Publications by authors named "Siegbert Faiss"

28 Publications

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Endoscopic Submucosal Dissection in Europe: Results of 1000 neoplastic lesions from the German ESD Registry.

Gastroenterology 2021 Jun 25. Epub 2021 Jun 25.

Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany. Electronic address:

Background & Aims: Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD.

Methods: The German ESD registry is a prospective uncontrolled multicenter study. Over a 35-month-period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤ 20 ESDs/year), middle-volume (20-50/year), and high-volume centers (>50/year). A multivariate analysis investigating risk factors for non-curative resection was performed.

Results: Overall, en bloc, R0 and curative resection rates of 92.4% (95%CI 0.90-0.94), 78.8% (95%CI 0.76-0.81) and 72.3% (95%CI 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI 0.067-0.102) while the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, recurrence rates and lower complication rates than middle or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for non-curative ESD.

Conclusion: In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center's yearly case volume.
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http://dx.doi.org/10.1053/j.gastro.2021.06.049DOI Listing
June 2021

A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence.

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Institut for Medical Education, University Hospital of LMU Munich, Munich, Germany.

Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany.

Material And Methods: In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed.

Results: Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001).

Conclusions: Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.
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http://dx.doi.org/10.11152/mu-2892DOI Listing
June 2021

Hybrid resection of large colorectal adenomas combining EMR and FTRD.

Scand J Gastroenterol 2021 Aug 2;56(8):978-983. Epub 2021 Jun 2.

Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany.

Background: The introduction of the full-thickness resection device (FTRD) allowed resection of difficult adenomas in the duodenum and colorectum with non-lifting. The main limitation of this endoscopic technique is the lesion size. We describe a hybrid approach combining endoscopic mucosal resection (EMR) and FTRD in a cohort of 17 patients to reduce tumor size and enable full-thickness resection.

Methods: Retrospective analysis from data of 17 patients who underwent hybrid EMR-FTRD for large adenomas in the colorectum at our institution. Technical success, histological confirmation of margin-free resection and adverse advents were studied.

Results: 16 of 17 (94.1%) lesions could be resected macroscopically complete with confirmed full-thickness resection. Histological work-up of the full-thickness specimens showed free lateral margins in 13 patients (76.4%), unclear margins in two patients (11.8%) and positive margins in two patients (11.8%). There were no immediate perforation or major bleeding, however one patient showed a stenosis after resection in the follow-up endoscopy. Follow-up endoscopy was available in 12 patients. In two of 12 patients a recurrent adenoma was detected.

Conclusions: Hybrid EMR-EFTR in the colorectum seems to be a safe and effective technique for large non-lifting lesions with positive lifting signs in the margins. Further prospective evaluation of efficacy, safety and long-term outcome of this hybrid technique is necessary.
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http://dx.doi.org/10.1080/00365521.2021.1933583DOI Listing
August 2021

Endoscopic prediction of submucosal invasion in Barrett's cancer with the use of artificial intelligence: a pilot study.

Endoscopy 2020 Nov 16. Epub 2020 Nov 16.

III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany.

Background: The accurate differentiation between T1a and T1b Barrett's-related cancer has both therapeutic and prognostic implications but is challenging even for experienced physicians. We trained an artificial intelligence (AI) system on the basis of deep artificial neural networks (deep learning) to differentiate between T1a and T1b Barrett's cancer on white-light images.

Methods: Endoscopic images from three tertiary care centers in Germany were collected retrospectively. A deep learning system was trained and tested using the principles of cross validation. A total of 230 white-light endoscopic images (108 T1a and 122 T1b) were evaluated using the AI system. For comparison, the images were also classified by experts specialized in endoscopic diagnosis and treatment of Barrett's cancer.

Results: The sensitivity, specificity, F1 score, and accuracy of the AI system in the differentiation between T1a and T1b cancer lesions was 0.77, 0.64, 0.74, and 0.71, respectively. There was no statistically significant difference between the performance of the AI system and that of experts, who showed sensitivity, specificity, F1, and accuracy of 0.63, 0.78, 0.67, and 0.70, respectively.

