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Leifeld L, Denzer U, Frieling T, Jakobs R, Faiss S, Lenzen H, Lynen P, Mayerle J, Ockenga J, Tappe U, Terjung B, Wedemeyer H, Albert J. [Structural, procedural, and personnel requirements for cross-sectoral provision of endoscopic gastroenterological procedures]. Z Gastroenterol 2023; 61:799-809. [PMID: 37494075 DOI: 10.1055/a-2105-4995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Gastroenterology has made crucial advances in diagnostic and interventional endoscopic procedures, opening up improvements in the treatment of many patients. Thus, organ-preserving treatments are increasingly being made possible, replacing more invasive organ resecting surgical procedures. At the same time, the degree of complexity and risks varies widely between different endoscopic procedures. In many cases, simpler endoscopic procedures are now offered on an outpatient basis. Further potential for cross-sectoral performance of endoscopic procedures exists in the case of complex endoscopic procedures, which, however, require special structural, procedural and personnel requirements in order to provide quality-assured treatment, enable post-interventional monitoring and, if necessary, take measures to ensure the success of the treatment. We summarize the essential prerequisites and limitations for cross-sector performance of endoscopic procedures in gastroenterology.
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Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Allgemeine Innere Medizin und Gastroenterologie, St Bernward Krankenhaus, Hildesheim, Deutschland
| | - Ulrike Denzer
- Klinik und Poliklinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
| | - Thomas Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen, Deutschland
| | - Siegbert Faiss
- Gastroenterologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Henrike Lenzen
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Julia Mayerle
- Klinik für Innere Medizin II, LMU München, Deutschland
| | - Johann Ockenga
- Medizinische Klinik II, Gesundheit Nord, Klinikverbund Bremen, Deutschland
| | - Ulrich Tappe
- Gastropraxis an der St. Barbara Klinik, Hamm, Deutschland
| | - Birgit Terjung
- Klinik für Innere Medizin und Gastroenterologie, GFO Kliniken Bonn, Deutschland
| | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Jörg Albert
- Klinik für Gastroenterologie, gastroenterologische Onkologie, Hepatologie, Infektiologie und Pneumologie, Klinikum der Landeshauptstadt Stuttgart gemeinnützige Kommunalanstalt öffentlichen Rechts (gKAöR), Stuttgart, Deutschland
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Leifeld L, Denzer U, Frieling T, Jakobs R, Faiss S, Lenzen H, Lynen P, Mayerle J, Ockenga J, Tappe U, Terjung B, Wedemeyer H, Albert J. [Correction: Structural, procedural, and personnel requirements for cross-sectoral provision of endoscopic gastroenterological procedures]. Z Gastroenterol 2023; 61:e627. [PMID: 37625458 DOI: 10.1055/a-2157-3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Allgemeine Innere Medizin und Gastroenterologie, St Bernward Krankenhaus, Hildesheim, Deutschland
| | - Ulrike Denzer
- Klinik und Poliklinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
| | - Thomas Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen, Deutschland
| | - Siegbert Faiss
- Gastroenterologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Henrike Lenzen
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Julia Mayerle
- Klinik für Innere Medizin II, LMU München, Deutschland
| | - Johann Ockenga
- Medizinische Klinik II, Gesundheit Nord, Klinikverbund Bremen, Deutschland
| | - Ulrich Tappe
- Gastropraxis an der St. Barbara Klinik, Hamm, Deutschland
| | - Birgit Terjung
- Klinik für Innere Medizin und Gastroenterologie, GFO Kliniken Bonn, Deutschland
| | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Jörg Albert
- Klinik für Gastroenterologie, gastroenterologische Onkologie, Hepatologie, Infektiologie und Pneumologie, Klinikum der Landeshauptstadt Stuttgart gemeinnützige Kommunalanstalt öffentlichen Rechts (gKAöR), Stuttgart, Deutschland
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Spada C, Fiori G, Uebel P, Tontini GE, Cesaro P, Grazioli LM, Soru P, Bravi I, Hinkel C, Prada A, Di Paolo D, Zimmermann T, Manes G, Valats JC, Jakobs R, Elli L, Carnovali M, Ciprandi G, Radaelli F, Vecchi M. Oral mannitol for bowel preparation: a dose-finding phase II study. Eur J Clin Pharmacol 2022; 78:1991-2002. [PMID: 36287232 DOI: 10.1007/s00228-022-03405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Successful bowel preparation (BP) for colonoscopy depends on the instructions, diet, the laxative product, and patient adherence, which all affect colonoscopy quality. Nevertheless, there are no laxatives which combine effectiveness, safety, easy self-administration, good patient acceptance, and low cost. However, mannitol, a sugar alcohol, could be an attractive candidate for use in clinical practice if it is shown to demonstrate adequate efficacy and safety.
Aims
The present phase II dose-finding study compared three doses of mannitol (50, 100, and 150 g) to identify the best dose to be used in a subsequent phase III study.
Methods
The Boston Bowel Preparation Scale, caecal intubation rate, adherence, acceptability, and safety profile, including measurement of potentially dangerous colonic gas concentrations (CH4, H2, O2), were considered in all patients. A weighted algorithm was used to identify the best mannitol dose for use in the subsequent study.
Results
The per-protocol population included 60 patients in the 50 g group, 54 in the 100 g group, and 49 in the 150 g group. The 100 g dose was the best as it afforded optimal colon cleansing efficacy (94.4% of patients had adequate BP), adherence, acceptability, and safety, including negligible gas concentrations.
Conclusions
The present study demonstrated that the colon cleansing efficacy and safety of mannitol were dose dependent. Conversely, gas concentrations were not dose dependent and negligible in all patients. Combined evaluation of efficacy, tolerability, and safety, using a weighted algorithm, determined that mannitol 100 g was the best dose for the phase III study.
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Fiori G, Spada C, Soru P, Tontini GE, Bravi I, Cesana BM, Cesaro P, Manes G, Orsatti A, Prada A, Quadarella A, Schettino M, Spina L, Trovato C, Carnovali M, Vecchi M, Cavallaro F, Codazzi M, De Nucci G, De Roberto G, Devani M, Di Paolo D, Elli L, Hinkel C, Jakobs R, Janke D, Lombardo V, Lovera M, Radaelli F, Ravizza D, Uebel P, Valats JC, Vollmar J, Zimmermann T, Ciprandi G. Pharmacokinetics of oral mannitol for bowel preparation for colonoscopy. Clin Transl Sci 2022; 15:2448-2457. [PMID: 37074807 PMCID: PMC9579383 DOI: 10.1111/cts.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/16/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
This study aimed to define the pharmacokinetics (PKs) of oral mannitol used as an osmotic laxative for bowel preparation for colonoscopy. The PKs of oral mannitol was evaluated in a substudy as part of a phase II dose‐finding, international, multicenter, randomized, parallel‐group, endoscopist‐blinded study. Patients were randomly assigned to take 50, 100, or 150 g mannitol. Venous blood samples were drawn at baseline (T0), 1 h (T1), 2 h (T2), 4 h (T4), and 8 h (T8) after completion of mannitol self‐administration. The mean mannitol plasma concentrations (mg/ml) were dose‐dependent with a consistent difference among doses. The mean maximum concentration (Cmax) ± SD was 0.63 ± 0.15, 1.02 ± 0.28, and 1.36 ± 0.39 mg/ml, in the three dosage groups, respectively. The mean area under the curve from zero to infinity (AUC0−∞) was 2.667 ± 0.668, 4.992 ± 1.706, and 7.403 ± 3.472 mg/ml*h in the 50, 100, and 150 g mannitol dose groups, respectively. Bioavailability was similar in the three dose groups and was just over 20% (0.243 ± 0.073, 0.209 ± 0.081, and 0.228 ± 0.093 in the 50, 100, and 150 g mannitol dose groups, respectively). The present study showed that the bioavailability of oral mannitol is just over 20% and is similar for the three tested doses (50, 100, and 150 g). The linear increase in Cmax, AUC0−t8, and AUC0−∞ must be considered when choosing the oral mannitol dose for bowel preparation to avoid its systemic osmotic effects.
