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Kozarek RA. DDS Profile: Richard A. Kozarek, MD. Dig Dis Sci 2023; 68:4294-4296. [PMID: 37798572 DOI: 10.1007/s10620-023-08116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Richard A Kozarek
- Center for Interventional Immunology, Benaroya Research Institute, Seattle, USA.
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Schmitz D, Valiente CT, Dollhopf M, Perez-Miranda M, Küllmer A, Gornals J, Vila J, Weigt J, Voigtländer T, Redondo-Cerezo E, von Hahn T, Albert J, vom Dahl S, Beyna T, Hartmann D, Franck F, García-Alonso FJ, Schmidt A, Garcia-Sumalla A, Arrubla A, Joerdens M, Kleemann T, Tomo JRA, Grassmann F, Rudi J. Percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage in malignant distal bile duct obstruction using a self-expanding metal stent: Study protocol for a prospective European multicenter trial (PUMa trial). PLoS One 2022; 17:e0275029. [PMID: 36302047 PMCID: PMC9612485 DOI: 10.1371/journal.pone.0275029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) was associated with better clinical success and a lower rate of adverse events (AEs) than fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD) in recent single center studies with mainly retrospective design and small case numbers (< 50). The aim of this prospective European multicenter study is to compare both drainage procedures using ultrasound-guidance and primary metal stent implantation in patients with malignant distal bile duct obstruction (PUMa Trial). Methods The study is designed as a non-randomized, controlled, parallel group, non-inferiority trial. Each of the 16 study centers performs the procedure with the best local expertise (PTBD or EUS-BD). In PTBD, bile duct access is performed by ultrasound guidance. EUS-BD is performed as an endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade stenting (EUS-AGS). Insertion of a metal stent is intended in both procedures in the first session. Primary end point is technical success. Secondary end points are clinical success, duration pf procedure, AEs graded by severity, length of hospital stay, re-intervention rate and survival within 6 months. The target case number is 212 patients (12 calculated dropouts included). Discussion This study might help to clarify whether PTBD is non-inferior to EUS-BD concerning technical success, and whether one of both interventions is superior in terms of efficacy and safety in one or more secondary endpoints. Randomization is not provided as both procedures are rarely used after failed endoscopic biliary drainage and study centers usually prefer one of both procedures that they can perform best. Trial registration ClinicalTrials.gov ID: NCT03546049 (22.05.2018).
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
- Department of Gastroenterology and Infectiology, Helios Kliniken Schwerin, Schwerin, Germany
- * E-mail:
| | - Carlos T. Valiente
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
| | - Markus Dollhopf
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach, München, Germany
| | - Manuel Perez-Miranda
- Department of Gastrointestinal Endoscopy, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Armin Küllmer
- Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Joan Gornals
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Juan Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jochen Weigt
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Eduardo Redondo-Cerezo
- Department of Gastrointestinal Endoscopy, Hospital universitario Virgen de las Nieves, Granada, Spain
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology, and Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Jörg Albert
- Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Torsten Beyna
- Department of Internal Medicine, Gastroenterology and Interventional Endoscopy Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Dirk Hartmann
- Department of General Internal Medicine, Diabetology, Gastroenterology and Oncology, Katholisches Klinikum Mainz, Mainz, Germany
| | - Franziska Franck
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach, München, Germany
| | | | - Arthur Schmidt
- Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Albert Garcia-Sumalla
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Amaia Arrubla
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Markus Joerdens
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | | | - Felix Grassmann
- Institute for Medical Statistics and Epidemiology, Medical School Hamburg, Hamburg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
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Landin MD, Guerrón AD. Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection. Surg Clin North Am 2020; 100:1069-1078. [PMID: 33128880 DOI: 10.1016/j.suc.2020.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Therapeutic endoscopy is an emerging field within general surgery. This article explores the evidence for and usage of endoscopic mucosal resection and endoscopic submucosal dissection throughout the gastrointestinal tract. We aim to educate surgeons and provide an understanding of these techniques. With education and appropriate training, the surgeon will gain confidence and hopefully adopt these tools into their daily practice.
