0000000000053209
AUTHOR
Liebwin Gossner
Secondary sclerosing cholangitis after long-term treatment in an intensive care unit: clinical presentation, endoscopic findings, treatment, and follow-up.
Background and study aims We present ten patients who developed secondary sclerosing cholangitis following long-term treatment in an intensive care unit (ICU) between 1999 and 2004. Patients and methods Ten consecutive patients who had no evidence suggestive of pre-existing hepatobiliary disease were admitted to an ICU because of trauma (n = 5), intracerebral hemorrhage (n = 3), or nonabdominal postsurgical complications (n = 2). All the patients had required treatment with long-term ventilation, catecholamines, total parenteral nutrition, and several antimicrobial agents. Results Cholestasis was first noted within 11 days after the initial insult. Endoscopic retrograde cholangiopancreatogr…
Prospective Multicenter Trial Comparing Push-and-Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders
Prospective Multicenter Trial Comparing Push-and-Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders
Long-term Efficacy and Safety of Endoscopic Resection for Patients With Mucosal Adenocarcinoma of the Esophagus
Background & Aims Barrett's esophagus–associated high-grade dysplasia is commonly treated by endoscopy. However, most guidelines offer no recommendations for endoscopic treatment of mucosal adenocarcinoma of the esophagus (mAC). We investigated the efficacy and safety of endoscopic resection in a large series of patients with mAC. Methods We collected data from 1000 consecutive patients (mean age, 69.1 ± 10.7 years; 861 men) with mAC (481 with short-segment and 519 with long-segment Barrett's esophagus) who presented at a tertiary care center from October 1996 to September 2010. Patients with low-grade and high-grade dysplasia and submucosal or more advanced cancer were excluded. All patien…
Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett's cancer and high-grade intraepithelial neoplasia
Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) has proven to be safe and effective in patients with early neoplasia in Barrett's esophagus. However, long-term results in patients with high-grade intraepithelial neoplasia (HGIN) or with early cancer are still lacking.The aim of the study was to evaluate the efficacy of ALA-PDT and the survival of patients with early Barrett's neoplasia. ALA-PDT was carried out in 66 patients. Protoporphyrin IX induced by oral administration of ALA (60 mg/kg body weight orally applied 4-6 hours before PDT) was used as the photosensitizer. Acid suppression was maintained in all patients.Between September 1996 and September 2002, 667 patients with …
[Early duodenal adenocarcinoma arising in gastric metaplasia treated by endoscopic resection].
Duodenale Fruhkarzinome sind eine Seltenheit. Die meisten duodenalen Karzinome werden in einem fortgeschrittenen Stadium diagnostiziert. Wir berichten den Fall einer 59-jahrigen Patientin, welche zur weiteren Diagnostik und Therapie eines auswarts diagnostizierten duodenalen Fruhkarzinoms zu uns uberwiesen wurde. Die Osophagogastroduodenoskopie bei Aufnahme ergab eine Typ IIa+c-Lasion im proximalen Duodenum (10 - 12 mm grose zentral diskret eingesenkte Lasion). Mittels Chromo- und Magnifikationsendoskopie konnte die Lasion gut demarkiert und Veranderungen der Zottenarchitektur im Sinne einer Neoplasie gesehen werden. Nach Unterspritzung mit einer verdunnten Adrenalin-Losung konnte die Lasio…
Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions
The macroscopic appearance of early gastric cancers, classified according to the Japanese criteria, has been shown to be an important prognostic factor for local endoscopic therapy. No prospective data about the distribution of macroscopic types and their location in early Barrett's neoplasia are available, however. The present study was conducted to evaluate the clinical applicability of this macroscopic classification and to analyze the relative proportions of the different gross types in early Barrett's neoplasms and the correlation between the macroscopic classification and the stage or grade of differentiation.A total of 344 patients with 380 Barrett's neoplastic lesions who were refer…
Long-term results of endoscopic resection in early gastric cancer: the Western experience.
Top of pageAbstract OBJECTIVES: In the West, neither acute nor long-term results of endoscopic resection (ER) for early gastric cancer (EGC) have been reported in large studies. The aim of this study was to prospectively evaluate the efficacy and safety of ER in patients with EGC in a long-term follow-up (FU). METHODS: From May 1995 to October 2004, 179 patients were referred to our department for endoscopic therapy (ET) of gastric cancer (GC). Of these, 43 patients had intramucosal GC with a diameter of up to 30 mm and underwent ER with curative intent. All patients underwent a strict FU protocol at regular intervals. RESULTS: Of the 43 patients, 42 fulfilled our low-risk criteria for E…
Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia.