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Affiliation(s)
- Giancarla Fiori
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Cristiano Spada
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Pietro Soru
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Organ Transplantation University of Milan Milan Italy
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Ivana Bravi
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Bruno Mario Cesana
- Department of Molecular and Transactional Medicine, Statistics and Biomathematics Unit, Faculty of Medicine and Surgery University of Brescia Brescia Italy
| | - Paola Cesaro
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Gianpiero Manes
- U.O.C. Gastroenterologia, ASST Rhodense Presidi di Rho e Garbagnate Garbagnate Milanese (MI) Italy
| | | | - Alberto Prada
- Servizio Gastroenterologia ed Endoscopia Digestiva Istituto Auxologico Italiano Milan Italy
| | - Alessandro Quadarella
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza – Istituto Ospedaliero Brescia Italy
| | - Mario Schettino
- U.O.C. Gastroenterologia, ASST Rhodense Presidi di Rho e Garbagnate Garbagnate Milanese (MI) Italy
| | - Luisa Spina
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Cristina Trovato
- Divisione di Endoscopia, Istituto Europeo di Oncologia IRCCS Milan Italy
| | | | - Maurizio Vecchi
- Department of Pathophysiology and Organ Transplantation University of Milan Milan Italy
- Gastroenterology and Endoscopy Unit IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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Ebert MP, Meindl-Beinker NM, Gutting T, Maenz M, Betge J, Schulte N, Zhan T, Weidner P, Burgermeister E, Hofheinz R, Vogel A, Angermeier S, Bolling C, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience P, Leidig T, Gaiser T, Kather JN, Haertel N. Second-line therapy with nivolumab plus ipilimumab for older patients with oesophageal squamous cell cancer (RAMONA): a multicentre, open-label phase 2 trial. Lancet Healthy Longev 2022; 3:e417-e427. [PMID: 36098320 DOI: 10.1016/s2666-7568(22)00116-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The overall survival of patients with advanced and refractory oesophageal squamous cell carcinoma, mostly aged 65 years and older, is poor. Treatment with PD-1 antibodies showed improved progression-free survival and overall survival. We assessed the safety and efficacy of combined nivolumab and ipilimumab therapy in this population. METHODS This multicentre, open-label, phase 2 trial done in 32 sites in Germany included patients aged 65 years and older with oesophageal squamous cell carcinoma and disease progression or recurrence following first-line therapy. Patients were treated with nivolumab (240 mg fixed dose once every 2 weeks, intravenously) in the safety run-in phase and continued with nivolumab and ipilimumab (nivolumab 240 mg fixed dose once every 2 weeks and ipilimumab 1 mg/kg once every 6 weeks, intravenously). The primary endpoint was overall survival, which was compared with a historical cohort receiving standard chemotherapy in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03416244. FINDINGS Between March 2, 2018, and Aug 20, 2020, we screened 75 patients with advanced oesophageal squamous cell carcinoma. We enrolled 66 patients (50 [76%] men and 16 [24%] women; median age 70·5 years [IQR 67·0-76·0]), 44 (67%) of whom received combined nivolumab and ipilimumab therapy and 22 (33%) received nivolumab alone. Median overall survival time at the prespecified data cutoff was 7·2 months (95% CI 5·7-12·4) and significantly higher than in a historical cohort receiving standard chemotherapy (p=0·0063). The most common treatment-related adverse events were fatigue (12 [29%] of 42), nausea (11 [26%]), and diarrhoea (ten [24%]). Grade 3-5 treatment-related adverse events occurred in 13 (20%) of 66 patients. Treatment-related death occurred in one patient with bronchiolitis obliterans while on nivolumab and ipilimumab treatment. INTERPRETATION Patients aged at least 65 years, with advanced oesophageal squamous cell carcinoma might benefit from combined nivolumab and ipilimumab therapy in second-line treatment. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Matthias P Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany.
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Gutting
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johannes Betge
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany; Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center, Heidelberg, Germany
| | - Nadine Schulte
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Elke Burgermeister
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf Hofheinz
- Interdisciplinary Tumor Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany
| | - Stefan Angermeier
- Department of Internal Medicine I, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Claus Bolling
- Department of Internal Medicine, Agaplesion Markus Krankenhaus Frankfurt, Diakonie Kliniken, Frankfurt, Germany
| | - Maike de Wit
- Department of Internal Medicine, Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ralf Jakobs
- Department of Medicine C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Gertraud Stocker
- University Cancer Center, University Medicine Leipzig, Leipzig, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Medical Oncology and Tumor Immunology, Charité Universitätsmedizin, Berlin, Germany
| | | | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jakob N Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Nicolai Haertel
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Ebert MP, Meindl-Beinker NM, Gutting T, Maenz M, Betge J, Schulte N, Zhan T, Weidner P, Hofheinz RD, Vogel A, Angermeier S, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience PC, Leidig T, Haertel N. Nivolumab plus ipilimumab in second-line combination therapy for older patients with esophageal squamous cell cancer (AIO-STO-0117 trial). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
303 Background: Overall survival of patients with advanced and refractory esophageal squamous cell carcinoma (ESCC) is poor. Most patients are 65 years or older, present with advanced and metastatic disease and suffer from extensive co-morbidity and decreased functionality. While approved therapies beyond first-line therapy have not been available for decades, just recently treatment with PD-1 antibodies has shown to improve progression-free and overall survival in this patient cohort. Thus, we assessed the combination of nivolumab and ipilimumab in this vulnerable and older patient population. Methods: In this multi-center, open-label phase II trial older patients with ESCC with progression or recurrence of disease following first-line therapy were treated with nivolumab and ipilimumab. Patients had to pass a brief geriatric assessment using the G8 screening tool in combination with the Deficit Accumulation Frailty Index (DAFI). A safety run–in phase was initiated with nivolumab (240mg fixed dose Q2W). Following a safety assessment, patients then went on to receive the combination therapy of nivolumab/ipilimumab (nivolumab 240 mg fixed dose Q2W; ipilimumab 1 mg/kg Q6W), in case safety was critical patients were allowed to continue with nivolumab monotherapy. The primary outcome was overall survival. Progression-free survival, quality of life and adverse events were also assessed. Results: In total 66 evaluable patients (16 female, 50 male) with ESCC were enrolled in this trial after successful geriatric assessment, median age was 70.5 years (range 55-84 years). 44 patients were treated with the combination therapy of nivolumab and ipilimumab, 22 patients with nivolumab only. The primary endpoint was met with a median OS of 7.2 months (95% CI, 5.7 to 12.4 months) (p < 0.006; versus historical control treated with standard chemotherapy). Median PFS was 2.7 months (95% CI, 2.5 to 2.9 months). ORR was 18.2% (95% CI, 9.8 to 29.6), all cases were partial responses. Grade 3 or more treatment related adverse events were observed in ̃25% of patients. Conclusions: The combination therapy of nivolumab and ipilimumab demonstrates improved overall survival and sustained confirmed responses in the second line therapy of older European patients with ESCC. Geriatric assessment is feasible in the setting of a prospective immune therapy trial. Overall, the RAMONA trial confirmed efficacy and safety of combination checkpoint inhibitor therapy in G8 prescreened older patients with ESCC in Europe beyond first line therapy. Clinical trial information: NCT03416244.
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Affiliation(s)
- Matthias Philip Ebert
- Department of Medicine II, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Gutting
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johannes Betge
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadine Schulte
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumor Center Mannheim, University Medical Centre Mannheim, University Heidelberg, Mannheim, Germany
| | | | | | | | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| | | | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Nicolai Haertel
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Trojan J, Hoffmeister A, Neu B, Kasper S, Dechêne A, Jürgensen C, Schirra J, Jakobs R, Palmer D, Selbo PK, Olivecrona H, Finnesand L, Høgset A, Walday P, Sturgess R. OUP accepted manuscript. Oncologist 2022; 27:430-e433. [PMID: 35675633 PMCID: PMC9177099 DOI: 10.1093/oncolo/oyab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Photochemical internalization (PCI) is a novel technology for light-induced enhancement of the local therapeutic effect of cancer drugs, utilizing a specially designed photosensitizing molecule (fimaporfin). The photosensitizing molecules are trapped in endosomes along with macromolecules or drugs. Photoactivation of fimaporfin disrupts the endosomal membranes so that drug molecules are released from endosomes inside cells and can reach their therapeutic target in the cell cytosol or nucleus. Compared with photodynamic therapy, the main cytotoxic effect with PCI is disruption of the endosomal membrane resulting in delivery of chemotherapy drug, and not to the photochemical reactions per se. In this study we investigated the effect of PCI with gemcitabine in patients with inoperable perihilar cholangiocarcinoma (CCA). Methods The in vitro cytotoxic effect of PCI with gemcitabine was studied on two CCA-derived cell lines. In a fimaporfin dose-escalation phase I clinical study, we administered PCI with gemcitabine in patients with perihilar CCA (n = 16) to establish a safe and tolerable fimaporfin dose and to get early signals of efficacy. The patients enrolled in the study had tumors in which the whole length of the tumor could be illuminated from the inside of the bile duct, using an optical fiber inserted via an endoscope (Fig. 1). Fimaporfin was administered intravenously at day 0; gemcitabine (i.v.) and intraluminal biliary endoscopic laser light application on day 4; followed by standard gemcitabine/cisplatin chemotherapy. Results Preclinical experiments showed that PCI enhanced the effect of gemcitabine. In patients with CCA, PCI with gemcitabine was well tolerated with no dose-limiting toxicities, and no unexpected safety signals. Disease control was achieved in 10 of 11 evaluable patients, with a clearly superior effect in the two highest dose groups. The objective response rate (ORR) was 42%, including two complete responses, while ORR at the highest dose was 60%. Progression-free survival at 6 months was 75%, and median overall survival (mOS) was 15.4 months, with 22.8 months at the highest fimaporfin dose. Conclusion Photochemical internalization with gemcitabine was found to be safe and resulted in encouraging response and survival rates in patients with unresectable perihilar CCA.