Conclusion: This pilot study demonstrates the first multicenter application of an AI-based system in the prediction of submucosal invasion in endoscopic images of Barrett's cancer. AI scored equally to international experts in the field, but more work is necessary to improve the system and apply it to video sequences and real-life settings. Nevertheless, the correct prediction of submucosal invasion in Barrett's cancer remains challenging for both experts and AI.
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http://dx.doi.org/10.1055/a-1311-8570DOI Listing
November 2020

Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report.

World J Gastrointest Endosc 2020 Jun;12(6):193-197

Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin 13065, Germany.

Background: Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique. There have been several recent studies of full-thickness resection device (FTRD) use in the colon, but data regarding its use and efficacy in the duodenum are still limited.

Case Summary: A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior. The biopsies revealed a low-grade adenoma. The adenoma was removed using the gastroduodenal FTRD, and the pathology results revealed clear margins. Except for minor bleeding that was treated by argon plasma coagulation, no further complications occurred.

Conclusion: Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions. Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.
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http://dx.doi.org/10.4253/wjge.v12.i6.193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415228PMC
June 2020

Treatment of Zenker's diverticulum: different tastes all leading to the same flavor?

Authors:
Siegbert Faiss

Endoscopy 2018 02 29;50(2):96-97. Epub 2018 Jan 29.

Gastroenterology and Interventional Endoscopy, Asklepios Clinic Barmbek, Hamburg, Germany.

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http://dx.doi.org/10.1055/s-0043-123878DOI Listing
February 2018

Arguments for and against Centralization in Oncologic Visceral Medicine.

Visc Med 2017 May 30;33(2):148-152. Epub 2017 Mar 30.

Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.

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http://dx.doi.org/10.1159/000467970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447158PMC
May 2017

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series.

World J Gastroenterol 2017 May;23(17):3084-3091

Johanna Wilmsen, Robert Baumbach, Siegbert Faiss, Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Medical Faculty, Campus Hamburg, 22291 Hamburg, Germany.

Aim: To report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.

Methods: From November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.

Results: In eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.

Conclusion: Flexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.
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http://dx.doi.org/10.3748/wjg.v23.i17.3084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423045PMC
May 2017

[Acute gastrointestinal bleeding].

Dtsch Med Wochenschr 2016 Jul 30;141(13):922. Epub 2016 Jun 30.

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http://dx.doi.org/10.1055/s-0042-110771DOI Listing
July 2016

[Endoscopic strategies in minimal invasive therapy].

Dtsch Med Wochenschr 2016 Apr 28;141(9):609-12. Epub 2016 Apr 28.

Due to higher detection rates of early gastrointestinal neoplasia endoscopic resection of early GI cancers or precancerous lesions is increasing. Endoscopic piece-meal resection (EMR) remains the standard technique for the endoscopic resection of large sessile colorectal adenomas. Cap-assisted EMR techniques show excellent long-term results in the endoscopic therapy of neoplastic Barrett's esophagus. For the endoscopic resection of early gastrointestinal cancers of more than 2 cm endoscopic submucosal dissection (ESD) is the method of choice. The value of endoscopic full thickness resection in the therapy of GI tumors remains to be seen.
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http://dx.doi.org/10.1055/s-0042-102309DOI Listing
April 2016

[Acute gastrointestinal bleeding].

Dtsch Med Wochenschr 2016 Apr 14;141(8):561-8; quiz 569-70. Epub 2016 Apr 14.

Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered.
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http://dx.doi.org/10.1055/s-0042-101721DOI Listing
April 2016

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum.

Scand J Gastroenterol 2015 3;50(12):1512-5. Epub 2015 Jul 3.

Department of Gastroenterology & Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Medical Faculty, Campus Hamburg , Hamburg , Germany.

Objective: Zenker´s diverticulum (ZD) is a rare cause of dysphagia. Various surgical and flexible endoscopic therapies are available with either higher morbidity or either higher recurrence rate. Therefore, improved treatment options are needed.

