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…

A New Self-Expanding Nitinol Stent (JoStent SelfX) for Palliation of Malignant Biliary Obstruction: a Pilot Study

Background and Study Aims: The JoStent SelfX is a new biliary uncovered self-expanding nitinol stent. The main advantage of this stent in comparison with the gold standard Wallstent is the minimal shortening (< 10%) that occurs during stent deployment. A prospective feasibility study was conducted to evaluate the method of stent implantation and the stent's short-term efficacy. Patients and Methods: Between April 2001 and December 2002, the JoStent SelfX was implanted in 20 patients with inoperable malignant biliary obstructions, mainly caused by pancreatic cancer (12 of 20). All patients underwent sphincterotomy prior to stent insertion. After implantation, laboratory parameters for choles…

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

Prospective multicenter trial of capsule endoscopy in patients with chronic abdominal pain, diarrhea and other signs and symptoms (CEDAP-Plus Study)

Background On the basis of the published data, capsule endoscopy cannot be recommended in patients whose only symptom is chronic abdominal pain. The present study therefore focused on the diagnostic yield of capsule endoscopy in patients with chronic abdominal pain who were also suffering from additional symptoms. Patients and methods A total of 50 patients with chronic abdominal pain, plus other symptoms singly or in combination were enrolled in this prospective multicenter trial. The "plus" symptoms or signs consisted of weight loss (> 10 % of body weight), inflammation shown by laboratory tests, chronic anemia, or suspected mid-gastrointestinal bleeding. Chronic diarrhea was recorded if …

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…

Shared Genetic Etiology of Obesity-Related Traits and Barrett's Esophagus/Adenocarcinoma: Insights from Genome-Wide Association Studies

Abstract Background: Obesity is a major risk factor for esophageal adenocarcinoma (EA) and its precursor Barrett's esophagus (BE). Research suggests that individuals with high genetic risk to obesity have a higher BE/EA risk. To facilitate understanding of biological factors that lead to progression from BE to EA, the present study investigated the shared genetic background of BE/EA and obesity-related traits. Methods: Cross-trait linkage disequilibrium score regression was applied to summary statistics from genome-wide association meta-analyses on BE/EA and on obesity traits. Body mass index (BMI) was used as a proxy for general obesity, and waist-to-hip ratio (WHR) for abdominal obesity. …

Barrett's esophagus: endoscopic resection

In experienced hands, ER is a safe method of resecting dysplastic lesions and early carcinomas of the GI tract, and it has decisive advantages compared with other local endoscopic treatment procedures (such as thermal destruction and PDT). The opportunity for histological processing of the resected specimen provides information regarding the depth of invasion of the individual layers of the GI tract wall. Additionally, it has advantages regarding excision with healthy margins. This means that even when there is infiltration of the submucosa that has not been detected before treatment--in which case local endoscopic therapy is no longer appropriate--a patient with early Barrett's cancer stil…

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 …

Conclusions from the histological diagnosis of low-grade intraepithelial neoplasia in Barrett's oesophagus.

It is well known that low-grade intraepithelial neoplasia (LGIN) in Barrett's oesophagus (BE) might progress to high-grade intraepithelial neoplasia (HGIN) or carcinoma. Since accurate diagnosis of LGIN is difficult, general pathologists are frequently uncertain about the diagnosis of LGIN and its follow-up risks. The purpose of this study was to analyse the divergence between the diagnoses of general and specialized gastrointestinal pathologists.Fifty consecutive patients with a previous diagnosis of LGIN in BE, made by a general pathologist, were included in our study. The histopathological slides of every patient were reassessed in a blinded fashion by two specialized gastrointestinal (G…

Impact of fluoroscopy on oral double-balloon enteroscopy: results of a randomized trial in 156 patients

Background and study aims The routine utility of fluoroscopy during double-balloon enteroscopy (DBE) via the oral route has been not prospectively evaluated. Up to now, there have been no prospective randomized trials to assess whether fluoroscopy improves outcomes. The aim of this study was to assess the value of fluoroscopy during oral DBE. Patients and methods A total of 156 patients (88 men, 56.4 %) of mean (standard deviation [SD]) age 56 (19) years were randomly assigned to undergo oral DBE either with or without fluoroscopy. The majority of the patients had obscure gastrointestinal bleeding (n = 96, 62 %). The primary target criteria for the study were postpyloric insertion depth and…

European experiences with push-and-pull enteroscopy in double-balloon technique (double-balloon enteroscopy).