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Affiliation(s)
- Jörg Trojan
- Corresponding author: Jörg Trojan, MD, University Hospital and Cancer Center Medical Department 1, Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany. Tel: +49 69 6301 7860;
| | - Albrecht Hoffmeister
- Department of Medicine (Gastroenterology), University of Leipzig, Leipzig, Germany
| | - Bruno Neu
- Technical University, Munich, Germany (now at Krankenhaus Lanshut-Achdorf)
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer, University Hospital Essen, Essen, Germany
| | - Alexander Dechêne
- Department of Gastroenterology, Hepatology and Endocrinology, Klinikum Nuremberg, Paracelsus Medical University, Nuremburg, Germany
| | | | - Jörg Schirra
- Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Ralf Jakobs
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Dan Palmer
- University Hospital Aintree, Liverpool, UK
| | - Pål k. Selbo
- Oslo University Hospital--The Norwegian Radium Hospital, Oslo, Norway
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Leifeld L, Denzer U, Frieling T, Jakobs R, Koop H, van Leeuwen P, Madisch A, Rosien U, Stier A, Siegmund B, Tappe U, Lammert F, Lynen Jansen P. [Quality management in the field of gastroenterology - Proposals of the Quality Commission of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) for Outpatient and Inpatient Quality Assurance]. Z Gastroenterol 2021; 59:665-676. [PMID: 34255315 DOI: 10.1055/a-1451-6350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The quality of the medical care depends on numerous factors that can often be influenced by the doctor itself. It is a great challenge to follow the constant scientific progress in practice. Scientific standards in gastroenterology are defined in DGVS guidelines and regularly revised. The implementation of evidence-based recommendations in practice remains challenging. On the basis of the DGVS guidelines, the Quality Commission has therefore developed a selection of quality indicators with particular relevance using standardized criteria, the broad implementation of which could contribute to improved patient care in gastroenterology.
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Affiliation(s)
- Ludger Leifeld
- Klinik für Allgemeine Innere Medizin & Gastroenterologie - Medizinische Klinik III, St. Bernward Krankenhaus, Hildesheim
| | - Ulrike Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg
| | - Thomas Frieling
- Medizinische Klinik II - Gastroenterologie, Helios Klinikum Krefeld
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen
| | - Herbert Koop
- ehem. Klinik für Innere Medizin und Gastroenterologie, Helios-Klinikum Berlin-Buch, Berlin
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
| | - Ahmed Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg
| | - Albrecht Stier
- Klinik für Allgemein- u. Viszeralchirurgie, Helios Klinikum Erfurt
| | - Britta Siegmund
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin
| | | | | | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
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Hartel N, Meindl-Beinker NM, Maenz M, Hiegl W, Betge J, Hofheinz RD, Vogel A, Angermeier S, Bolling C, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience PC, Ebert MP. Nivolumab and ipilimumab for second-line therapy in elderly patients with advanced esophageal squamous cell cancer: Safety interim analysis of the RAMONA trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4029 Background: Advanced esophageal squamous cell cancer (ESCC) is frequently diagnosed in elderly patients (pts) with additional comorbidities. Limited treatment options are available. We report the safety interim analysis of a phase II clinical trial evaluating nivolumab and ipilimumab as second-line therapy for advanced ESCC in elderly pts. Methods: RAMONA is a multicenter open-label phase II trial assessing nivolumab/ipilimumab combination therapy in elderly pts (≥65 years). The geriatric status of the pts was assessed using the G8 screening tool and the Deficit Accumulation Frailty Index (DAFI). After a run-in phase of 3 cycles nivolumab (240mg Q2W), cohort assignment was based on a safety assessment. Pts with toxicities grade ≤2 were considered eligible for escalation to nivolumab (240mg Q2W)/ipilimumab (1mg/kg Q6W) combination therapy (cohort B). Other pts remained on nivolumab monotherapy (cohort A). Primary endpoint is overall survival (OS). Key secondary endpoint is time to Quality of Life deterioration defined as a loss of ≥ 10 points in the EORTC QLQ-C30 compared to baseline. Adverse events were assessed according to NCI-CTCAE version 4.03. Results: From February 2018 until February 2020, 69 pts entered the study. 61 pts were eligible for safety interim analysis. Median age of the pts was 71.9 yrs (± 5.4), median KPS score was 80% (50-100%). In 73.8% of the pts, metastases were detected at the time of study inclusion. Most pts received the IO therapy in ≥ 2nd line (91.8%). The mean G8-score at screening was 11.9 points (46 pts ≤ 14 points, 75.4%) (mean DAFI: 0.19). Based on safety assessment, 42 pts were escalated to nivolumab/ipilimumab, while 9 pts remained on nivolumab monotherapy. 10 pts were not allocated at the time of analysis. Median numbers of cumulative doses were 3.0 [1.0 - 3.0] for the run-in phase (nivolumab), 6.0 [1.0 – 48.0] for nivolumab therapy (cohort A/B) and 2.5 [1.0 – 16.0] for ipilimumab (cohort B). Median treatment duration was 144.5 days (56-781 days) in cohort A and 231 days (85-484 days) in cohort B. Frailty indices remained stable after 3 cycles of nivolumab with limited toxicity at the time of the safety assessment. Drug-related treatment emergent adverse events (AEs) were observed in 42 pts (68.9%); 29/42 in cohort A, 8/9 in cohort B, and 5/10 pts not allocated at the time of analysis. Grade ≥3 AEs were detected in 9 pts of 42 in cohort A and 4 of 9 pts in cohort B. Drug-related treatment emergent serious adverse events (SAEs) were detected in 12 pts (19.7%); 8/42 in cohort A, 2/9 pts in cohort B, and 2/10 pts not yet allocated. Conclusions: Combined nivolumab/ipilimumab is a safe and feasible second-line therapy for elderly pts with advanced ESCC. Most pts could be escalated to nivolumab/ipilimumab. Treatment duration was exceptional long for a subset of pts. Clinical trial information: NCT03416244.
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Affiliation(s)
| | | | | | | | - Johannes Betge
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf Dieter Hofheinz
- Department of Medicine III, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | | | | | | | | | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| | | | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias Philip Ebert
- Department of Medicine II, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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10
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Kunzmann V, Siveke JT, Algül H, Goekkurt E, Siegler G, Martens U, Waldschmidt D, Pelzer U, Fuchs M, Kullmann F, Boeck S, Ettrich TJ, Held S, Keller R, Klein I, Germer CT, Stein H, Friess H, Bahra M, Jakobs R, Hartlapp I, Heinemann V. Nab-paclitaxel plus gemcitabine versus nab-paclitaxel plus gemcitabine followed by FOLFIRINOX induction chemotherapy in locally advanced pancreatic cancer (NEOLAP-AIO-PAK-0113): a multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 2020; 6:128-138. [PMID: 33338442 DOI: 10.1016/s2468-1253(20)30330-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal preoperative treatment for locally advanced pancreatic cancer is unknown. We aimed to compare the efficacy and safety of nab-paclitaxel plus gemcitabine with nab-paclitaxel plus gemcitabine followed by fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) as multidrug induction chemotherapy regimens in locally advanced pancreatic cancer. METHODS In this open-label, multicentre, randomised phase 2 study, done at 28 centres in Germany, eligible patients were adults (aged 18-75 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1 and histologically or cytologically confirmed, treatment-naive locally advanced pancreatic adenocarcinoma, as determined by local multidisciplinary team review. After two cycles of nab-paclitaxel 125 mg/m2 plus gemcitabine 1000 mg/m2 (administered intravenously on days 1, 8, and 15 of each 28-day cycle), patients without progressive disease or unacceptable adverse events were randomly assigned (1:1) to receive either two additional cycles of nab-paclitaxel plus gemcitabine (nab-paclitaxel plus gemcitabine group) or four cycles of sequential FOLFIRINOX (oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 180 mg/m2, fluorouracil 400 mg/m2 by intravenous bolus followed by a continuous intravenous infusion of 2400 mg/m2 for 46 h on day 1 of each 14-day cycle; sequential FOLFIRINOX group). Randomisation was done by the clinical research organisation on request of the trial centre using a permuted block design (block size 2 and 4). Patients, investigators, and study team members were not masked to treatment allocation. The primary endpoint was surgical conversion rate (complete macroscopic tumour resection) in the randomised population by intention-to-treat analysis, which was assessed by surgical exploration in all patients with at least stable disease after completion of induction chemotherapy. This trial is registered with ClinicalTrials.gov, NCT02125136. FINDINGS Between Nov 18, 2014, and April 27, 2018, 168 patients were registered and 130 were randomly assigned to either the nab-paclitaxel plus gemcitabine group (64 patients) or the sequential FOLFIRINOX group (66 patients). Surgical exploration after completed induction chemotherapy was done in 40 (63%) of 64 patients in the nab-paclitaxel plus gemcitabine group and 42 (64%) of 66 patients in the sequential FOLFIRINOX group. 23 patients in the nab-paclitaxel plus gemcitabine group and 29 in the sequential FOLFIRINOX group had complete macroscopic tumour resection, yielding a surgical conversion rate of 35·9% (95% CI 24·3-48·9) in the nab-paclitaxel plus gemcitabine group and 43·9% (31·7-56·7) in the sequential FOLFIRINOX group (odds ratio 0·72 [95% CI 0·35-1·45]; p=0·38). At a median follow-up of 24·9 months (95% CI 21·8-27·6), median overall survival was 18·5 months (95% CI 14·4-21·5) in the nab-paclitaxel plus gemcitabine group and 20·7 months (13·9-28·7) in the sequential FOLFIRINOX group (hazard ratio 0·86 [95% CI 0·55-1·36]; p=0·53). All other secondary efficacy endpoints, such as investigator-assessed progression-free survival, radiographic response rate, CA 19-9 response rate, and R0 resection rate, were not significantly different between the two treatment groups except for improved histopathological downstaging in evaluable resection specimens from the sequential FOLFIRINOX group (ypT1/2 stage: 20 [69%] of 29 patients in the sequential FOLFIRINOX group vs four [17%] of 23 patients in the nab-paclitaxel plus gemcitabine group, p=0·0003; ypN0 stage: 15 [52%] of 29 patients in the sequential FOLFIRINOX group vs four [17%] of 23 patients in the nab-paclitaxel plus gemcitabine group, p=0·02). Grade 3 or higher treatment-emergent adverse events during induction chemotherapy occurred in 35 (55%) of 64 patients in nab-paclitaxel plus gemcitabine group and in 35 (53%) of 66 patients in the sequential FOLFIRINOX group. The most common of which were neutropenia (18 [28%] in nab-paclitaxel plus gemcitabine group, 16 [24%] in the sequential FOLFIRINOX group), nausea and vomiting (two [3%] in nab-paclitaxel plus gemcitabine group, eight [12%] in the sequential FOLFIRINOX group), and bile duct obstruction with cholangitis (six [9%] in nab-paclitaxel plus gemcitabine group, seven [11%] in the sequential FOLFIRINOX group). No deaths were caused by treatment-related adverse events during the induction chemotherapy phase. INTERPRETATION Our findings suggest that nab-paclitaxel plus gemcitabine is similarly active and safe as nab-paclitaxel plus gemcitabine followed by FOLFIRINOX as multidrug induction chemotherapy regimens for locally advanced pancreatic cancer. Although conversion to resectability was achieved in about a third of patients, additional evidence is required to determine whether this translates into improved overall survival. FUNDING Celgene.