Background and study aims Endoscopic resection of esophageal squamous-cell neoplasia with curative intent is considered to be a safe and effective alternative treatment to radical surgery in cases where the neoplasia is intraepithelial or limited to the mucosal layer. These patients are at risk for recurrent malignancy in the preserved esophagus, however. We conducted a prospective study to evaluate the efficacy and safety of endoscopic resection and to analyze variables associated with recurrence in patients with mucosal or intraepithelial squamous-cell neoplasia. Patients and methods Between December 1997 and September 2005, 65 patients (mean age +/- standard deviation [SD] 62.9 +/- 9.5 y…
Invisible gastric carcinoma detected by random biopsy: long-term results after photodynamic therapy
Background and study aims Gastric cancer diagnosed from routine gastric biopsies without any evidence of a visible lesion and negative repeated biopsies is an infrequent but serious clinical problem for which gastrectomy has usually been recommended, even if operative specimens do not show cancer either. We report on a series of 22 such patients undergoing long-term follow-up after attempted treatment with photodynamic therapy (PDT). Patients and methods 22 patients with invisible gastric cancer (IGC) who presented during a 10-year period (10 men, mean age 56 +/- 15 years) were prospectively included. Initial histopathological findings confirmed by second opinion included 10 well-differenti…
Successful Endoscopic Resection of an Esophageal Metastasis from a Preceding Squamous-Cell Tonsillar Carcinoma
This report describes the case of a 62-year-old man with tonsillar carcinoma who had undergone esophagectomy due to an esophageal metastasis. Subsequently, a second metastasis occurred in the residual esophagus, and he presented for evaluation for local endoscopic therapy. The initial upper endoscopy revealed a type IIa - c lesion at 21 cm from the incisors, within a segment suspicious for Barrett's mucosa. As part of the complex treatment approach in this patient, endoscopic resection of the lesion was carried out using the suck-and-cut technique with ligation. Histology showed that the lesion was a metastasis from a squamous-cell carcinoma, with focal infiltration of the upper submucosal …
The Impact of Endoscopic Ultrasound and Computed Tomography on the TNM Staging of Early Cancer in Barrett's Esophagus
Computed tomography (CT) and endoscopic ultrasound (EUS) are part of the regular staging protocol in esophageal cancer. The value of the two methods was assessed in patients with early cancer in Barrett's esophagus.One hundred consecutive patients (median age 64 yr, interquartile range [IQR] 58-72) with suspected early cancer in Barrett's esophagus who were referred to our hospital for endoscopic therapy were prospectively included in a standardized staging program with upper gastrointestinal endoscopy, EUS (7.5 MHz in all cases plus 12.5 or 20 MHz for elevated and/or depressed lesions), CT of the chest and upper abdomen, and abdominal ultrasonography. The results were summarized in accorda…
Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer).
Background In view of the increasing incidence of adenocarcinoma in Barrett's esophagus and the mortality and high morbidity rates associated with surgical therapy for this condition, safe and effective but less invasive methods of treatment are needed. Objective To evaluate efficacy and safety of endoscopic resection in these patients. Design Single-center prospective study. Setting Teaching hospital, conducted between October 1996 and September 2003. Patients A total of 100 consecutive patients (mean age, 62.1 ± 10.9 years; range, 31–86 years) with low-risk adenocarcinoma of the esophagus (macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion without invasion…
Endoscopic Resection of Superficial Esophageal Squamous-Cell Carcinomas: Western Experience
Objectives Endoscopic resection of esophageal squamous-cell neoplasia with curative intent appears to be an alternative treatment to radical surgery when the malignant neoplasia is intraepithelial or limited to the mucosal layer, since the risk for lymph-node metastases is very low. In contrast to Japan, there has so far been only limited experience in Europe and the United States with endoscopic resection in such cases. In the present observational study, we report on the largest prospective series so far in Western countries of patients with early squamous-cell cancer or carcinoma in situ, who were treated using endoscopic resection therapy. Methods Between December 1997 and November 2001…
In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy.
Background & Aims: Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy. Here, we have applied this technique to the in vivo diagnosis of Barrett's epithelium and associated neoplasia. Methods: Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus. Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed. In vivo histology was compared with the histologic specimens. All digitally stored images were re-assessed by a b…