This article describes research concerning push-and-pull enteroscopy. Clear and possible indications for this technique are highlighted.

[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…

Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett's esophagus.

Background and study aims Computed virtual chromoendoscopy (CVC) is a new imaging technique that enhances mucosal surface contrast and highlights the vascular pattern without the need for dye-spraying as in conventional chromoendoscopy. The aim of this prospective randomized pilot study with a crossover design was to compare CVC with conventional chromoendoscopy with acetic acid (CAA) for the detection of high grade intraepithelial neoplasia (HGIN) or early cancer in patients with Barrett's esophagus. Patients and methods 57 patients with Barrett's esophagus (mean length 3.8 cm) and a history of HGIN/early cancer or suspected HGIN/early cancer were randomly allocated to undergo either CAA o…

Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations.

Double-balloon enteroscopy (DBE) is a new endoscopic tool that not only allows diagnostic workup of small bowel diseases, but also makes it possible to carry out therapeutic interventions. However, for a variety of reasons, endoscopic therapy appears to be more difficult to carry out deep in the small bowel than in the upper or lower gastrointestinal tract.The purpose of this study was to evaluate the acute technical success and acute complication rate of DBE.Between June 2003 and July 2006, 353 patients (152 women, 201 men; mean age 60.3 +/- 17.1 yr) with suspected or known small bowel disease underwent 635 consecutive DBE procedures. The majority of the patients were suffering from midgas…

Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial

The increasing use of endoscopic resection for curative treatment of early oesophageal cancers requires accurate staging before therapy. In a prospective blinded trial, we compared staging of early oesophageal carcinoma using high resolution endoscopy (HR-E) with staging using high resolution endosonography (HR-EUS).A total of 100 patients (89 men, 11 women; mean age 63.9 (10.8) years (range 31-91)) with a suspicion of early oesophageal adenocarcinoma (n = 81) or squamous cell carcinoma (n = 19) were enrolled in the study. After endoscopic staging with high resolution video endoscopy by two experienced endoscopists, HR-EUS was performed by an experienced endosonographer who was blinded to t…

The Barrett‐associated variants at GDF 7 and TBX 5 also increase esophageal adenocarcinoma risk

Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) represent two stages within the esophagitis-metaplasia-dysplasia-adenocarcinoma sequence. Previously genetic risk factors have been identified that confer risk to BE and EAC development. However, to which extent the genetic variants confer risk to different stages of the BE/EAC sequence remains mainly unknown. In this study we analyzed three most recently identified BE variants at the genes GDF7 (rs3072), TBX5 (rs2701108), and ALDH1A2 (rs3784262) separately in BE and EAC samples in order to determine their risk effects during BE/EAC sequence. Our data show that rs3072 at GDF7 and rs2701108 at TBX5 are also associated with EAC and …

ag) Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.

BACKGROUND AND STUDY AIMS The aim of this study was to evaluate the feasibility, safety, and clinical impact of push-and-pull enteroscopy (PPE) in patients with suspected or documented small-bowel diseases, in a prospective multicenter trial in three European medical centers. PATIENTS AND METHODS A total of 100 patients (mean age 56 +/- 16 years; range 13 - 90) were included at the three institutions between July and November 2004. The leading symptoms were: acute recurrent or chronic gastrointestinal bleeding (n = 64), polyposis syndrome (n = 8), chronic abdominal pain (n = 7), chronic diarrhea (n = 7), and others (n = 14). RESULTS No major PPE-associated complications such as perforation,…

Double-Balloon Enteroscopy: Preliminary Experience in Patients with Obscure Gastrointestinal Bleeding or Chronic Abdominal Pain

Background and Study Aims: Even in the era of capsule endoscopy, diseases of the small bowel are sometimes difficult to diagnose, and endoscopic treatment is not possible without surgical laparotomy. The new method of carrying out enteroscopy using a double-balloon technique allows not only diagnostic but also therapeutic endoscopic interventions for lesions in the small bowel. Preliminary experience with this new method is reported here. Patients and Methods: Between the end of March 2003 and August 2003, eight patients (four women, four men; mean age 59 ± 23 years, range 20 - 90) with chronic gastrointestinal bleeding or abdominal pain, or both, underwent enteroscopy using the double-bal…