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Affiliation(s)
- MacKenzie D Landin
- Division of Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC 27704, USA
| | - A Daniel Guerrón
- Division of Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC 27704, USA.
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Aisu Y, Yasukawa D, Kimura Y, Hori T. Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits. World J Gastrointest Oncol 2018; 10:381-397. [PMID: 30487950 PMCID: PMC6247108 DOI: 10.4251/wjgo.v10.i11.381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.
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Affiliation(s)
- Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri 632-8552, Nara, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yusuke Kimura
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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Stergios K, Damaskos C, Frountzas M, Nikiteas N, Lalude O. Can gallbladder polyps predict colorectal adenoma or even neoplasia? A systematic review. Int J Surg 2016; 33 Pt A:23-7. [PMID: 27461907 DOI: 10.1016/j.ijsu.2016.06.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/30/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of the present systematic review is to identify whether an association between gallbladder polyps and colorectal adenoma or neoplasia exists. DATA SOURCES We conducted a systematic review searching the Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) databases together with reference lists from included studies. STUDY ELIGIBILITY CRITERIA All prospective and retrospective observational cohort studies were included. RESULTS Four studies were finally included which included 17,437 patients. The association between gallbladder polyps and colorectal adenoma or even neoplasia is not unanimously supported. However, a possible association is clearly depicted. According to one study it seems that this correlation seems to become significant only when the gallbladder polyps exceed the size of 5 mm. However, the impact of size of gallbladder polyps was not investigated in the remaining studies. CONCLUSION According to the results of our systematic review there is some evidence to support the hypothesis that gallbladder polyps might adequately predict future risk of colorectal neoplasia. At present, however, current knowledge is very limited and the available data scarce. In this context further studies are necessary to be carried out, before the presence of gallbladder polyps on ultrasound can be recommended as an indication to perform a screening colonoscopy on the same patient.
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Affiliation(s)
- Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research N.S.Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Colorectal Department, General Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research N.S.Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S.Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research N.S.Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Olutunde Lalude
- Colorectal Department, General Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Abstract
Mucositis is among the most debilitating side effects of radiotherapy, chemotherapy, and targeted anticancer therapy. Research continues to escalate regarding key issues such as etiopathology, incidence and severity across different mucosae, relationships between mucosal and nonmucosal toxicities, and risk factors. This approach is being translated into enhanced management strategies. Recent technology advances provide an important foundation for this continuum. For example, evolution of applied genomics is fostering development of new algorithms to rapidly screen genomewide single-nucleotide polymorphisms (SNPs) for patient-associated risk prediction. This modeling will permit individual tailoring of the most effective, least toxic treatment in the future. The evolution of novel cancer therapeutics is changing the mucositis toxicity profile. These agents can be associated with unique mechanisms of mucosal damage. Additional research is needed to optimally manage toxicity caused by agents such as mammalian target of rapamycin (mTOR) inhibitors and tyrosine kinase inhibitors, without reducing antitumor effect. There has similarly been heightened attention across the health professions regarding clinical practice guidelines for mucositis management in the years following the first published guidelines in 2004. New opportunities exist to more effectively interface this collective guideline portfolio by capitalizing upon novel technologies such as an Internet-based Wiki platform. Substantive progress thus continues across many domains associated with mucosal injury in oncology patients. In addition to enhancing oncology patient care, these advances are being integrated into high-impact educational and scientific venues including the National Cancer Institute Physician Data Query (PDQ) portfolio as well as a new Gordon Research Conference on mucosal health and disease scheduled for June 2013.
