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Lange J, Knievel J, Wichmann D, Kähler G, Wiedbrauck F, Hellmich T, Kandler M, Bernhardt J, Scholz D, Beyna T, Hausmann J, Wedi E, Ellrichmann M, Hügle U, Dormann AJ, Eisenberger CF, Heiss MM. Clinical implantation of 92 VACStents in the upper gastrointestinal tract of 50 patients-applicability and safety analysis of an innovative endoscopic concept. Front Surg 2023; 10:1182094. [PMID: 37215348 PMCID: PMC10198570 DOI: 10.3389/fsurg.2023.1182094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Endoscopic vacuum therapy (EVT) has emerged as a promising treatment option for upper gastrointestinal wall defects, offering benefits such as evacuation of secretions and removal of wound debris by suction, and reduction and healing of wound cavities to improve clinical outcomes. In contrast, covered stents have a high rate of migration and lack functional drainage, while endoluminal EVT devices obstruct the GI tract. The VACStent is a novel device that combines the benefits of EVT and stent placement. Its design features a fully covered Nitinol-stent within a polyurethane sponge cylinder, enabling EVT while maintaining stent patency. Methods This study analyzes the pooled data from three different prospective study cohorts to assess the safe practicality of VACStent placement, complete leak coverage, and effective suction-treatment of esophageal leaks. By pooling the data, the study aims to provide a broader base for analysis. Results In total, trans-nasal derivation of the catheter, suction and drainage of secretion via vacuum pump were performed without any adversity. In the pooled study cohort of 92 VACStent applications, the mean stent indwelling time was 5.2 days (range 2-8 days) without any dislocation of the device. Removal of the VACStent was done without complication, in one case the sponge was lost but subsequently fully preserved. Minor local erosions and bleeding and one subsequent hemostasis were recorded unfrequently during withdrawal of the device (5.4%, 5/92) but no perforation or pressure ulcer. Despite a high heterogeneity regarding primary disease and pretreatments a cure rate of 76% (38/50 patients) could be achieved. Discussion In summary, insertion and release procedure was regarded as easy and simple with a low potential of dislocation. The VACStent was well tolerated by the patient while keeping the drainage function of the sponge achieving directly a wound closure by continuous suction and improving the healing process. The implantation of the VACStent provides a promising new procedure for improved clinical treatment in various indications of the upper gastrointestinal wall, which should be validated in larger clinical studies.Clinical Trial Registration: Identifier [DRKS00016048 and NCT04884334].
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Affiliation(s)
- J. Lange
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - J. Knievel
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - D. Wichmann
- Department for Visceral, General and Transplant Surgery, Tübingen University Hospital, Tübingen, Germany
| | - G. Kähler
- Multispecialty Endoscopy Center, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany
| | - F. Wiedbrauck
- Department of Gastroenterology, AKH Celle, Celle, Germany
| | - T. Hellmich
- Department of Gastroenterology, Städtisches Klinikum Dresden, Dresden, Germany
| | - M. Kandler
- Department of Gastroenterology, Städtisches Klinikum Dresden, Dresden, Germany
| | - J. Bernhardt
- Department of Surgery, Klinikum Suedstadt Rostock, Rostock, Germany
| | - D. Scholz
- Department of Gastroenterology and Metabolism, Ameos Klinikum Am Bürgerpark, Bremerhaven, Germany
| | - T. Beyna
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - J. Hausmann
- Department of Gastroenterology/Internal Medicine, St. Vinzenz-Hospital Hanau, Hanau, Germany
| | - E. Wedi
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - M. Ellrichmann
- Department of Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - U. Hügle
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - A. J. Dormann
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - C. F. Eisenberger
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - M. M. Heiss
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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Seefeldt CS, Meyer JS, Knievel J, Rieger A, Geißen R, Lefering R, Heiss MM. BIOLAP: biological versus synthetic mesh in laparo-endoscopic inguinal hernia repair: study protocol for a randomized, multicenter, self-controlled clinical trial. Trials 2019; 20:55. [PMID: 30651127 PMCID: PMC6335692 DOI: 10.1186/s13063-018-3122-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background Inguinal hernia repair is one of the most common surgical operations globally; more than 20 million groin herniae are repaired annually worldwide. Recurrence after an inguinal hernia operation is a considerable clinical problem. Another remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is increasing evidence that biological meshes could be advantageous concerning the occurrence of chronic pain due to different postoperative remodeling, without the disadvantages of a life-long implant. We hypothesize that the use of a biological mesh reduces postoperative pain without being inferior in terms of recurrence rate compared with a synthetic mesh. Methods/design The trial compares possible the advantages of biological matrices to synthetic meshes in laparo-endoscopic inguinal hernia repair. Four hundred and ninety-six patients with primary bilateral inguinal herniae in 20 German hernia centers will be enrolled. Biological mesh is used for one of the bilateral herniae, the other side will be operated on with a synthetic mesh. Randomization will preset which side is repaired with which material and trial participants will not be informed about the location of each mesh type. The primary endpoints will be intensity of postoperative local pain and the incidence of recurrent hernia after 2 