Extraction of Entrapped Capsules from the Small Bowel by Means of Push-and-Pull Enteroscopy with the Double-Balloon Technique

The new technique of push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) makes it possible to remove swallowed foreign bodies causing intestinal obstruction deep in the small bowel without the need for surgical laparotomy. This report describes two cases of enteroscopic removal of entrapped capsules. In one patient with acute recurrent intestinal bleeding and recurrent abdominal pain, Crohn's disease had been suspected on capsule endoscopy. The second patient, with known Crohn's disease, was suffering from abdominal pain and underwent capsule endoscopy for investigation of the small bowel. Prior enteroclysis had not revealed stenoses in either patient. …

Management of pre-malignant and malignant lesions by endoscopic resection

Endoscopic resection (ER) has gained more and more importance in the treatment of early gastrointestinal neoplasia over the last few years. The choice of the different available techniques depends on the site, the macroscopic type of the tumour and the personal experience of the endoscopist. The 'suck-and-cut' technique with ligation device or cap should be favoured to normal strip biopsy in the oesophagus because of the size of the resected specimen and its technical feasibility. A recently described method of ER in the stomach is the circumferential mucosal incision with a type of needle-knife and subsequent en-bloc resection following prior injection under the lesions. ER of high-grade i…

Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease

Background Double-balloon enteroscopy (push-and-pull enteroscopy) is a new method that allows complete visualization, biopsy, and treatment in the small bowel. This study evaluated the feasibility and the diagnostic and the therapeutic yield of double-balloon enteroscopy (push-and-pull enteroscopy) in comparison with current imaging methods. Methods Between March 2003 and November 2004, 248 consecutive double-balloon enteroscopies (push-and-pull enteroscopies) were performed in a prospective study in 137 patients with suspected small-bowel disease (60 women, 77 men; mean age 56.6 ± 17.8 years), most with chronic GI bleeding (66%). The examinations were carried out after negative evaluations…

Influence of Patient Selection on the Outcome of Capsule Endoscopy in Patients With Chronic Gastrointestinal Bleeding

Background: In chronic gastrointestinal bleeding, success rates in the range of 48% to 76% have been reported for diagnosing clear bleeding sources using capsule endoscopy. The influence of patient selection on the numbers of positive findings yielded by capsule endoscopy is as yet unclear. Methods: From April 2001 to June 2003, capsule endoscopy was carried out in 74 of a total of 127 patients (58%) who presented for capsule endoscopy with a high suspicion of gastrointestinal bleeding in the small-bowel region. Seventy of the 74 patients were included in the analysis. This group of patients was divided into a study group (32 patients) and a post-study group (38 patients), and the two group…

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…

Germline variation in the insulin-like growth factor pathway and risk of Barrett's esophagus and esophageal adenocarcinoma

Contains fulltext : 235640.pdf (Publisher’s version ) (Closed access) Genome-wide association studies (GWAS) of esophageal adenocarcinoma (EAC) and its precursor, Barrett's esophagus (BE), have uncovered significant genetic components of risk, but most heritability remains unexplained. Targeted assessment of genetic variation in biologically relevant pathways using novel analytical approaches may identify missed susceptibility signals. Central obesity, a key BE/EAC risk factor, is linked to systemic inflammation, altered hormonal signaling and insulin-like growth factor (IGF) axis dysfunction. Here, we assessed IGF-related genetic variation and risk of BE and EAC. Principal component analys…

Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy.

Background and study aims Several factors predict difficult or incomplete colonoscopy with a standard colonoscope, including female gender, low body mass index, extensive diverticulosis, and prior pelvic surgery. Patients and methods A push-and-pull enteroscopy device and a single-balloon technique was used in 14 patients (six men, eight women; mean age 62 +/- 15 years) after failure of ileocolonoscopy or endoscopic therapy using either a standard or a pediatric colonoscope. The original ileocolonoscopy had been performed to investigate colon polyps (n = 6), an obscure inflammatory process in the ileocecal region (n = 6), or iron deficiency anemia with a positive fecal occult stool test (n …

Computed Virtual Chromoendoscopy for Classification of Small Colorectal Lesions: A Prospective Comparative Study

Standard colonoscopy offers no reliable discrimination between neoplastic and nonneoplastic colorectal lesions. Computed virtual chromoendoscopy with the Fujinon intelligent color enhancement (FICE) system is a new dyeless imaging technique that enhances mucosal and vascular patterns. This prospective trial compared the feasibility of FICE, standard colonoscopy, and conventional chromoendoscopy with indigo carmine in low- and high-magnification modes for determination of colonic lesion histology.Sixty-three patients with 150 flat or sessile lesions less than 20 mm in diameter were enrolled. At colonoscopy, each lesion was observed with six different endoscopic modalities: standard colonosco…

How much importance do we have to place on complete enteroscopy?