Material And Methods: This case report involves an 83-year-old female patient with symptomatic ZD. Under flexible endoscopic control, a new 5 mm fully rotatable surgical stapler was used for the dissection of the septum between the ZD and the esophageal lumen. An ultrathin endoscope and the 5 mm stapler were introduced together through a flexible overtube under conscious sedation.

Results: ZD treatment with this new stapler technique was feasible and effective in our patient. Procedure time was 10 min. Clinical symptoms improved immediately and the patient could be discharged the day after the procedure.

Conclusion: The described stapler technique under flexible endoscopic control is the first report of this new treatment option for ZD. This new technique under conscious sedation may have some potential advantages compared to standard techniques such as better long-term results and lower complication rates. Further studies are needed.
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http://dx.doi.org/10.3109/00365521.2015.1063154DOI Listing
May 2016

Management of early asymptomatic gastrointestinal stromal tumors of the stomach.

World J Gastrointest Endosc 2014 Jul;6(7):266-71

Hans Scherübl, Klinik für Innere Medizin II, Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. Approximately two thirds of clinically manifest tumors occur in the stomach, nearly one third in the small bowel, and the rest in the colorectal region with a few cases in the esophagus. GIST originate within the smooth muscle layer in the wall of the tubular gastrointestinal tract and grow mostly toward the serosa, far less often toward the mucosa. In the latter case, ulceration may develop and can cause gastrointestinal bleeding as the cardinal symptom. However, most GIST of the stomach are asymptomatic. They are increasingly detected incidentally as small intramural or submucosal tumors during endoscopy and particularly during endoscopic ultrasound. Epidemiological and molecular genetic findings suggest that early asymptomatic GIST of the stomach (< 1 cm) show self-limiting tumorigenesis. Thus, early (< 1 cm) asymptomatic gastric GIST (synonym: micro-GIST) are found in 20%-30% of the elderly. The mostly elderly people with early gastric GIST have an excellent GIST-specific prognosis. Patients with early GIST of the stomach can therefore be managed by endoscopic surveillance.
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http://dx.doi.org/10.4253/wjge.v6.i7.266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094984PMC
July 2014

Interventional endoscopic ultrasonography: an overview of safety and complications.

Surg Endosc 2014 Mar 7;28(3):712-34. Epub 2013 Nov 7.

Department of Gastroenterology and Hepatology, Hôpital Privé Jean Mermoz, 55 Avenue Jean Mermoz, 69008, Lyon, France,

Background: In recent years, endoscopic ultrasonography (EUS)-guided techniques have been developed as alternatives to surgical, radiologic, or conventional endoscopic approaches for the treatment or palliation of several digestive diseases. The use of EUS guidance allows the therapeutic area to be targeting more precisely, with a possible clinical benefit and less morbidity. Nevertheless, the risks persist and must be taken into consideration. This review gives an overview of the complications observed with the most established procedures of therapeutic EUS.

Methods: The PubMed and Embase databases were used to search English language articles on interventional EUS. The studies considered for inclusion were those reporting on complications of EUS-guided celiac plexus block (EUS-CPB), EUS-guided celiac plexus neurolysis (EUS-CPN), drainage of fluid pancreatic and pelvic collections, and EUS-guided biliary and pancreatic drainage (EUS-BD and EUS-PD). Variations in methodology and design in most studies made a thorough statistical analysis difficult. Instead, a frequency analysis of complications and a critical discussion were performed.

Results: Although EUS-guided celiac plexus injection causes mainly mild and transient complications, growing experience shows that EUS-CPN is not as benign a procedure as previously thought. Most of the major complications have been observed in patients with chronic pancreatitis. The findings show that EUS-guided drainage of fluid collections is a safe procedure. Complications occur more often after the drainage of pancreatic abscesses and necrosis. Although the heterogeneity of studies dealing with pancreatobiliary drainage makes the evaluation of risks after these procedures difficult, complications after EUS-BD and EUS-PD are relatively frequent and can be severe. The technical complexity and the lack of specifically designed devices may account for their complication rates.