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Affiliation(s)
- Volker Kunzmann
- Department of Internal Medicine II, Medical Oncology, Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany.
| | - Jens T Siveke
- Department of Medical Oncology and Division of Solid Tumour Translational Oncology, West German Cancer Center, University Medicine Essen, Essen, Germany
| | - Hana Algül
- Comprehensive Cancer Center Munich, Klinikum rechts der Isar, Department of Internal Medicine II, Technical University Munich, Munich, Germany
| | - Eray Goekkurt
- North-German Trial Center for Innovative Oncology, Hematology-Oncology Practice Eppendorf, Hamburg, Germany
| | - Gabriele Siegler
- Department of Internal Medicine 5, Hematology and Medical Oncology, Paracelsus Medical University, Nürnberg, Germany
| | - Uwe Martens
- Department of Internal Medicine III, SLK-Clinics Heilbronn, Heilbronn, Germany
| | - Dirk Waldschmidt
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Uwe Pelzer
- Division of Oncology and Hematology, Charite Campus Mitte and Charite Campus Virchow Klinikum, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin Germany
| | - Martin Fuchs
- Clinic for Gastroenterology, Hepatology and Gastrointestinal-Oncology, München Klinik Bogenhausen, Munich, Germany
| | - Frank Kullmann
- Department of Internal Medicine I, Kliniken Nordoberpfalz, Klinikum Weiden, Weiden, Germany
| | - Stefan Boeck
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University - Grosshadern, Munich, Germany
| | - Thomas J Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - Swantje Held
- Department of Biometrics, ClinAssess, Leverkusen, Germany
| | - Ralph Keller
- Clinical Research, Arbeitsgemeinschaft für Internistische Onkologie Studien, Berlin, Germany
| | - Ingo Klein
- Department of Surgery I, Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of Surgery I, Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Hubert Stein
- Department of Surgery, Paracelsus Medical University, Nürnberg, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Technical University Munich, Munich, Germany
| | - Marcus Bahra
- Department of Surgery, Charite Campus Mitte and Charite Campus Virchow Klinikum, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin Germany
| | - Ralf Jakobs
- Department of Internal Medicine C, Gastroenterology and Gastrointestinal Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Ingo Hartlapp
- Department of Internal Medicine II, Medical Oncology, Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University - Grosshadern, Munich, Germany
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11
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Trojan J, Sturgess R, Harrison Palmer D, Neu B, Kasper S, Dechene A, Jürgensen C, Schirra J, Jakobs R, Högset A, Finnesand L, Olivecrona H. PhotoChemical internalization of gemcitabine followed by gemcitabine/cisplatin in perihilar cholangiocarcinoma: Results from a phase I dose escalation trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Baltes P, Bota M, Albert J, Philipper M, Hörster HG, Hagenmüller F, Steinbrück I, Jakobs R, Bechtler M, Hartmann D, Neuhaus H, Charton JP, Mayershofer R, Hohn H, Rösch T, Groth S, Nowak T, Wohlmuth P, Keuchel M. PillCamColon2 after incomplete colonoscopy - A prospective multicenter study. World J Gastroenterol 2018; 24:3556-3566. [PMID: 30131662 PMCID: PMC6102503 DOI: 10.3748/wjg.v24.i31.3556] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.
METHODS This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.
RESULTS Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn’s disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.
CONCLUSION Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
| | - Marc Bota
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
| | - Jörg Albert
- Department of Internal Medicine I, Klinikum der JW. Goethe Universität, Frankfurt 60590, Germany
| | | | | | | | - Ingo Steinbrück
- 1st Medical Department, Asklepios Klinikum Altona, Hamburg 22763, Germany
| | - Ralf Jakobs
- Medical Clinic C, Klinikum der Stadt Ludwigshafen, Ludwigshafen 67063, Germany
| | - Matthias Bechtler
- Medical Clinic C, Klinikum der Stadt Ludwigshafen, Ludwigshafen 67063, Germany
| | - Dirk Hartmann
- Clinic for Internal Medicine, Sana Klinikum Lichtenberg, Berlin 10365, Germany
| | - Horst Neuhaus
- Clinic for Internal Medicine, Evangelisches Krankenhaus, Düsseldorf 40217, Germany
| | - Jean-Pierre Charton
- Clinic for Internal Medicine, Evangelisches Krankenhaus, Düsseldorf 40217, Germany
| | | | - Horst Hohn
- Schwerpunktpraxis Gastroenterologie, Koblenz 56068, Germany
| | - Thomas Rösch
- Clinic for Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg 20251, Germany
| | - Stefan Groth
- Clinic for Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg 20251, Germany
| | - Tanja Nowak
- CorporateHealth International, Hamburg 20149, Germany
| | - Peter Wohlmuth
- Biometry and Data Management, Asklepios Proresearch, Hamburg 20099, Germany
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
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13
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Turowski F, Hügle U, Dormann A, Bechtler M, Jakobs R, Gottschalk U, Nötzel E, Hartmann D, Lorenz A, Kolligs F, Veltzke-Schlieker W, Adler A, Becker O, Wiedenmann B, Bürgel N, Tröger H, Schumann M, Daum S, Siegmund B, Bojarski C. Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study. Surg Endosc 2018. [PMID: 29532224 DOI: 10.1007/s00464-018-6141-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The aim of the study was to evaluate the usefulness and diagnostic and therapeutic outcome of the single-operator cholangiopancreatoscopy (SOC) with SpyGlassDS™. METHODS In a retrospective multicenter study between November 2015 and January 2017, SpyGlassDS™ procedures were analyzed in participating centers. Indications, accuracy of SOC-guided biopsies, management of large bile duct stones, and complications were analyzed. Follow-up was 4 months. RESULTS Two hundred and six patients out of 250 examinations were evaluated. Indications were biliary stones (n = 132), bile duct stenosis (n = 93), stones and stenosis combined (n = 24), and bile duct leakage (n = 1). Of the 117 cases which were suspicious of malignancy, in 99 cases the lesion could be stratified into benign (n = 55) or malignant (n = 44) indicating a sensitivity of 95.5% and a specificity of 94.5% for the indication tumor. SOC-guided biopsies revealed a sensitivity of 57.7% with a specificity of 100%. In 107 examinations, biliary stones were visualized and could be completely removed in 91.1% with a need of three procedures (range 1-6) to achieve final stone clearance. In 75 cases, lithotripsy was performed and was successful in 71 cases (95%). Four out of 45 patients (8.9%) underwent cholecystectomy with surgical bile duct revision as a final therapy. Adverse Event (AE) occurred in 33/250 patients (13.2%) and Serious Adverse Event (SAE) occurred in 1/250 patients (0.4%). Cholangitis was 1% (n = 102) after peri-interventional administration of antibiotics and 12.8% (n = 148) without antibiotic prophylaxis (p < 0.001). CONCLUSIONS SOC with SpyGlassDS™ became a new standard for the diagnosis of indefinite biliary lesions and therapy of large bile duct stones. The diagnostic yield of SOC-guided biopsies facilitated a definite diagnosis in most cases and should be improved by standardized biopsy protocols. SOC-guided interventions allowed removal of large biliary stones by SOC-guided lithotripsy. The complication rate of 13.2% can be considerably reduced by use of a single-shot antibiotic treatment.