Double-balloon enteroscopy-facilitated cyanoacrylate-injection endotherapy of small-bowel varices: an international experience from 2 European tertiary centers (with videos).

Background and Aims Small-bowel varices (SBVs) are an uncommon consequence of portal hypertension. Radiologic intervention is usually considered for first-line management. When radiologic intervention is not possible, management options become very limited. The aim of this study was to evaluate the usefulness of double-balloon enteroscopy (DBE)-facilitated cyanoacrylate-injection endotherapy of SBVs. Methods This was a retrospective review of DBE-facilitated cyanoacrylate-injection endotherapy of SBVs (December 2015 to October 2016). Results Ten DBEs were performed in 6 patients (4 women; median age, 68.5 years). No radiologic or surgical options were deemed feasible. Thirteen nests of SBVs…

Supportive evidence for FOXP 1 , BARX 1 , and FOXF 1 as genetic risk loci for the development of esophageal adenocarcinoma

The Barrett's and Esophageal Adenocarcinoma Consortium (BEACON) recently performed a genome-wide association study (GWAS) on esophageal adenocarcinoma (EAC) and Barrett's esophagus. They identified genome-wide significant association for variants at three genes, namely CRTC1, FOXP1, and BARX1. Furthermore, they replicated an association at the FOXF1 gene that has been previously found in a GWAS on Barrett's esophagus. We aimed at further replicating the association at these and other loci that showed suggestive association with P < 10(-4) in the BEACON sample. In total, we tested 88 SNPs in an independent sample consisting of 1065 EAC cases and 1019 controls of German descent. We could repl…

Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus

Background. Barrett’s oesophagus embodies the risk of malignant transformation. High-grade intraepithelial neoplasia and early cancer in Barrett’s oesophagus are often discrete or macroscopically occult lesions and show a patchy distribution and therefore, directed biopsies in combination with four-quadrant random biopsies are the gold standard for surveillance. Aims. The aim of this prospective study was to compare methylene blue staining and random biopsies in patients with early Barrett’s neoplasia. Patients and methods. Eighty-six patients (mean age 65 ± 8 years) with histologically proven but macroscopically in evident high-grade intraepithelial neoplasia (n = 17) or early cancer in Ba…

Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders

Background Double-balloon enteroscopy (DBE) is an established method in diagnostic and therapeutic small-bowel enteroscopy. Objective Spiral enteroscopy (SE) appears to be a promising new technique. A randomized, prospective study was conducted to compare both methods. Design Randomized, prospective study. Setting Single tertiary referral center. Patients Between September 2009 and March 2011, 26 patients with suspected mid-GI disorders completed the study. Interventions Patients were randomly assigned to DBE or SE. The oral examination was conducted first, with the deepest point reached being marked with India ink. An additional anal examination followed the day after, with the aim of reac…

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…

Small-Bowel Diagnosis in Patients with Familial Adenomatous Polyposis: Comparison of Push Enteroscopy, Capsule Endoscopy, Ileoscopy, and Enteroclysis

BACKGROUND: Conventional upper endoscopy (EGD), EGD with side-view endoscope and ileoscopy are established procedures for endoscopic evaluation of patients with familial adenomatous polyposis (FAP). However, we still have little data on the frequency and relevance of adenomas in those parts of the small bowel which are not accessible to EGD and ileoscopy. Adenomas distal to the duodenum are found more often in FAP patients with known duodenal adenomas. The question is, whether these patients can benefit from additional endoscopic and/or radiographic examinations. METHODS: Between July 2001 and August 2006 we performed comparative small bowel studies with push enteroscopy (PE), capsule endos…