Conclusions: Clinicians can consider EUS-guided celiac injection and EUS-guided drainage of fluid collections to be safe alternatives to surgical and radiologic interventions. Well-designed prospective trials are needed to assess the risks of EUS-BD and EUS-PD accurately before they are broadly advocated after a failed endoscopic retrograde cholangiopancreatography (ERCP).
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http://dx.doi.org/10.1007/s00464-013-3260-5DOI Listing
March 2014

Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications.

World J Gastroenterol 2012 Sep;18(34):4659-76

Department of Internal Medicine, Krankenhaus Märkisch-Oderland GmbH, D15344 Strausberg, Germany.

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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http://dx.doi.org/10.3748/wjg.v18.i34.4659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442204PMC
September 2012

A study comparing an endoscopy nurse and an endoscopy physician in capsule endoscopy interpretation.

Eur J Gastroenterol Hepatol 2011 Feb;23(2):166-70

Gastrointestinal and Liver Unit, Faculty of Nursing, Kifissia General and Oncology Hospital, Agioi Anargyroi, Athens, Greece.

Objective: Complete review of wireless capsule endoscopy (WCE) recordings by a physician is time-consuming and laborious and may be perceived as a limitation to perform WCE. The aim of this study was to evaluate the efficacy of a nurse in interpreting WCE.

Methods: A total of 102 WCE videos were evaluated by a single gastroenterologist and a nurse experienced as an assistant in diagnostic and interventional endoscopy and trained in WCE. After independently reviewing WCE videos, the two readers discussed their findings and came to a consensus.

Results: The mean capsule reading time was significantly longer for the nurse compared with the gastroenterologist (117.3+/-24.8 vs. 63.8+/-8.5 min, P<0.001). No statistical differences were observed regarding the correct recognition of first gastric, duodenal and caecal images between the two readers. For the gastroenterologist, both sensitivity and specificity in detecting abnormal findings were 100% except for angiodysplasia [sensitivity 88.5%, 95% confidence interval (CI): 70-97.4]. For the nurse, the lowest sensitivity rates were in detecting polyps (70%, 95% CI: 34.9-92.3) and angiodysplasias (92.3%, 95% CI: 74.8-98.9). The interobserver agreement as determined by Cohen's κ coefficient was excellent except for polyps (k=0.71, 95% CI: 0.46-0.96).

Conclusion: A trained nurse is highly accurate in detecting abnormal findings and interpreting WCE recordings. Physician's role could be limited to consider and confirm thumbnails created by a nurse.
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http://dx.doi.org/10.1097/meg.0b013e3283433abfDOI Listing
February 2011

Subacute axonal neuropathy in Parkinson's disease with cobalamin and vitamin B6 deficiency under duodopa therapy.

Mov Disord 2010 Aug;25(11):1748-52

Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany.

We describe two patients who developed subacute axonal peripheral neuropathy under duodopa treatment. Comprehensive diagnostic workup including muscle and sural nerve biopsy revealed that the most probable cause of subacute axonal peripheral neuropathy was cobalamin and vitamin B6 deficiency in both the patients.
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http://dx.doi.org/10.1002/mds.23342DOI Listing
August 2010

Detection of up to 65% of Precancerous Lesions of the Human Colon and Rectum by Mutation Analysis of APC, K-Ras, B-Raf and CTNNB1.

Cancers (Basel) 2010 Dec 29;3(1):91-105. Epub 2010 Dec 29.

Chair of Nutritional Toxicology, Institute of Nutritional Science, University of Potsdam, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.