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Affiliation(s)
- Felicia Turowski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ulrich Hügle
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Arno Dormann
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Matthias Bechtler
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Uwe Gottschalk
- Klinik für Innere Medizin I, Dietrich Bonhoeffer Klinikum, Salvador-Allende-Str. 30, 17036, Neubrandenburg, Germany
| | - Ellen Nötzel
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Dirk Hartmann
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Albrecht Lorenz
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Frank Kolligs
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Wilfried Veltzke-Schlieker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Adler
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Olaf Becker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bertram Wiedenmann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nataly Bürgel
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hanno Tröger
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Michael Schumann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Severin Daum
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Britta Siegmund
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Bojarski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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14
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Kunzmann V, Martens UM, Alguel H, Siveke JT, Goekkurt E, Pelzer U, Siegler GM, Hennes E, Waldschmidt D, Jakobs R, Ferenczy P, Keller R, Boeck SH, Kullmann F, Kapp M, Germer CT. Secondary resectability in locally advanced pancreatic cancer (LAPC) after nab-paclitaxel/gemcitabine- versus FOLFIRINOX-based induction chemotherapy: Interim results of a randomized phase II AIO trial (NEOLAP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
348 Background: Although there is a strong rationale for downstaging non-resectable pancreatic ductal adenocarcinoma (PDAC) for secondary resections by multi-agent chemotherapy, evidence from prospective randomized studies is missing. Methods: This prospective, randomized, open-label, phase II study aims to assess the activity, safety and feasibility of nab-paclitaxel/gemcitabine (nPG)- and FOLFIRINOX-based induction chemotherapy for patients (pts) with non-resectable PDAC. After two cycles of nPG pts are randomly allocated to receive either two additional cycles of nPG (arm A) or four cycles of FOLFIRINOX (arm B). Secondary resectability is assessed by exploratory laparotomy in all pts with at least stable disease (SD) after induction chemotherapy. The primary endpoint is to compare secondary complete macroscopic resection rates (R0/R1) in both arms. Results: We report the results of a planned interim (futility) analysis for efficacy data after at least 50 patients had completed induction chemotherapy and are evaluable for secondary surgical resection. Of pts who underwent randomization 42 pts were allocated to arm A and 44 pts to arm B, respectively. Disease control rate (DCR) after randomization was 93% in arm A and 89% in arm B. Explorative laparotomy was performed in 55% of randomized pts in arm A and 48% in arm B. Complete macroscopic resection (R0/R1) rate of randomized pts was 24% in arm A and 29% in arm B. For pts who received surgical exploration by laparotomy after completion of induction chemotherapy (n = 44) the complete macroscopic resection (R0/R1) rate was 43% in arm A and 62% in arm B. No new safety signals were identified thus far. Conclusions: nPG- and FOLFIRINOX-based induction chemotherapy approach revealed both effective and feasible in pts with LAPC supporting completion of patient recruitment in this trial. Interim results suggest promising secondary resection rates after multi-agent chemotherapy, especially when secondary resectability is assessed by surgical exploration. Clinical trial information: NCT02125136.
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Affiliation(s)
- Volker Kunzmann
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Uwe Marc Martens
- SLK-Kliniken Heilbronn, Klinik für Innere Medizin, Heilbronn, Germany
| | - Hana Alguel
- Klinikum Rechts der Isar, Technische Universtität München, Munich, Germany
| | - Jens T. Siveke
- Universitätsklinikum Essen, Innere Klinik, Essen, Germany
| | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf, Hamburg, Germany
| | - Uwe Pelzer
- Charité-Universitätsmedizin, Berlin, Germany
| | | | - Elke Hennes
- Asklepios Klinik Hamburg Barmbek, Hamburg, Germany
| | - Dirk Waldschmidt
- Universitätsklinikum Köln, Klinik für Gastroenterologie und Hepatologie, Köln, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | | | | | - Stefan Hubert Boeck
- Universitätsklinikum der LMU, Medizinische Klinik und Poliklinik III and Comprehensive Cancer Center Munich, München, Germany
| | - Frank Kullmann
- Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany
| | - Markus Kapp
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Christoph Thomas Germer
- Universitätsklinikum Würzburg, Chirurgische Klinik und Poliklinik I and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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Eickhoff A, Hartmann D, Jakobs R, Schilling D, Adamek H, Kohler B, Benz C, Arnold J, Harloff M, Maier M, de Mas CR, Martin WR, Weber J, Dorlars D, Pereira-Lima JC. Vorsorge und Screening beim kolorektalen Karzinom. Dtsch Med Wochenschr 2018; 143:115-122. [DOI: 10.1055/s-0043-124737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Götz M, Braun G, Jakobs R, Messmann H, Stange EF, Lerch MM. [German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) position statement on endoscopic decompression in acute Ileus]. Z Gastroenterol 2017; 55:1499-1508. [PMID: 29212105 DOI: 10.1055/s-0043-120351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In patients with ileus with dilated intestine in imaging studies, endoscopic decompression appears a feasible option. However, its use is often uncritical and without scientific evidence. Before considering endoscopic intervention, CT-imaging should differentiate between mechanical obstruction and paralytic ileus/intestinal pseudo-obstruction. Tumor diagnosis and localisation are essential because the latter determines the choice of the decompression procedure. Coecal dilatation of more than 12 cm indicates an increased risk of perforation. In patients with toxic megacolon, dilation of the transverse colon to more than 6 cm is considered critical without much prospective evidence. Endoscopic decompression has a high complication rate and should be performed electively, and not as an emergency procedure, whenever possible. The use of CO2 insufflation rather than ambient air is strongly recommended, as is the availability of fluoroscopy. Prior trans-nasal or oral decompression-tube placement is routinely performed, and tracheobronchial intubation frequently required. In over 90 % of patients with pseudo-obstruction, conservative treatment is successful within 24 to 48 hours, and endoscopic decompression is, therefore, unnecessary. Placement of self-expanding metal stents to decompress a tumor stenosis is considered mostly for the left colon and rectum and burdened with significant risks of perforation and stent migration. Stent impact on oncological outcome is controversial because of possible tumor cell mobilization and increased postoperative cancer recurrence rates. Surgery, as primary intervention, achieves its objective in most cases. Decompression effect by endoscopic suctioning of gas and intestinal fluid is usually transient so that it is combined with transrectal decompression tubes insertion. This paper reviews the advantages and flaws of various decompression procedures in different clinical settings.
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Affiliation(s)
- Martin Götz
- Innere Medizin 1, Universitätsklinikum Tübingen
| | - Georg Braun
- III. Medizinischen Klinik, Klinikum Augsburg
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen
| | | | | | - Markus M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsklinikum Greifswald
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Meining A, Schmidbaur W, Schumacher B, Toermer T, Keuchel M, Baltes P, Denzer U, Götz M, Hochberger J, Jakobs R, Klaus J, Moog G, Rosien U, von Delius S, Wehrmann T, Lerch M, Lammert F. Neufassung der Standard-Terminologie in der gastroenterologischen Endoskopie – Ergebnis eines Konsensusprojekts der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. Z Gastroenterol 2017; 56:e1. [DOI: 10.1055/s-0035-1567241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Brigitte Schumacher
- Klinik für Innere Medizin und Gastroenterologie, Elisabeth-Krankenhaus Essen
| | | | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Hamburg-Bergedorf
| | - Peter Baltes
- Klinik für Innere Medizin, Bethesda Krankenhaus Hamburg-Bergedorf
| | - Ulrike Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Marburg
| | - Martin Götz
- Innere Medizin I, Universitätsklinikum Tübingen
| | | | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen
| | - Jochen Klaus
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - Gero Moog
- Gastroenterologische Facharztpraxis Kassel
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus Hamburg
| | - Stefan von Delius
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar München
| | | | - Markus Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - Frank Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg
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Mueller-Gerbes D, Hartmann B, Lima JP, de Lemos Bonotto M, Merbach C, Dormann A, Jakobs R. Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients. Endosc Int Open 2017; 5:E603-E607. [PMID: 28670617 PMCID: PMC5482745 DOI: 10.1055/s-0043-106582] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Buried bumper syndrome is an infrequent complication of percutaneous endoscopic gastrostomy (PEG) that can result in tube dysfunction, gastric perforation, bleeding, peritonitis or death. The aim of this study was to compare the efficacy of different PEG tube removal methods in the management of buried bumper syndrome in a large retrospective cohort. PATIENTS AND METHODS From 2002 to 2013, 82 cases of buried bumper syndrome were identified from the databases of two endoscopy referral centers. We evaluated the interval between gastrostomy tube placement and diagnosis of buried bumper syndrome, type of treatment, success rate and complications. Four methods were analyzed: bougie, grasp, needle-knife and minimally invasive push method using a papillotome, which were selected based on the depth of the buried bumper. RESULTS The buried bumper was cut free with a wire-guided papillotome in 35 patients (42.7 %) and with a needle-knife in 22 patients (26.8 %). It could be pushed into the stomach with a dilator without cutting in 10 patients (12.2 %), and was pulled into the stomach with a grasper in 12 patients (14.6 %). No adverse events (AEs) were registered in 70 cases (85.4 %). Bleeding occurred in 7 patients (31.8 %) after cutting with a needle-knife papillotome and in 1 patient (8.3 %) after grasping. No bleeding was recorded after using a standard papillotome or a bougie ( P < 0.05). Ten of 22 patients (45.5 %) treated with the needle-knife had a serious AE and 1 patient died (4.5 %). CONCLUSIONS We recommend that incomplete buried bumpers be removed with a bougie. In cases of complete buried bumper syndrome, the bumper should be cut with a wire-guided papillotome and pushed into the stomach.