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 …

Balloon Enteroscopy: Single- and Double-Balloon Enteroscopy

Balloon enteroscopy is a method that allows endoscopic inspection of the entire small bowel, or large parts of it, while simultaneously making it possible to obtain histologic samples and carry out treatment measures. Studies of double-balloon enteroscopy (DBE) have confirmed the high diagnostic yield of the procedure, with an acceptably low complication rate (approximately 1% for diagnostic DBE and 3% to 4% for therapeutic DBE). The principal indication for the procedure is midgastrointestinal bleeding, that is, when the bleeding source is located in the small bowel. With good patient selection, the diagnostic yield here is 70% to 80%, and this has a substantial influence on subsequent tre…

No Association Between Vitamin D Status and Risk of Barrett's Esophagus or Esophageal Adenocarcinoma: A Mendelian Randomization Study.

Contains fulltext : 215282.pdf (Publisher’s version ) (Closed access) BACKGROUND & AIMS: Epidemiology studies of circulating concentrations of 25 hydroxy vitamin D (25(OH)D) and risk of esophageal adenocarcinoma (EAC) have produced conflicting results. We conducted a Mendelian randomization study to determine the associations between circulating concentrations of 25(OH)D and risks of EAC and its precursor, Barrett's esophagus (BE). METHODS: We conducted a Mendelian randomization study using a 2-sample (summary data) approach. Six single-nucleotide polymorphisms (SNPs; rs3755967, rs10741657, rs12785878, rs10745742, rs8018720, and rs17216707) associated with circulating concentrations of 25(O…

Current status of double balloon enteroscopy with focus on the Wiesbaden results.

Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding.

BACKGROUND The management of patients with suspected mid-gastrointestinal bleeding has in the past been AND AIMS: difficult, as push enteroscopy (PE) only allows limited endoscopic access for diagnosis and treatment. Recently published uncontrolled data on push-and-pull enteroscopy (PPE) using the double-balloon technique suggest that this new method has a high diagnostic yield and therapeutic efficacy. A prospective controlled study was therefore carried out to compare PPE with PE as the common nonsurgical gold standard method. METHODS: The diagnostic yield, complications, and various examination parameters were compared in 52 consecutive patients with suspected mid-gastrointestinal bleedi…

Prospective, cross-over, single-center trial comparing oral double-balloon enteroscopy and oral spiral enteroscopy in patients with suspected small-bowel vascular malformations

BACKGROUND AND STUDY AIMS: Spiral enteroscopy is a new, promising rapid enteroscopy technique. A prospective cross-over study was carried out to compare this new method with the established technique of double-balloon enteroscopy (DBE). PATIENTS AND METHODS: From an initial group of 18 patients with suspected mid-gastrointestinal bleeding due to vascular malformations but no previous history of small-bowel or colonic surgery, 10 patients (mean age 69 years) completed the study. Patients underwent both enteroscopy techniques with an oral approach, in a randomized sequence. The deepest point reached during advancement in the first enteroscopy was marked with India ink. The primary end point o…

Push-and-Pull Enteroscopy using the Double-Balloon Technique: Method of Assessing Depth of Insertion and Training of the Enteroscopy Technique using the Erlangen Endo-Trainer

Background and study aims This study was conducted to test a method of measuring the depth of insertion into the small bowel during push-and-pull enteroscopy using the Erlangen Endo-Trainer. Furthermore, the Erlangen Endo-Trainer model for training in the new method of push-and-pull enteroscopy using the double-balloon technique was also evaluated. Materials and methods Specially prepared packages of porcine upper visceral organs were used, including the esophagus, stomach, duodenum, and small bowel, implanted into the Erlangen Endo-Trainer. In the first step of this study, all of the modifications needed to obtain a model useful for training in the new enteroscopy technique were tested, in…

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…

Push-and-Pull Enteroscopy Using the Double-Balloon Technique (Double-Balloon Enteroscopy) for the Diagnosis of Meckel's Diverticulum in Adult Patients with GI Bleeding of Obscure Origin

Meckel's diverticulum (MD) occurs in 2-3% of the population. Although the clinical, histopathologic, and radiologic features of the complications of MD are well known, the diagnosis may be difficult before surgery.Three patients (age 22-34 yr, two women) presenting with gastrointestinal (GI) bleeding of obscure origin underwent multiple endoscopic and radiologic tests including capsule endoscopy and Tc-99m pertechnetate scintigraphy before push-and-pull enteroscopy using a double-balloon technique (double-balloon enteroscopy). Double-balloon enteroscopy was performed in all three patients using oral and anal approaches to evaluate the entire intestine. In one case, MD was detected using the…

Double-balloon endoscopy for retrograde cholangiography in patients with choledochojejunostomy and Roux-en-Y reconstruction.