In the present study a recently conceived 4-gene marker panel covering the Wnt and Ras-Raf-MEK-MAPK signaling pathways was used to analyze 20 colorectal serrated lesions and 41 colorectal adenoma samples and to determine the percentage of each of the above-mentioned potentially precancerous lesions carrying at least one of the four above-mentioned genes in a mutated form. CTNNB1 and B-Raf were screened by PCR-single-strand conformation polymorphism analysis, K-Ras by restriction fragment length polymorphism analysis and the APC gene mutation cluster region (codons 1243-1567) by direct DNA sequencing. APC mutations were only detected in 10% of the serrated lesions but in 34% of the adenomas. Twenty percent of the serrated lesions and 14% of the adenomas carried a mutated K-Ras. B-Raf was found to be mutated in 50% of the serrated lesions and in 22% of the adenomas. CTNNB1 was altered in 12% of the adenomas, but not in serrated lesions. By using the above gene marker panel it could be shown that 65% of the serrated lesions and 61% of the adenomas carried at least one of the four genes in a mutated form. Based on its excellent performance in detecting mutations in sporadic preneoplastic (in this study) and neoplastic lesions (in a previous study) of the human colon and rectum, this primer combination might also be suited to efficiently and non-invasively detect genetic alterations in stool DNA of patients with early colorectal cancer.
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http://dx.doi.org/10.3390/cancers3010091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756351PMC
December 2010

Capsule retention: a feared complication of wireless capsule endoscopy.

Scand J Gastroenterol 2009 ;44(10):1158-65

Department of Medicine III, Gastroenterology and Hepatology, Asklepios Klinik Barmbek, Hamburg, Germany.

Wireless capsule endoscopy is a simple, non-invasive technique for the visualization of the entire small bowel. It was introduced in clinical praxis in 2001 and has already become the method of choice for the investigation of small-bowel pathology. Capsule retention is a major complication, with an overall incidence of 1-2%, although reported rates vary widely from 0% to 21%, depending on the indication for the examination. This complication can occur at any level of the gastrointestinal tract and in most cases runs asymptomatically. However, symptomatic bowel obstruction requiring surgical or endoscopic removal of the impacted capsule can occur. Rarely, capsule retention can lead to intestinal perforation. Despite several years of experience with wireless capsule endoscopy, there is up to the present no safe means of predicting capsule retention. Radiological studies have a low diagnostic yield and tend to underestimate or overestimate small-bowel strictures. The role of the new generation patency capsule (Agile patency capsule) needs to be further documented. The experts agree that obtaining a careful history is perhaps the best single method to detect the possibility of retention.
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http://dx.doi.org/10.1080/00365520903132039DOI Listing
March 2010

EUS-guided Trucut needle biopsies as first-line diagnostic method for patients with intestinal or extraintestinal mass lesions.

Surg Endosc 2009 Oct 5;23(10):2351-5. Epub 2009 Mar 5.

Department of Medicine A, Gastroenterology, Endocrinology, Nutrition and Nephrology University Hospital, Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Loeffler-Strasse 23a, D-17475, Greifswald, Germany.

Introduction: Fine-needle aspiration (FNA) is a well-established technique to obtain cytological specimens, but it does not permit the extraction of histological tissue-core samples, which, if available, may increase the yield and accuracy of the histopathological diagnosis. This prospective study was designed to assess the yield and diagnostic accuracy of endoscopic ultrasound (EUS)-guided Trucut needle biopsy (TNB) as first-line diagnostic method for suspected malignant lesions identified by upper gastrointestinal EUS.

Methods: In a prospective case series, 24 consecutive patients (14 women; median age, 68 (range, 38-84) years) with suspected malignancy underwent EUS-TNB with a 19-gauge needle. EUS was performed with a linear scanning echo endoscope. When the EUS-TNB device did not collect adequate samples, subsequent EUS-FNA was performed. The presence or absence of malignancy was confirmed by postoperative histopathology or diagnostic imaging follow-up for at least 9 months.

Results: Adequate tissue specimens were obtained in 20 of 24 (83%) patients by TNB. An accurate diagnosis was achieved in 19 of 20 (95%) patients in whom TNB was successful with a sensitivity and specificity of 93% and 100%, respectively. In 11 patients malignant disease was found, whereas 8 patients showed benign lesions on TNB-obtained histopathology. Thirteen patients underwent additional EUS-FNA. The diagnosis by TNB was confirmed in seven of nine (78%) patients with additional FNA. In three of four patients with inadequate TNB, the diagnosis was established by FNA. The overall accuracy of EUS-TNB was 79% (19/24) for all patients and 92% (22/24) with subsequent FNA. The positive and negative predictive values for the diagnosis of a malignant lesion by EUS-TNB were 57.9% and 88.9%, respectively. Neither method had any procedure-related complications.

