusion test; p<0.05). Conclusions: Multichannel impedance is a sensitive test of GI involvement in scleroderma. Esophageal involvement may be present in very early stages and does not appear to increase with the duration of the disease. MCII reflects a systemic involvement better than manometry (which is more severely affected by the atrophy of the circular muscolar layer often found in SSC). # A. Oesophagus 1. GERD
OC1.05.6 DOUBLE-DOSE THERAPY WITH ESOMEPRAZOLE IS MORE EFFECTIVE THAN PANTOPRAZOLE TO MODIFY TISSUTAL HOMEOSTASIS IN PATIENTS WITH BARRETT ESOPHAGUS. A RANDOMIZED STUDY
Table 2. The results of immunohistochemistry in group with pantoprazole 40 therapy KI-67 T0 T1 0 1 2 3
7 11 11 10
8 13 11 7
p
0.932 N.S.
COX-2 T0 T1 10 12 10 8
11 12 9 7
p
0.792 N.S.
TUNEL T0 T1 10 10 9 10
9 8 11 11
p
0.859 N.S.
modification was statistically significant (see table 1). The mean acid exposure was 0.8% in group A and 1.2% in groupB. Conclusions: Esomeprazole could induce a stabilization of cellular omeostasis in patients with Barrett esophagus probably for greater esophageal acid exposure control. # A. Oesophagus 4. Barrett
OC1.06.1
N. de Bortoli ∗ ,2 , S. Maltinti 1 , E. Ciancia 2 , G. Leonardi 1 , M. Bellini 1 , F. Costa 1 , M.G. Mumolo 1 , A. Ricchiuti 1 , S. Marchi 1
PUSH AND PULL ENTEROSCOPY USING SINGLEBALLOON ENTEROSCOPE SYSTEM: TECHNIQUE, FEASIBILITY AND PRELIMINARY RESULTS
Gastroenterologia Universitaria, Università di Pisa, Pisa; 2 U.O. Anatomia Patologia 2, A.U.O.P., Pisa
M.E. Riccioni ∗ ,1 , R. Urgesi 2 , E.C. Nista 1 , C. Spada 1 , M. Mutignani 1 , G. Costamagna 1
1 U.O.
Background and aim: Barrett’s esophagus (BE) is the most important risk factor for adenocarcinoma. Few and unclear data are available about the effect of maintaining therapy with PPI in patients with BE. The aim of the study is to evaluate the effect of two different approach with double dose of pantoprazole 40 or esomeprazole 40 in two groups of randomised patients with BE using proliferation markers (Ki-67 and Cox-2) and tissutal apoptosis level (TUNEL) after 18 month of continuing therapy. Material and methods: From gennary 2006 to november 2007 were diagnosed 77 patients (49 M, 28 F; mean age 58.7±12.3) with BE. All patients underwent multiple endoscopic biopsy specimens as ACG guidelines. All patients were randomised in two different schedules of therapy: (group A) 39 patients (24M and 15F mean age 56.3±11.2 yrs) started esomeprazole 40mg bid and (group B) 38 patients (25M and 13F mean age 59.8±13.6yrs) started pantoprazole 40 mg bid. All patients underwent a second endoscopy with multiple biopsies and a pH-metric test after 18 months. Immunohistochemistry was performed on tissue sections incubating samples with anti-COX2 or anti-Ki-67 primary antibody. Moreover apoptosis was quantified on tissue samples using the DeadEnd TM Colorimetric TUNEL System. The staining of all markers were scored as scale of 0–3 based on the percentage of specific strong epithelial cell staining: grade 0, no or < 5% specific staining; grade 1, >5% to <35%; grade 2, >35% to <65% of the cells; grade 3, >65% of the cells. Statistical analysis was performed by t-test and results were considered significant when p value <0.05. Results: After 18 months of therapy all patients was complied with follow-up. In first endoscopy esophagitis was present in 24.7% of patients (19/77) and in second one and half-year later endoscopy was absent in all patients. In Group A we observe an important reduction in proliferation markers (Ki-67 and COX-2) and a significative increase of apoptosis (p<0.05). In Group B we recorded only a partial regression in proliferation markers and a little increase in apoptosis but no
Table 1. The results of immunohistochemistry in group with esomeprazole 40 therapy KI-67 T0 T1 0 1 2 3
6 8 12 12
14 12 7 5
p
0.040
COX-2 T0 T1 6 9 12 11
15 12 6 5
p
0.036
TUNEL T0 T1 12 11 9 6
6 6 10 16
p
0.045
1 Policlinico
Universitario “A. Gemelli”, Roma; 2 Ospedale Bel Colle,
Viterbo Background and aim: Several endoscopic techniques have been developed in recent years including capsule endoscopy (CE) and double balloon enteroscope. Recently another a new method was also developed: the single-balloon enteroscope (SBE–Olympus, Tokyo, Japan). The SBE consists of a high-resolution videoendoscope and a flexible overtube. A latex free silicone balloon is attached at the tip of the overtube and is inflated and deflated with air from a pressure-controlled pump system. The tip of the enteroscope has a broad bending capability due to its extreme flexibility allowing anchorage to the small bowel without balloon. By using these method to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops. Material and methods: Between July 2006 and November 2007, 37 SBE procedures (34 oral and 3 anal approaches) were performed under general anesthesia on 34 patients. Starting insertion route of SBE was chosen according to the estimated location of the suspected lesions based on the clinical presentation and on the findings of previous investigations such as CE performed in 26 patients. Indications were acute recurrent or chronic OGIB (N=18), chronic abdominal pain and or chronic diarrhea (N=5), suspected tumors (N=3), suspected Crohn’s disease (N=2), suspected refractory celiac disease (N=2), polyposis syndromes (N=4): 3 Peutz-Jeghers and 1 Familial Adenomatous Polyposis respectively. Results: In 2 patients the SBE was not carried out for technical problems. A definite bleeding source was found and treated in 16 patients: APC was used in 13 patients with multiple angiodysplasias and in 1 with a bleeding jejunal polyp. In one patient the bleeding source was a capillary hemangioma-angiomatosis of the jejunum, treated with sclerotherapy using polidocanol and in another one a Dieulafoy’s lesion treated with APC and epinephrine injection. In patients with Peutz-Jeghers syndrome and FAP multiple resections of small-bowel polyps were carried out. In another 2 cases SBE plus histology led to the diagnosis of idiopathic eosinophilic enteritis and of melanoma metastases, respectively. SBE was diagnostic for celiac disease in 1 patient and for GIST and Crohn’s disease in 2 cases respectively. No complication occurred. Conclusions: According to our prelimirary experience, SBE seems to be safe and useful highly effective in the diagnosis and therapy of several small bowel diseases. # Q. Diagnostic endoscopy 3. Enteroscopy