0000000000234383
AUTHOR
Angelika Behrens
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…
Strategies for identifying dysplasia in Barrett's oesophagus
Abstract Early neoplastic changes in Barrett's oesophagus are often only recognizable visually as discrete mucosal irregularities. With timely diagnosis, the prognosis is excellent, in contrast to advanced tumours in Barrett's oesophagus. The international specialist societies therefore recommend regular endoscopic surveillance for patients who have been diagnosed with Barrett's oesophagus. Following the 1993 Seattle Protocol, the various guidelines consistently require four-quadrant biopsy sampling every 1–2 cm over the entire Barrett's segment and additional biopsies from visually suspicious-appearing areas. This approach is time-consuming and costly, and inevitably involves sampling erro…
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…
Prospective randomized comparison of short-access mother-baby cholangioscopy versus direct cholangioscopy with ultraslim gastroscopes
Mother-baby technologies, the criterion standard for cholangioscopy, have several limitations. A novel, short-access, mother-baby (SAMBA) system may improve this technique. Direct cholangioscopy (DC) was recently developed as an alternative to mother-baby cholangioscopy.Comparison of success rates with SAMBA and DC.Single-center, randomized, controlled trial.Academic tertiary-care referral center.Sixty patients with suspected cholangiopathies randomized to either SAMBA (n = 30) or DC (n = 30).Cholangioscopy under deep sedation.Technical success rate of diagnostic or therapeutic procedure.A total of 24 and 21 diagnostic procedures were performed in the SAMBA and DC groups, respectively. Ther…
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…
Tu1253 How Safe Is Sedation in Gastrointestinal Endoscopy? a Prospective Multicenter Trial: an Interim Analysis of 73,941 Endoscopies. Data From Prospective Registries of Complications Managed by Members of the Working Group of Leading Hospital Gastroenterologists (Algk)
were those plausibly associated with the procedure and severe enough for the patient to seek medical attention. We compared the proportion of patients with adverse events associated with gastrointestinal endoscopy identified with direct patient contact to the proportion identified through our current infrastructure using the chi-square statistic. Results: During the study period, 11,710 endoscopic procedures were performed on 9,683 patients. Our study personnel made 3205 calls over a three month period and ultimately made contact with 1999 (17%; 84.5% of those called) patients. 28 (1.4%) adverse events were identified through direct patient contact. Our adverse event tracking infrastructure…
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…