Conclusions: EUS-guided TNB is a safe and accurate technique to obtain core specimen for histopathologic diagnosis in patients with suspected malignancies on upper gastrointestinal EUS. FNA can serve as rescue technique and should be performed if TNB fails to obtain adequate tissue samples.
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http://dx.doi.org/10.1007/s00464-009-0345-2DOI Listing
October 2009

Through the endoscope balloon dilation of ileocolonic strictures: prognostic factors, complications, and effectiveness.

Int J Colorectal Dis 2008 Jul 13;23(7):689-96. Epub 2008 Mar 13.

Medizinische Klinik I mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Charité, Campus Benjamin Franklin, 12200 Berlin, Germany.

Background/aims: About half of all Crohn's disease (CD) patients undergo surgery at some point, many because of strictures. An alternative possibility is to dilate strictures endoscopically. However, little is known about prognostic factors.

Patients And Methods: Thirty-two patients with primary CD (n=2), radiogenic strictures (n=1), or postoperative strictures (27 because of CD; 2 after resection because of cancer), were planned to undergo colonoscopic dilatation of which 25 patients were dilated (10 men; 15 women; median age 48). Length of stenosis, diameter of stricture, balloon size, smoking status, ulcer in the stricture, passage postdilatation, hemoglobin level, complications, redilatation, and subsequent surgery were recorded. Only patients with at least 6 months follow up were included.

Results: Five out of 32 patients had no stenosis, marked inflammation, or fistulas adjacent to the stricture. One patient each had a long stricture (8 cm) or a filiform stenosis ruling out dilatation [technical success, 25/27 (92.6%)]. Among these 25 patients, 39 colonoscopies with 51 dilatations were performed. After a single dilatation, 52% were asymptomatic while 48% needed another intervention, half of them surgery. Bleeding without need for transfusion occurred in 3 out of 39 colonoscopies and one perforation required surgery. Significant prognostic factors were smoking and ulcers in the stricture (P<0.05 each). Some ulcers led to intussusception requiring surgery in spite of good dilatation results.

Conclusion: Through the endoscope balloon stricture dilatation is a relatively safe and often effective treatment modality in ileocolonic strictures. The presence of ulcers in the stricture have a worse outcome as do smokers.
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http://dx.doi.org/10.1007/s00384-008-0461-9DOI Listing
July 2008

Prospective, randomized, multicenter trial on the antiproliferative effect of lanreotide, interferon alfa, and their combination for therapy of metastatic neuroendocrine gastroenteropancreatic tumors--the International Lanreotide and Interferon Alfa Study Group.

J Clin Oncol 2003 Jul;21(14):2689-96

Universitätsklinikum Charité, Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Augustenburger Platz 1, D-13353 Berlin, Germany.

Purpose: Somatostatin analogs and interferon alfa control hormone-active/functional neuroendocrine gastroenteropancreatic tumors. In addition to hormonal control, variable degrees of antiproliferative effects for both agents have been reported. Until now, however, no prospective, randomized studies in therapy-naive patients have compared somatostatin analogs or interferon alfa alone with a combination of the two.

Methods: Eighty therapy-naive patients with histologically verified neuroendocrine tumor disease (primary localization: foregut, n = 36; midgut, n = 30; hindgut, n = 3; unknown, n = 11; functional, n = 29; nonfunctional, n = 51) were randomly treated either with lanreotide (1 mg three times a day administered subcutaneously [SC]) or interferon alfa (5 x 106 U three times a week SC) or both. All patients had disease progression in the 3 months before study entry, verified with imaging procedures.