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Affiliation(s)
- Daniela Mueller-Gerbes
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik/Gastroenterologie, Köln, Germany,Corresponding author Daniela Mueller-Gerbes Kliniken der Stadt Köln gGmbHKrankenhaus Holweide, Medizinische KlinikNeufelder Str. 3251067 Köln
| | - Bettina Hartmann
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
| | | | - Michele de Lemos Bonotto
- Santa Casa Hospital/Porto Alegre University of Health Sciences, Department of Gastroenterology, Porto Alegre, Brazil
| | | | - Arno Dormann
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik, Köln, Germany
| | - Ralf Jakobs
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
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Hartmann B, Vetter S, Mark B, Wagner A, Weidenhammer J, Jakobs R. Life threatening abdominal compartment syndrome as an early complication of new onset ketosis prone type 2 diabetes mellitus. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Hartmann
- Klinikum Ludwigshafen, Med. Klinik C, Ludwigshafen, Germany
| | - S Vetter
- Klinikum Ludwigshafen, Med. Klinik C, Ludwigshafen, Germany
| | - B Mark
- Klinikum Ludwigshafen, Med. Klinik B, Ludwigshafen, Germany
| | - A Wagner
- Klinikum Ludwigshafen, Chirurgische Klinik A, Ludwigshafen, Germany
| | - J Weidenhammer
- Klinikum Ludwigshafen, Med. Klinik C, Ludwigshafen, Germany
| | - R Jakobs
- Klinikum Ludwigshafen, Med. Klinik C, Ludwigshafen, Germany
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Rademacher C, Bechtler M, Schneider S, Hartmann B, Striegel J, Jakobs R. Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis. World J Gastroenterol 2016; 22:9554-9561. [PMID: 27920476 PMCID: PMC5116599 DOI: 10.3748/wjg.v22.i43.9554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of self-expanding metal stents (SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis (PC).
METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.
RESULTS In most cases, obstruction was caused by pancreatic (47%) or gastric cancer (23%). Technical success was achieved in 96.8% (60/62), clinical success in 79% (49/62) of all patients. Signs of carcinomatosis were identified in 27 patients (43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients (11.2%) and suspected by CT, MRI or ultrasound in 20 patients (32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease (66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC (median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure (median 14.5 d vs 75 d, P = 0.0003).
CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.
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Hartmann B, Cornelius B, Fischer K, Gass S, Schaumann A, Striegel J, Jakobs R. Hemiballismus – ein seltenes reversibles Symptom der Erstmanifestation eines Diabetes mellitus. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Denzer U, Beilenhoff U, Eickhoff A, Faiss S, Hüttl P, In der Smitten S, Jakobs R, Jenssen C, Keuchel M, Langer F, Lerch MM, Lynen Jansen P, May A, Menningen R, Moog G, Rösch T, Rosien U, Vowinkel T, Wehrmann T, Weickert U. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022]. Z Gastroenterol 2016; 53:E1-227. [PMID: 26783975 DOI: 10.1055/s-0041-109598] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- U Denzer
- Klinik und Poliklinik für Interdisziplinäre Endoskopie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - A Eickhoff
- Medizinische Klinik II, Gastroenterologie und Infektiologie, Klinikum Hanau, Hanau
| | - S Faiss
- Asklepios Klinik Barmbek, Hamburg
| | - P Hüttl
- Dr. Heberer & Kollegen, München
| | | | - R Jakobs
- Med. Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - C Jenssen
- Krankenhaus Märkisch Oderland GmbH, Klinik für Innere Medizin, Strausberg
| | - M Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg
| | - F Langer
- II. Medizinische Klinik und Poliklinik, Onkologisches Zentrum, Hubertus Wald Tumorzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald
| | | | - A May
- Medizinische Klinik II/IV, Sana Klinikum, Offenbach
| | - R Menningen
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Münster
| | - G Moog
- Gastroenterologische Facharztpraxis, Kassel
| | - T Rösch
- Medizinischen Klinik, Israelitisches Krankenhaus, Hamburg
| | - U Rosien
- FB Gastroenterologie, DKD Helios-Klinik, Wiesbaden
| | - T Vowinkel
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Münster
| | - T Wehrmann
- Medizinischen Klinik II. Klinikum am Gesundbrunnen, Heilbronn
| | - U Weickert
- Medizinischen Klinik II. Klinikum am Gesundbrunnen, Heilbronn
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Denzer U, Beilenhoff U, Eickhoff A, Faiss S, Hüttl P, In der Smitten S, Jakobs R, Jenssen C, Keuchel M, Langer F, Lerch MM, Lynen Jansen P, May A, Menningen R, Moog G, Rösch T, Rosien U, Vowinkel T, Wehrmann T, Weickert U. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022]. Z Gastroenterol 2015; 53:1496-530. [PMID: 26666284 DOI: 10.1055/s-0041-109520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- U Denzer
- Klinik und Poliklinik für Interdisziplinäre Endoskopie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - A Eickhoff
- Medizinische Klinik II, Gastroenterologie und Infektiologie, Klinikum Hanau, Hanau
| | - S Faiss
- Asklepios Klinik Barmbek, Hamburg
| | - P Hüttl
- Dr. Heberer & Kollegen, München
| | | | - R Jakobs
- Med. Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - C Jenssen
- Krankenhaus Märkisch Oderland GmbH, Klinik für Innere Medizin, Strausberg
| | - M Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg
| | - F Langer
- II. Medizinische Klinik und Poliklinik, Onkologisches Zentrum, Hubertus Wald Tumorzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald
| | | | - A May
- Medizinische Klinik II/IV, Sana Klinikum, Offenbach
| | - R Menningen
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Münster
| | - G Moog
- Gastroenterologische Facharztpraxis, Kassel
| | - T Rösch
- Medizinischen Klinik, Israelitisches Krankenhaus, Hamburg
| | - U Rosien
- FB Gastroenterologie, DKD Helios-Klinik, Wiesbaden
| | - T Vowinkel
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Münster
| | - T Wehrmann
- Medizinischen Klinik II. Klinikum am Gesundbrunnen, Heilbronn
| | - U Weickert
- Medizinischen Klinik II. Klinikum am Gesundbrunnen, Heilbronn
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Dietrich C, Hochdörffer R, Fuchs ES, Vetter S, Jakobs R, Bechtler M. Successful use of Hemospray to control refractory duodenal diverticular bleeding. Endoscopy 2015; 46 Suppl 1 UCTN:E605-6. [PMID: 25502262 DOI: 10.1055/s-0034-1390713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Christian Dietrich
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Rico Hochdörffer
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Erik S Fuchs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Stephan Vetter
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Bechtler
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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Schmidt A, Riecken B, Rische S, Klinger C, Jakobs R, Bechtler M, Kähler G, Dormann A, Caca K. Wing-shaped plastic stents vs. self-expandable metal stents for palliative drainage of malignant distal biliary obstruction: a randomized multicenter study. Endoscopy 2015; 47:430-6. [PMID: 25590188 DOI: 10.1055/s-0034-1391232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND STUDY AIMS Previous studies have shown superior patency rates for self-expandable metal stents (SEMS) compared with plastic stents in patients with malignant biliary obstruction. The aim of this study was to compare stent patency, patient survival, and complication rates between a newly designed, wing-shaped, plastic stent and SEMSs in patients with unresectable, malignant, distal, biliary obstruction. PATIENTS AND METHODS A randomized, multicenter trial was conducted at four tertiary care centers in Germany. A total of 37 patients underwent randomization between March 2010 and January 2013. Patients underwent endoscopic retrograde cholangiography with insertion of either a wing-shaped, plastic stent without lumen or an SEMS. RESULTS Stent failure occurred in 10/16 patients (62.5 %) in the winged-stent group vs. 4/18 patients (22.2 %) in the SEMS group (P = 0.034). The median time to stent failure was 51 days (range 2 - 92 days) for the winged stent and 80 days (range 28 - 266 days) for the SEMS (P = 0.002). Early stent failure (< 8 weeks after placement) occurred in 8 patients (50 %) vs. 2 patients (11.1 %), respectively (P = 0.022). After obtaining the results from this interim analysis, the study was discontinued because of safety concerns. CONCLUSIONS The frequency of stent failure was significantly higher in the winged-stent group compared with the SEMS group. A high incidence of early stent failure within 8 weeks was observed in the winged-stent group. Thus, the winged, plastic stent without central lumen may not be appropriate for mid or long term drainage of malignant biliary obstruction. Study registration ClinicalTrials.gov (NCT01063634).
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Susanne Rische
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Christoph Klinger
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Ralf Jakobs
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Bechtler
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Georg Kähler
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Arno Dormann
- Department of Medicine, Cologne City Hospital, Holweide, Cologne, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Hartmann B, Jakobs R. Erste Ergebnisse der Epidermis Mikrograft Transplantation bei Patienten mit Diabetes mellitus- eine neue vielversprechende minimalinvasive Methode zur Deckung chronischer Wunden. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fuchs ES, Hartmann B, Jakobs R. Transgastric and percutaneous transhepatic rendezvous maneuver for the treatment of difficult intrahepatic stones. Endoscopy 2014; 46 Suppl 1 UCTN:E184-5. [PMID: 24756286 DOI: 10.1055/s-0034-1365113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | - Bettina Hartmann
- Med. Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Jakobs
- Med. Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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Bechtler M, Vollmer H, Vetter S, Fuchs ES, Weickert U, Jakobs R. Long-term follow-up after dilation in symptomatic esophageal intramural pseudodiverticulosis: an observational study in 22 cases. Endoscopy 2014; 46:795-7. [PMID: 24977396 DOI: 10.1055/s-0034-1377304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Endoscopic bougienage seems to be the most effective therapy for dysphagia in esophageal intramural pseudodiverticulosis (EIPD), but nothing is known about the long-term success of this treatment option. This report presents long-term results for 21 of 22 patients with EIPD who were treated with bougienage. A total of 103 sessions of bougienage up to a diameter of 18 mm were performed, without major complications and with 100 % clinical success. During follow-up, symptom recurrence with further bougienage occurred in 12 /21 patients (57 %), who had variable symptom-free intervals (range 1.5 - 96 months). Symptom recurrence was associated with concomitant reflux esophagitis. Although this series demonstrates that bougienage is an effective method for relieving dysphagia in EIPD, the long-term effectiveness is limited.