years. Discussion There is no reasonably sized trial that assesses the use of biological meshes in laparo-endoscopic inguinal hernia repair. Our self-controlled trial design allows a direct comparison of the two meshes with very few confounding factors as well as minimizing the exclusion criteria. As we compare CE-certified medical devices in their designated indication the medical risk is not different compared to routine clinical care. Due to the common nature of bilateral inguinal hernia, a high recruitment rate is achievable. Because guidelines for hernia repair have stressed the need for reliable data on the already frequent use of biological meshes, we can expect our trial to have a direct implication on hernia-repair standards. Trial registration German Clinical Trials Register, ID: DRKS00010178. Registered on 16.June.2016. BIOLAP underwent full external peer review as part of the funding process with the German Research Foundation. Electronic supplementary material The online version of this article (10.1186/s13063-018-3122-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C S Seefeldt
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany
| | - J S Meyer
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany
| | - J Knievel
- Institut für Forschung in der Operativen Medizin der Universität Witten/Herdecke, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Germany
| | - A Rieger
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany.,Chirurgische Klinik, St. Elisabeth Hospital Köln, Former Krankenhaus Merheim, Kliniken der Stadt Köln, Werthmannstr. 1, 50935, Köln, Germany
| | - R Geißen
- Zentrum für klinische Studien der Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - R Lefering
- Institut für Forschung in der Operativen Medizin der Universität Witten/Herdecke, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Germany
| | - M M Heiss
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany.
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Grusdat M, McIlwain DR, Xu HC, Pozdeev VI, Knievel J, Crome SQ, Robert-Tissot C, Dress RJ, Pandyra AA, Speiser DE, Lang E, Maney SK, Elford AR, Hamilton SR, Scheu S, Pfeffer K, Bode J, Mittrücker HW, Lohoff M, Huber M, Häussinger D, Ohashi PS, Mak TW, Lang KS, Lang PA. IRF4 and BATF are critical for CD8⁺ T-cell function following infection with LCMV. Cell Death Differ 2014; 21:1050-60. [PMID: 24531538 PMCID: PMC4207473 DOI: 10.1038/cdd.2014.19] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/18/2013] [Accepted: 01/10/2014] [Indexed: 02/04/2023] Open
Abstract
CD8(+) T-cell functions are critical for preventing chronic viral infections by eliminating infected cells. For healthy immune responses, beneficial destruction of infected cells must be balanced against immunopathology resulting from collateral damage to tissues. These processes are regulated by factors controlling CD8(+) T-cell function, which are still incompletely understood. Here, we show that the interferon regulatory factor 4 (IRF4) and its cooperating binding partner B-cell-activating transcription factor (BATF) are necessary for sustained CD8(+) T-cell effector function. Although Irf4(-/-) CD8(+) T cells were initially capable of proliferation, IRF4 deficiency resulted in limited CD8(+) T-cell responses after infection with the lymphocytic choriomeningitis virus. Consequently, Irf4(-/-) mice established chronic infections, but were protected from fatal immunopathology. Absence of BATF also resulted in reduced CD8(+) T-cell function, limited immunopathology, and promotion of viral persistence. These data identify the transcription factors IRF4 and BATF as major regulators of antiviral cytotoxic T-cell immunity.
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Affiliation(s)
- M Grusdat
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - D R McIlwain
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - H C Xu
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
- Institute of Immunology, Medical Faculty, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany
| | - V I Pozdeev
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - J Knievel
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - S Q Crome
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - C Robert-Tissot
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - R J Dress
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - A A Pandyra
- Institute of Immunology, Medical Faculty, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany
| | - D E Speiser
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
- Clinical Tumor Biology & Immunotherapy Group, Department of Oncology and Ludwig Center for Cancer Research, University of Lausanne HO-05/1552, Av. P.-Decker 4, CH-1011 Lausanne, Switzerland
| | - E Lang
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - S K Maney
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - A R Elford
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - S R Hamilton
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - S Scheu
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - K Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - J Bode
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - H-W Mittrücker
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lohoff
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, Marburg, Germany
| | - M Huber
- Institute for Medical Microbiology and Hospital Hygiene, University of Marburg, Marburg, Germany
| | - D Häussinger
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - P S Ohashi
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - T W Mak
- Department of Medical Biophysics and Immunology, Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network (UHN), University of Toronto, 620 University Avenue, Toronto, Ontario, Canada M5G 2C1
| | - K S Lang
- Institute of Immunology, Medical Faculty, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany
| | - P A Lang
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
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