BACKGROUND Choledochojejunal anastomoses with Roux-en-Y reconstruction excludes the biliary tract from conventional endoscopic retrograde cholangiography (ERC) with standard endoscopes due to the length of the interposed small bowel segment. Double-balloon enteroscopy (DBE) facilitates deep insertion into the small bowel and may be used to perform ERC in these patients. In the present case series we report our experience with diagnostic and therapeutic double-balloon ERC in patients with choledochojejunostomy to a long Roux-en-Y loop previously unavailable for standard length endoscopes. PATIENTS AND METHODS Between December 2004 and May 2008 15 patients (mean age: 60.2 years) with choledoc…

Ileo-ileal invagination--a cause of recurrent mid-gastrointestinal bleeding: diagnostic and endoscopic therapy by means of push-and-pull enteroscopy.

The types of lesions that cause bleeding in the small bowel are similar to those found in other areas in the gastrointestinal tract, such as vascular malformations, ulcers and inflammatory lesions, neoplasms and other less common lesions like Meckel's diverticulum. This report describes three patients with suspected mid-gastrointestinal bleeding with no significant past medical history. Before presenting to our unit the diagnostic work-up such as oesophagogastroduodenoscopy, colonoscopy and radiological small bowel imaging such as conventional enteroclysis or magnet resonance imaging enteroclysis had been performed without detecting any bleeding source. Capsule endoscopy suspected an angiod…

Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding

BACKGROUND AND STUDY AIMS Vascular malformations are the most common sources of bleeding in the small bowel. They can be treated with argon plasma coagulation (APC) during double-balloon enteroscopy (DBE). This study aimed to evaluate the long-term follow-up of the effectiveness of APC for small-bowel bleeding by means of a single-center retrospective study. PATIENTS AND METHODS Between June 2003 and December 2005, APC treatment for small-bowel lesions was carried out during DBE in 63 patients with known or suspected mid-gastrointestinal bleeding. Fifty patients were included in the analysis. Main outcome measurements were comparison of hemoglobin values and blood transfusion requirements b…

Identification of loci of functional relevance to Barrett's esophagus and esophageal adenocarcinoma: Cross-referencing of expression quantitative trait loci data from disease-relevant tissues with genetic association data.

Esophageal adenocarcinoma (EA) and its precancerous condition Barrett's esophagus (BE) are multifactorial diseases with rising prevalence rates in Western populations. A recent meta-analysis of genome-wide association studies (GWAS) data identified 14 BE/EA risk loci located in non-coding genomic regions. Knowledge about the impact of non-coding variation on disease pathology is incomplete and needs further investigation. The aim of the present study was (i) to identify candidate genes of functional relevance to BE/EA at known risk loci and (ii) to find novel risk loci among the suggestively associated variants through the integration of expression quantitative trait loci (eQTL) and genetic…

Performing Double-Balloon Enteroscopy: The Utility of the Erlangen EndoTrainer

Double-balloon enteroscopy (DBE) is now an established method for endoscopic visualization of the deep small bowel. DBE is not only a diagnostic tool, but also makes it possible to take biopsy samples and perform endoscopic therapeutic interventions. However, DBE is a complex examination and should therefore only be performed by experienced endoscopists after appropriate training. The best method of teaching DBE and improving the acquisition of competence appears to be through step-by-step training. Lectures and videos are very useful during the initial steps, whereas hands-on training with animal models and demonstration of live DBE procedures are the main components used for providing tra…

Endoscopic Resection of Early Esophageal and Gastric Neoplasias

The advent of endoscopic resection (ER) techniques has enabled gastroenterologists to remove premalignant or neoplastic lesions throughout the gastrointestinal tract. This review discusses the indications and the several techniques of ER in early carcinomas of the esophagus and stomach. Before ER is performed an accurate evaluation of patients and careful staging of lesions is mandatory. After ER of the neoplasia histological assessment of the entire specimen with detailed histological analysis of layer infiltration is crucial. First long-term follow-up studies of large numbers of patients confirm the excellent effectiveness of ER for well-differentiated mucosal lesions without lymphangitic…