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Affiliation(s)
| | - Heiko Vollmer
- Medizinische Klinik II, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Stephan Vetter
- Medizinische Klinik C, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | - Uwe Weickert
- Medizinische Klinik II, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Fuchs ES, Jakobs R. [Novel oral anticoagulants in gastroenterology routine]. Dtsch Med Wochenschr 2014; 139:1784-6. [PMID: 25157869 DOI: 10.1055/s-0034-1370266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Novel direct-acting oral anticoagulants (NOAC) represent an effective new familiy of drugs and an interesting alternative to optimise and simplify anticoagulation. Rates of bleeding complications by NOAC are comparabel to those of warfarin but a previously assumed increase in gastrointestinal bleeding complications was meanwhile confirmed. Therefore, indications and contraindications concerning the use of NOAC should be closely considered. The endoscopic approach of gastrointestinal bleeding is conform to the recommended management of gastrointestinal bleeding complications under conventional anticoagulants or inhibitors of platelet aggregation. There are no specific antidotes to the anticoagulant effects of NOAC in case of bleeding. The recommendation concerning elective endoscopic procedures with high risk of bleeding more or less reflects expert oppinion. There are no recommendations on the basis of randomised studies. However, because of the short plasmatic half-life time of NOAC, their utilisation seems to be well controllable even in cases of high risk endoscopic interventions. More evidence based data about the periinterventional use of NOAC in endoscopic routine, in cases of endoscopic interventions with high bleeding risk or bleeding complications, bridging and the possibility of specific antidots in case of bleeding would be desirable.
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Affiliation(s)
- E-S Fuchs
- Medizinische Klinik C, Klinikum Ludwigshafen
| | - R Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen
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Mueller R, Gruenke M, Wendler J, Schuch F, Karina HP, Boettger I, Jakobs R, Schulze-Koops H, von Kempis J. AB1014 The Value of an Automated Ultrasound System in the Detection of Synovitis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hartmann B, Schneider S, Jakobs R. Malnutrition bei Patienten mit Diabetischem Fußsyndrom: Trotz Übergewicht teilweise schlechtere Laborparameter als Tumorpatienten. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rademacher C, Hartmann D, Spiethoff A, Jakobs R. [Ferritin and soluble interleukin-2-receptor in the diagnosis of fever of unknown origin]. Dtsch Med Wochenschr 2014; 139:23-7. [PMID: 24390846 DOI: 10.1055/s-0033-1359923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED HISTORY UND CLINICAL FINDINGS: Within a few weeks, two patients aged 16 and 75 years with fever of unknown origin were referred to the emergency unit. INVESTIGATIONS Laboratory tests revealed increased aminotransferase levels, progressive cytopenia and an increase of inflammatory markers. In the older patient a rapid clinical detoriation with multi organ failure was observed. Progressively increasing levels of ferritin and soluble-interleukin-2-receptor levels led to the diagnosis of hemophagocytic lymphohistiocytosis, which was confirmed by bone marrow examination in the case of the younger patient. TREATMENT AND COURSE Immunsuppressive treatment induced a clear improvement of clinical and laboratory findings and in the case of the older patient finally led to convalescence. CONCLUSION Hemophagocytic lymphohistiocytosis is a rare but potentially fatal differential diagnosis, which should be considered in patients with fever and cytopenia.
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Affiliation(s)
- C Rademacher
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen
| | - D Hartmann
- Innere Medizin I, Sana Klinikum Berlin Lichtenberg
| | - A Spiethoff
- Institut für Pathologie, Klinikum der Stadt Ludwigshafen
| | - R Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen
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Bandorski D, Stunder D, Höltgen R, Jakobs R, Keuchel M. [Capsule Endoscopy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators - Is the Formal Contraindication still Justified?]. Z Gastroenterol 2013; 51:747-52. [PMID: 23955141 DOI: 10.1055/s-0033-1335999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Capsule endoscopy is an established tool for investigation of the small intestine. Because of limited clinical experience in patients with cardiac devices the US Food and Drug Administration and the manufacturers recommend not to use capsule endoscopy in these patients. METHODS Studies investigating possible interference between small bowel capsule endoscopy and cardiac pacemakers and implanted cardioverters were analysed. For the review we considered studies published in English or German and indexed in PubMed (Medline) as well as relevant abstracts and technical data from the manufacturer. RESULTS In vitro and in vivo studies applying real capsules revealed no clinically relevant interference with pacemakers and implanted cardioverters. This evidence already has had an impact on clinical practice and recommendations of scientific societies. On the other hand wireless telemetry can interfere with CE video. CONCLUSION According to present evidence, small bowel capsule endoscopy can be used in patients with pacemakers and implanted cardioverters after obtaining informed consent concerning the formal existence of contraindication.
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Affiliation(s)
- Z Hirche
- Chirurgische Klinik A, Allgemein-, Viszeral-, Thorax- und Unfallchirurgie, Klinikum der Stadt Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Deutschland
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Grünke M, Wendler J, Schuch F, Jakobs R, Schulze-Koops H, von Kempis J, Mueller RB. SAT0517 Automated Ultrasound for the Detection of Joint Swelling in Arthritic Diseases. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hartmann B, Mark B, Zahn R, Jakobs R. Reduktion der Hypoglykämierate nach Einführung eines modifizierten Yale-Protokolls zur Therapie der Hyperglykämie auf einer medizinischen Intensivstation. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hartmann B, Jakobs R. Persönliche statt laborgestützter automatisierter Betreuung von Menschen mit Diabetes in einer operativen Klinik führt zu einer Verbesserung der Blutzuckerwerte, der Patientensicherheit und der Abbildung im DRG-System. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hartmann D, Keuchel M, Philipper M, Gralnek IM, Jakobs R, Hagenmüller F, Neuhaus H, Riemann JF. A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy. Endoscopy 2012; 44:482-6. [PMID: 22275051 DOI: 10.1055/s-0031-1291611] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Colon capsule endoscopy (CCE) offers an alternative approach for endoscopic visualization of the colon. Some of the current CCE bowel cleansing regimens use sodium phosphate, which has raised safety concerns. Therefore, the aim of the current study was to test the feasibility and efficacy of a new low-volume, sodium phosphate-free polyethylene glycol (PEG) bowel preparation. METHODS The first 26 patients (original cleansing procedure) received a colon cleansing regimen of PEG plus ascorbic acid: patients drank 1 L in the evening and 0.75 L in the morning before capsule ingestion. Patients also drank an additional 0.5 L PEG boost and an optional 0.25 L PEG boost during the capsule procedure. Following an interim analysis, the cleansing procedure of the subsequent 24 patients was modified, with the morning intake before capsule ingestion being increased to 1 L, as well as the second boost (0.25 L) being administered 1 - 2 hours earlier (modified cleansing procedure). RESULTS The overall colon cleanliness was considered to be good or excellent in 83 % (original cleansing procedure) and 82 % (modified cleansing procedure) of patients, without any significant difference between regimens (P > 0.05). In 37 /49 (76 %) of the CCE procedures, the hemorrhoidal plexus was identified and thus the examination was considered complete, with no significant differences between the two CCE cleansing procedures. The capsule sensitivity and specificity for detecting colonic polyps ≥ 6 mm were 91 % (95 %CI 70 % - 98 %) and 94 % (95 %CI 87 % - 97 %), respectively, compared with standard optical colonoscopy. CONCLUSION A colon cleansing procedure using PEG + ascorbic acid for capsule colonoscopy yielded an adequate cleansing level in > 80 % of patients, a completion rate of 76 %, and good accuracy for detecting polyps. This procedure may be considered as an alternative, particularly for patients in whom sodium phosphate-based preparations are contraindicated.
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Affiliation(s)
- D Hartmann
- Department of Internal Medicine I, Sana Klinikum Lichtenberg, Berlin, Germany.
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Bandorski D, Jakobs R, Brück M, Hoeltgen R, Wieczorek M, Keuchel M. Capsule Endoscopy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators: (Re)evaluation of the Current State in Germany, Austria, and Switzerland 2010. Gastroenterol Res Pract 2011; 2012:717408. [PMID: 22253620 PMCID: PMC3255108 DOI: 10.1155/2012/717408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/11/2011] [Indexed: 01/01/2023] Open
Abstract
Background and Aims. The study was a repeated evaluation of the experience of capsule endoscopy (CE) in patients with cardiac pacemaker or implantable cardioverter defibrillator (ICD). Patients and Methods. A standardized questionnaire was sent by the manufactors Given Imaging and Olympus to all centers in Germany, Austria, and Switzerland providing capsule endoscopy service. The questionnaire covers the number of examined patients, monitoring during CE, check of the electric implants before and after CE, occurrence of arrhythmia, quality of CE video, complications, indication of CE, and type of institution. Results. Overall 580 questionnaires were sent to the users. 26/5% (Germany/Austria + Switzerland) of the questionnaires were sent back anonymously to the authors. 114 centers (82 hospitals, 11 surgeries, 21 without specification) replied. In 58 centers (51%), patients with cardiac pacemaker (n = 300) and ICDs (n = 80) underwent uneventful capsule endoscopy. The predominant indication (patients with CP 97%, patients with ICD 100%) was mid gastrointestinal bleeding. Conclusion. The results of our inquiry show that in spite of formal contraindication CE is increasingly applied in bleeding patients with cardiac pacemakers/ICDs and seems to be safe even in a large cohort.