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Affiliation(s)
- Douglas E Peterson
- From the Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT; University of Adelaide, Adelaide, Australia; Harvard School of Dental Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, and Biomodels, LLC, Boston, MA
| | - Dorothy M Keefe
- From the Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT; University of Adelaide, Adelaide, Australia; Harvard School of Dental Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, and Biomodels, LLC, Boston, MA
| | - Stephen T Sonis
- From the Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT; University of Adelaide, Adelaide, Australia; Harvard School of Dental Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, and Biomodels, LLC, Boston, MA
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de Ruijter V, Halvax P, Dallemagne B, Swanström L, Marescaux J, Perretta S. The Business Engineering Surgical Technologies (BEST) teaching method: incubating talents for surgical innovation. Surg Endosc 2014; 29:48-54. [PMID: 24993171 DOI: 10.1007/s00464-014-3652-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/26/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Technological innovation in surgical science and healthcare is vital and calls for close collaboration between engineering and surgery. To meet this objective, BEST was designed as a free sustainable innovative teaching method for young professionals, combining surgery, engineering, and business in a multidisciplinary, high-quality, low-cost, and learning-by-doing philosophy. AIMS This paper reviews the initial outcomes of the program and discusses lessons learned and future directions of this innovative educational method. METHODS BEST educational method is delivered in two parts: the first component consisting of live streaming or pre-recorded online lectures, with an interdisciplinary profile focused on surgery, engineering, and business. The second component is an annual 5-day on-site course, organized at IRCAD-IHU, France. The program includes workshops in engineering, entrepreneurship team projects, and in-depth hands-on experience in laparoscopy, robotic surgery, interventional radiology, and flexible endoscopy with special emphasis on the interdisciplinary aspect of the training. A panel of surgeons, engineers, well-established entrepreneurs, and scientists assessed the team projects for potential patent application. RESULTS From November 2011 till September 2013, 803 individual and institutional users from 79 different countries attended the online course. In total, 134 young professionals from 32 different countries applied to the onsite course. Sixty participants were selected each year for the onsite course. In addition, five participants were selected for a web-based team. Thirteen provisional patents were filed for the most promising projects. CONCLUSION BEST proved to be a global talent incubator connecting students to high-quality education despite institutional and economical boundaries. Viable and innovative ideas arose from this revolutionary approach which is likely to spin-off significant technology transfer and lead the way for future interdisciplinary hybrid surgical education programs and career paths.
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Affiliation(s)
- V de Ruijter
- IRCAD-IHU, University Hospital of Strasbourg, Strasbourg, France,
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La Greca G, Sofia M, Primo S, Randazzo V, Lombardo R, Russello D. Laparoscopic implementation of the Altemeier procedure for recurrent rectal prolapse. Technical note. Int J Surg Case Rep 2014; 5:347-9. [PMID: 24846791 PMCID: PMC4064421 DOI: 10.1016/j.ijscr.2014.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/03/2014] [Accepted: 04/07/2014] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Many surgical options exist to treat rectal prolapse with different indications, feasibility and results in urgent and complicated cases. These include perineal or abdominal approaches including rectopexy with or without resection. Perineal approaches have reduced surgical invasivity and hospital stay if compared to transabdominal approaches by open surgery or laparoscopy. Up to now there was still a clear dividing line for surgical treatment between the perineal approach, used more for complicated emergency case while the transabdominal open, or laparoscopic approach more common in elective surgery, but more complex to perform. PRESENTATION OF CASE A 37 year old female patient affected by psychiatric disease presented with an unreducible second recurrence of a complicated rectal prolapse. The patient was treated with a third Altemeier procedure but now performed under laparoscopic control. The patient recovered promptly without any complication or recurrence up to the 24 months follow-up. DISCUSSION To the best of our knowledge, this is the first case report describing the combined laparoscopic-perineal approach for the treatment of a complicated recurrence of rectal prolapse. The technical feasibility, the rapidity, the optimal outcome and the rationale behind this option all suggest that this laparoscopic assistance certainly allows an implementation of the effectiveness, safety and results of an established effective perineal approach. CONCLUSION This combined approach has the advantage of maintaining the simplicity and rapidity of conventional perineal surgery, adding the advantages of abdominal control and avoiding the risks, the invasivity, and the longer duration of more complex laparoscopic procedures.
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Affiliation(s)
- Gaetano La Greca
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy.
| | - Maria Sofia
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy
| | - Stefano Primo
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy
| | - Valentina Randazzo
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy
| | - Rosario Lombardo
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy
| | - Domenico Russello
- Department of Surgical Sciences and Advanced Technologies, University of Catania - General Surgery and Minivasive HPB Surgery, Cannizzaro Hospital Via Messina 829, 95100 Catania, Italy
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