Results: Twenty-five patients were treated with lanreotide, 27 patients were treated with interferon alfa, and 28 patients were treated with the combination. Partial tumor remission was seen in four patients (one patient who received lanreotide, one patient who received interferon alfa, and two patients who received the combination). During the 12 months of therapy, stable disease was observed in 19 patients (seven patients who received lanreotide, seven patients who received interferon alfa, and five patients who received the combination), whereas tumor progression occurred in 14 of 25 patients (lanreotide), 15 of 27 patients (interferon alfa), and 14 of 28 patients (combination). Side effects leading to an interruption of therapy were more frequent in the combination group than in the monotherapy arms.

Conclusion: This prospective, randomized, multicenter study shows for the first time that somatostatin analogs, interferon alfa, or the combination of the two had comparable antiproliferative effects in the treatment of metastatic neuroendocrine gastroenteropancreatic tumors. Response rates were lower compared with those published in previous, nonrandomized studies. The antiproliferative effect of the tested substances was similar for functional and nonfunctional neuroendocrine tumors.
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http://dx.doi.org/10.1200/JCO.2003.12.142DOI Listing
July 2003

Endoscopically inserted endoluminal receiver coil for high-resolution magnetic resonance imaging of the pancreas: Initial results in an animal model.

Gastrointest Endosc 2003 Jan;57(1):106-10

Department of Gastroenterology, Benjamin Franklin University Hospital, Free University, Berlin, Germany.

Background: This study assessed the feasibility of high-resolution magnetic resonance imaging of the pancreas by means of an endoscopically inserted endoluminal magnetic resonance receiver coil.

Method: A 0.032-inch diameter internal magnetic resonance imaging receiver coil was endoscopically inserted into the pancreatic duct in 4 pigs through the accessory channel of a standard duodenoscope to obtain high-resolution magnetic resonance images by using T1- and T2-weighted sequences.

Results: The pig anatomy precluded the usual transoral approach; however, transgastric access allowed endoscopic transpapillary insertion of a receiver coil into the pancreatic duct in all animals without the need for sphincterotomy. The small swine pancreas could then be visualized by magnetic resonance imaging with a 0.3 x 0.3-mm in-plane resolution.

Conclusion: High-resolution pancreas magnetic resonance imaging is feasible by using an endoscopically inserted endoluminal receiver coil. The smaller stomach and larger pancreatic duct diameter in humans will facilitate clinical application of the imaging procedure.
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http://dx.doi.org/10.1067/mge.2003.50DOI Listing
January 2003

Specific ligands of the peripheral benzodiazepine receptor induce apoptosis and cell cycle arrest in human esophageal cancer cells.

Int J Cancer 2002 Dec;102(4):318-27

Medical Clinic I, Benjamin Franklin University Hospital, Free University of Berlin, Berlin, Germany.

Esophageal cancer is the most markedly increasing tumor entity in Western countries. Due to very poor 5-year-survival, new therapeutic approaches are mandatory. Peripheral benzodiazepine receptors (PBR) have been implicated in growth control of various tumor models, but they have not been studied yet in esophageal cancer. We used esophageal cancer cell lines and primary cell cultures of human esophageal cancers and evaluated (i) expression and localization of PBR; (ii) PBR-ligand-induced inhibition of cell growth; (iii) induction of apoptosis; and (iv) alterations in cell cycle. Expression of PBR was detected both in cell lines and in primary cell cultures of human esophageal cancers. PBR was localized in the mitochondria. The PBR-specific ligands FGIN-1-27 and PK 11195, but not the centrally acting benzodiazepine clonazepam or the indolacetamide FGIN-1-52, neither of which displaying any affinity to the PBR, inhibited cell proliferation. FGIN-1-27 and PK 11195, but not clonazepam, potently induced apoptosis. FGIN-1-27 was shown to sequentially decrease the mitochondrial membrane potential, then to activate caspase-3 and finally to cause DNA fragmentation. In addition, PBR-specific ligands induced cell cycle arrest in the G1/G0 phase. Our data qualify PBR-specific ligands as innovative proapoptotic and antiproliferative substances. They might prove suitable for the treatment of esophageal cancer.
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http://dx.doi.org/10.1002/ijc.10724DOI Listing
December 2002
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