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Affiliation(s)
- Dirk Bandorski
- Medizinische Klinik 2, Universitätsklinikum Gießen, Klinikstraße 32, 35392 Gießen, Germany
- Herz-/Kreislaufzentrum Rotenburg, Heinz-Meise-Straße 100, 36199 Rotenburg, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen, Germany
| | - Martin Brück
- Medizinische Klinik 1, Klinikum Wetzlar, Forsthausstraße 1, 35578 Wetzlar, Germany
| | - Reinhard Hoeltgen
- Medizinische Klinik III, Herzzentrum Duisburg, Gerrickstraße 21, 47137 Duisburg, Germany
| | - Marcus Wieczorek
- Medizinische Klinik III, Herzzentrum Duisburg, Gerrickstraße 21, 47137 Duisburg, Germany
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029 Hamburg, Germany
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Bandorski D, Lotterer E, Hartmann D, Jakobs R, Brück M, Hoeltgen R, Wieczorek M, Brock A, de Rossi T, Keuchel M. Capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter-defibrillators - a retrospective multicenter investigation. J Gastrointestin Liver Dis 2011; 20:33-37. [PMID: 21451795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND & AIMS Capsule endoscopy (CE) is an established tool for the investigation of the small intestine. The Food and Drug Administration, Given Imaging and Olympus have not recommended the use of capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators (ICDs). The aim of this retrospective study was to investigate the safety of capsule endoscopy systems (Given Imaging and Olympus) when applied in patients with different types of pacemakers/ICDs in vivo. METHODS A standardized questionnaire was sent to high volume centers in Germany and in Austria. The questionnaire covered the age and gender of the examined patients, indication of CE, brand and type of CE, brand and model of pacemaker/ICD, check of the devices before and after CE, monitoring during CE, possible interference between CE and cardiac pacemakers/ICDs and possible adverse events during CE. RESULTS Data from 62 patients were retrieved for this study. Capsules used were Given Imaging (n=58; M2A, M2Aplus, PillCam SB2), Olympus EndoCapsule (n=3), Given PillCam Colon (n=1). The collective included patients with pacemakers/ICDS from seven brands (Biotronik, Medtronic, St. Jude Medical, Guidant, Boston Scientific, Ela Sorin, Vitatron) with a total of 19/8 (pacemaker/ICD) different types. In two patients interference between capsule endoscopy and telemetry (loss of images/gaps in video) was recorded. None of the cardiac pacemakers or ICDs was impaired in function. No clinically evident event was observed in any of these patients. CONCLUSIONS Clinical use of these CE types is safe in patients with cardiac pacemakers and ICDs. Interference can occur between CE and ECG-telemetry leading to loss of images or impaired quality of video.
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Eickhoff A, Enderle M, Hartmann D, Eickhoff J, Riemann J, Jakobs R. Effectiveness and Safety of PRECISE APC for the Treatment of Bleeding Gastrointestinal Angiodysplasia - a Retrospective Evaluation. Z Gastroenterol 2011; 49:195-200. [DOI: 10.1055/s-0029-1245785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Eickhoff A, Vetter S, von Renteln D, Caca K, Kähler G, Eickhoff JC, Jakobs R, Riemann JF. Effectivity of current sterility methods for transgastric NOTES procedures: results of a randomized porcine study. Endoscopy 2010; 42:748-52. [PMID: 20669093 DOI: 10.1055/s-0030-1255597] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Natural-orifice transluminal endoscopic surgery (NOTES) is an emerging transluminal technique in which interventions are carried out by entering the abdominal cavity via a natural orifice such as the stomach. Infection is a potential risk of the procedure, and the potential pathogens are different from those encountered with skin incisions. Currently, available data regarding prophylactic anti-infective treatment are limited. We compared the effectiveness of topical antimicrobial lavage of mouth and stomach and proton pump inhibitor therapy with gastric cleansing with sterile saline solution in preventing NOTES-related contamination and infection. METHODS A randomized survival swine study was performed. Eight pigs underwent preparation with intravenously administered proton pump inhibitors, mouth and gastric lavage (chlorhexidine), and gastric irrigation (diluted neomycin), plus single-shot intravenous antibiotics. Control group (n = 8) underwent gastric cleansing with sterile saline solution. Peritoneal biopsy, multiple smears, and dilutions for cultures were taken and incubated. The swine were sacrificed after 14 days. Bacterial load was expressed in colony-forming units (CFU). RESULTS One pig died due to gallbladder perforation after 3 days, 2/15 swine presented minor clinical signs of infection in the 14-day follow-up (all 3 pigs were in the control group). Mean C-reactive protein levels were 5.7 +/- 2.4 g/dL (therapy group) and 12.2 +/- 3.8 g/dL (control) ( P = 0.17). Bacterial growth was seen in 1/8 swine (therapy group) and 6/8 swine (control group) ( P = 0.002). Bacterial load was 282 CFU/mL (therapy) vs. 3.2 x 10 (5) CFU/mL (control) ( P = 0.023) in the follow-up. CONCLUSION The use of intravenous antibiotics in addition to topical antimicrobial lavage of mouth and stomach and treatment with proton pump inhibitors decreased the peritoneal bacterial load to almost zero and this was associated with a significantly lower peritoneal infection rate compared with saline-only lavage.
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Affiliation(s)
- A Eickhoff
- Medical Department C, Klinikum Ludwigshafen gGmbH, Ludwigshafen, Germany.
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Hochdörffer R, Eickhoff A, Apel D, Eickhoff JC, Hartmann D, Jakobs R, Riemann JF. Endoscopic resection of "giant" colorectal lesions: long-term outcome and safety. Z Gastroenterol 2010; 48:741-7. [PMID: 20607630 DOI: 10.1055/s-0028-1109971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Today, endoscopic resection is a standard procedure for the resection of colonic polyps. Before the establishment of endoscopic techniques, the surgical approach was a clearly preferred method for removal of polyps with a size larger than three centimeters. The safety and effectiveness concerning endoscopic resections of colorectal polyps also with a size of more than 3 cm have been demonstrated in numerous studies. PATIENTS AND METHODS Data from 165 patients (age: 68 +/- 10.4 years) harboring 167 polyps with a minimum diameter of 3 cm were retrospectively evaluated. Objects of interest were macroscopic morphology and histopathology of the polyps, their localization in the colon, the modality of endoscopic resection and follow-up. In those cases with macroscopic signs of malignancy the patients were excluded. RESULTS Successful endoscopic resections were obtained in 72.5 %. Therefrom, resection in the piecemeal-technique was necessary in 73.6 %. Recurrence polyps after endoscopic complete resections occurred in 26.3 % after a mean follow-up of 16 +/- 12.5 months. We registered a complication rate of 19.2 %. Relevant bleeding and perforation were registered as early complications in 18.6 %. We observed no intervention-related mortality. CONCLUSION Endoscopic mucosal resection is a safe and efficient method even for removing giant colorectal polyps. Controls are recommended at defined intervals for detecting polyp recurrence.
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Affiliation(s)
- R Hochdörffer
- Medical Department C, Klinikum Ludwigshafen Ludwigshafen, Germany.
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Rothsching M, Riemann J, Salopek S, Jakobs R. Portsysteme und klinischer Umgang mit Ports. Dtsch Med Wochenschr 2010; 135:1134-6. [DOI: 10.1055/s-0030-1255137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vetter S, Jakobs R, Weickert U. Ursachen, Therapie und Verlauf benigner, nicht-peptischer Ösophagusstenosen in der klinischen Routine. Dtsch Med Wochenschr 2010; 135:1061-6. [DOI: 10.1055/s-0030-1253699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, gamma-GT [gamma-glutamyl transferase] 503 U/l). The patient's medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molecular biological tests. There was no diagnostic evidence for underlying autoimmune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient's social environment, so that a zoonotic origin has to be discussed.
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Affiliation(s)
- Stephan Vetter
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes, Gutenberg-Universität Mainz., Mainz, Germany.
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Hartmann B, Siegel E, Teichmann J, Jakobs R. Das Ludwigshafener Diabetes- Modell 2001–2009: Nachhaltige Verbesserung der Versorgungsstrukturen und Entwicklungspotential für die Zukunft in einem Krankenhaus der Maximalversorgung. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bedau S, Stahl U, Jakobs R. [Dysphagia, heartburn and esophageal bolus impaction in a 43-year old male patient: not always reflux disease]. Internist (Berl) 2009; 51 Suppl 1:289-92. [PMID: 20012257 DOI: 10.1007/s00108-009-2482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of a 43 year old male patient, who was admitted with recurring esophageal bolus impactions. Since his childhood he has been complaining about dysphagia and was unable to swallow medication. He also complained about heartburn. The last esophageal bolus impaction was some weeks ago. After elimination of the bolus impaction with a rigid endoscope we found a high grade stenosis in the proximal esophagus that could not even be passed with a children's endoscope. An initial treatment of eosinophil esophagitis would be the therapy with a local corticoid for 6-9 month. In patients with typical rings or stenosis a dilation therapy might be necessary.
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Affiliation(s)
- S Bedau
- Medizinische Klinik II, Klinikum Wetzlar-Braunfels (Standort Wetzlar), Forsthausstrasse 1 E, 35578, Wetzlar, Deutschland.
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Jakobs R, Riemann J. Kommentar. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1233693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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