0000000000072416
AUTHOR
Jürgen Pohl
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…
Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study.
Endoscopic removal of large, nonpedunculated colorectal lesions is challenging. Long-term outcome data based on standardized protocols, including detailed inspection of the resection site, are scarce. The aims of the present study were to evaluate the safety and efficacy of endoscopic resection (ER) of large, nonpedunculated lesions (LNLs;20 mm) and to assess the long-term recurrence rate afterward.A total of 243 consecutive patients (141 men, 102 women) with 252 adenomas (20 mm) was followed up using a standardized protocol after complete ER. After endoscopic treatment, the patients received standardized follow-up examinations after 3-6 months and 12 months. The postpolypectomy scar was re…
Confocal Laser Endomicroscopy for In Vivo Diagnosis of Early Squamous Cell Carcinoma in the Esophagus
Background & Aims: Confocal laser endomicroscopy has been shown to allow direct histologic imaging of gastrointestinal tumors in vivo. This study was designed to assess the potential of endomicroscopy for predicting histology in vivo during routine endoscopy in patients with early squamous cell cancer. Methods: Twenty-one consecutive patients with suspected early squamous cell cancer who had been referred for endoscopic therapy to a tertiary-care academic medical center were included in this prospective study. After staining with 0.5% Lugol's solution and injection of 500 mg fluorescein sodium, unstained mucosal areas were examined using confocal imaging. Images of each scanned lesion were …
Dialogue interdisciplinaire sur les approches de la construction sociale des territoires.: Colloque "La construction sociale des territoires européens : frontières, régionalisations et performances"
La société post-moderne et l’élaboration d’un espace européen de la recherche où l’insertion des SHS paraît de plus en plus stratégique ont confirmé que le territoire n’avait rien d’une donnée spatiale brute mais était bien un construit social, en particulier, mais non exclusivement, sur le Vieux Continent. Cette approche en termes de CST (construction sociale des territoires) s’est imposée dans la majorité des disciplines de SHS depuis les années 1980 : géographie/aménagement, sociologie, sciences politiques, histoire, économie. Il s’agit ici d’une approche fondamentalement transversale, interdisciplinaire, dans un questionnement qui représente un des socles des SHS. C’est dans le dialogue…
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…
Trans-Abdominal Ultrasound Guided ERC in a Pregnant Woman With Bile Duct Stones
Background: The change in lithogenicity of bile, increased stasis of bile and decreased gall bladder emptying are the possible reasons for an increased risk of gall stones during pregnancy. However, biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus. ERC under fluoroscopic control as gold standard is associated with higher risk of premature labor and teratogenity. Methods and patient: We performed transabdominal ultra-sound guided ERC in one patient in the second trimenon with gall stones. While the hilus area is observed by ultrasound, the papilla is carefully cannulated with a guidewire. A contrast agent is applied in the common bil…
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…
Direct transnasal cholangioscopy with ultraslim endoscopes: a one-step intraductal balloon-guided approach.
Background Direct cholangioscopy using an ultraslim endoscope is an attractive alternative to the conventional mother–baby endoscope system because it provides a single-operator platform and high-resolution image quality and allows advanced therapeutic interventions. However, biliary access is cumbersome and usually requires previous guidewire placement via retrograde cholangiography. Objective To evaluate the feasibility of a 1-step transnasal cholangioscopy (TNC) technique using an ultraslim endoscope with an intraductal balloon to maintain access without previous guidewire placement. Design Prospective, observational clinical feasibility study. Setting Single tertiary referral center. Ma…
"Dry biopsies" with spraying of dilute epinephrine optimize biopsy mapping of long segment Barrett's esophagus
BACKGROUND AND STUDY AIMS: For surveillance of Barrett’s esophagus random stepwise four-quadrant biopsy (4QB) is recommended for detecting macroscopically occult neoplasias. Thorough performance of the systematic protocol is commonly hampered by poor visibility due to oozing from biopsy sites. Topical application of dilute epinephrine may prevent bleeding by vasoconstriction of superficial microvessels and might therefore enable ”dry biopsy” sampling. The aim of this study was to examine the safety and efficacy of spraying dilute epinephrine for optimal 4QB mapping of Barrett’s esophagus. PATIENTS AND METHODS: In this prospective, double-blind trial 40 patients with known long segment Barre…
Transnasal endoscopy for direct visual control of esophageal stent placement without fluoroscopy
Placement of self-expanding metal stents (SEMSs) is a well-established treatment for esophageal stenosis and postoperative anastomotic leaks. Conventional endoscopic procedures for SEMS placement require fluoroscopic guidance, but transnasal endoscopy (TNE) with ultraslim endoscopes may allow precise stent release under direct visual control without the need for fluoroscopy. This prospectively collected data investigated the feasibility and safety of TNE-guided SEMS placement without fluoroscopy. Between March 2009 and February 2011, 20 consecutive patients underwent TNE-guided SEMS placement without fluoroscopy. The technical success rate was 100 % and no fluoroscopy was required during th…
Dialogue interdisciplinaire sur les approches de la construction sociale des territoires: Colloque: "La construction sociale des territoires européens : frontières, régionalisations et performances"
La société post-moderne et l’élaboration d’un espace européen de la recherche où l’insertion des SHS paraît de plus en plus stratégique ont confirmé que le territoire n’avait rien d’une donnée spatiale brute mais était bien un construit social, en particulier, mais non exclusivement, sur le Vieux Continent. Cette approche en termes de CST (construction sociale des territoires) s’est imposée dans la majorité des disciplines de SHS depuis les années 1980 : géographie/aménagement, sociologie, sciences politiques, histoire, économie. Il s’agit ici d’une approche fondamentalement transversale, interdisciplinaire, dans un questionnement qui représente un des socles des SHS.C’est dans le dialogue …
Water Infusion for Cecal Intubation Increases Patient Tolerance, but Does Not Improve Intubation of Unsedated Colonoscopies
Background & Aims Several studies have indicated that water infusion, instead of air insufflation, enhances cecal intubation in selected patients undergoing unsedated colonoscopy. We performed a prospective, randomized, controlled trial to investigate whether the water technique increases the proportion of patients that are able to complete unsedated colonoscopy. Methods We analyzed data from 116 consecutive outpatients who were willing to start colonoscopy without sedation; 58 were each randomly assigned to groups given water infusion or air insufflation during the insertion phase. Sedation and analgesia were administered on demand. Results Fewer patients requested sedation in the water gr…
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…
Endoscopic Management for Patients with Serrated Polyposis Syndrome is Feasible and Effective:
Background and Study Aims: Serrated polyposis syndrome is a rare condition in which multiple serrated lesions develop all over the colon, which is thought to be associated with an increased risk for the development of cancer. The aim of this study was to investigate the feasibility of endoscopic treatment and standardised surveillance in patients with this increasingly recognised syndrome. Methods: From September 2010 to November 2013, consecutive patients were included in a prospective study. All patients underwent chromoendoscopy at first presentation and during surveillance. Follow-up examinations were carried out at 3 month intervals until complete clearance was achieved. Afterwards, pa…
Efficacy and safety of direct transnasal cholangioscopy with standard ultraslim endoscopes: results of a large cohort study.
Background Direct cholangioscopy (DC) with ultraslim endoscopes and free-hand cannulation of the common bile duct (CBD) is a promising technique for evaluating and treating cholangiopathy. However, its safety and success rates are as yet unclear. Objective To evaluate the overall success rates and adverse events with the procedure. Design Single-center, prospective cohort study; 12 patients retrospectively enrolled. Setting Academic tertiary referral center. Patients A total of 100 DC procedures in 84 patients with biliary disease were evaluated prospectively. Interventions DC performed with the patient under conscious sedation. Main Outcome Measurements Overall success rates and adverse ev…
Enteroscopy and its relationship to radiological small bowel imaging
The field of radiological small bowel imaging is changing rapidly, as is small bowel enteroscopy. New techniques allow the depiction of intraluminal, mural, and extraintestinal features of various small bowel disorders, such as Crohn disease, small bowel polyposis syndromes, small intestinal malignancies, and celiac disease. For patients requiring repeated small bowel imaging, modalities that do not use ionizing radiation, such as ultrasound or magnetic resonance imaging, should be considered.
The Short-Access Mother–Baby-(SAMBA) Cholangioscopy System
Conventional mother–baby cholangioscopy systems have significant limitations including poor image resolution, limited maneuverability and fragile cholangioscopes. We propose the novel short-access mother–baby-(SAMBA) cholangioscopy system that involves a very short and flexible cholangioscope that is introduced in a dedicated mother duodenoscope with an extra distal side port. Clinical feasibility of this device is demonstrated in three complex cases with cholangiopathies. The strengths of SAMBA cholangioscopy are improved imaging quality and excellent maneuverability of the baby that allows access of small intrahepatic ducts. Evaluation of suspected intrahepatic biliary disease is an excel…
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…
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…