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Biomedical subjects

C Ell

Publications and source records attributed to C Ell.

At least 19 recordsLinked to original sources
PubMed2003

[Histopathological diagnosis of Barrett's mucosa and associated neoplasias. Results of a consensus conference of the Working Group for "Gastroenterological Pathology of the German Society for Pathology" on 22 September 2001].

There are a number of difficulties regarding the diagnosis of Barrett's mucosa and the varying grades of neoplasia that may be associated with it. It was therefore the aim of a consensus conference of the "Working Group for Gastroenterological Pathology within the German Society of Pathology" to achieve standardization regarding the following issues: definition and diagnostic criteria for Barrett's mucosa and its discrimination from intestinal metaplasia of the cardia, diagnostic criteria for intraepithelial neoplasia, number of biopsies necessary to establish the diagnosis, significance of additional immunohistochemical and/or molecular biological methods as well as importance of a second opinion in the diagnosis of intraepithelial neoplasia.

Barrett Esophagus↗
PubMed2003

A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*).

BACKGROUND AND STUDY AIMS: There are conflicting data regarding the optimal bowel preparation for colonoscopy. This study was carried out to compare the efficacy, safety, and tolerability of three widely used bowel lavage solutions: the standard polyethylene glycol-electrolyte solution based on the GoLytely formulation (PEG-EL1; Klean-Prep); a sulphate-free PEG-EL solution based on the NuLytely formulation (PEG-EL2, Endofalk); and a sodium phosphate preparation (NaP, Fleet Phospho-Soda). PATIENT AND METHODS: A total of 185 consecutive patients scheduled for elective colonoscopy were prospectively randomly assigned to undergo pre-colonoscopic bowel cleansing with either 4 l of PEG-EL1 (n=64), 3 l of PEG-EL2 (n=59), or 90 ml of NaP (n=62). The quality of preparatory colonic cleansing for each segment from the rectum to the ascending colon was scored on a five-level rating scale (1, very good to 5, very poor) by endoscopists who were blinded with regard to the type of preparation used. The primary outcome measure for the comparison of treatments was the "worst" score in any of the rated bowel segments. Safety and tolerability were evaluated by means of a symptom questionnaire completed by each patient immediately before the procedure. RESULTS: Of the 185 patients who were randomly assigned to one of the three treatments, 175 underwent colonoscopy and 173 were evaluable with regard to efficacy - 59, 54, and 60 patients treated with PEG-EL1, PEG-EL2, and NaP, respectively. The treatment groups were comparable with regard to the baseline characteristics. PEG-EL1 was statistically significantly superior to the other treatments in relation to the "worst cleansing" score ( P</=0.003). In addition, colonoscopic visualization was markedly better in each of the five bowel segments and general "very good" or "good" ratings were achieved in more than 90 % of patients treated with PEG-EL1. The percentages were consistently lower in the other two groups, particularly in the ascending colon. With the exception of the sigmoid, the differences in all segments of the large bowel were statistically significant (P</=0.04). Patient satisfaction was comparable between the treatment groups. Adverse events (mainly nausea/vomiting and abdominal pain) and deviations in laboratory values occurred more frequently in the NaP group. CONCLUSIONS: Preparatory PEG-EL1 (Klean-Prep) was significantly superior to PEG-EL2 (Endofalk) and NaP (Fleet Phospho-Soda) in achieving effective cleansing of the entire colon prior to colonoscopy. On the basis of these data, PEG-EL1 can be regarded as the "gold standard" for bowel cleansing prior to colonoscopy.

Adolescent↗
PubMed2003

Improving endoscopic resolution and sampling: fluorescence techniques.

Gastrointestinal tumours are usually associated with a poor prognosis, as most are only diagnosed at an advanced stage. Every effort to improve intraluminal diagnosis in gastroenterology must therefore be aimed at diagnosing gastrointestinal tract tumours at the earliest stage possible.

Barrett Esophagus↗
PubMed2002

Scorecard endoscopy: a pilot study to assess basic skills in trainees for upper gastrointestinal endoscopy.

BACKGROUND: The development of training models and structured training courses for endoscopic techniques provides practical experience. To assess individual performance and progress in this training we developed and tested a scorecard system. METHODS: Three test groups were compared: group 1, ten physicians without previous endoscopic experience; group 2, ten students, without endoscopic experience; group 3, a control group of experienced endoscopists. Groups 1 and 2 underwent 1 week of training with a theoretical introduction and practical demonstrations. They were assessed by the scorecard daily by an experienced tutor. The individual scores and learning curves of the two beginner groups were compared with those of the expert group using a biosimulation model was used. RESULTS: Each participant improved significantly during the 1-week course. Mean scores on the first day in groups 1-3 were, respectively, 26.7+/-10.7, 33.4+/-5.3, and 72.0+/-5.8, and on day 6 they were 62.2+/-6.6, 63.4+/-7.6, and 86.6+/-4.3. The difference between group 3 and the other two groups was significant but not that between groups 1 and 2. CONCLUSIONS: Training in endoscopy can be assessed using our training model and our scorecard protocol, which distinguishes between various levels of experience. In physicians beginning in the field of gastrointestinal endoscopy this approach could help to reduce risks to patients, shorten learning curves, and exclude unskilled individuals from further fruitless interventions.

Animals↗
PubMed2002

[Barrett esophagus--esophageal carcinoma: conservative therapy and observation].

Chronic acid reflux is strongly associated with cancer of the esophagogastric junction and the main reason for the development of specialised intestinalised metaplasia in the esophagus (Barrett's esophagus). Endoscopic surveillance, therefore, is mandatory for long-segment Barrett's esophagus as well as short segment Barrett's. Videoendoscopy with four quadrant random biopsies are standard and new diagnostic tools like chromoendoscopy with methylene blue, magnifying endoscopy or fluorescence detection may turn out to be helpful. Differential surveillance strategies according to the recommendations of the American College of Gastroenterology and the Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen should be performed for medical and cost-efficiency reasons. Local endoscopic therapy of early cancer and high-grade dysplasia in Barrett's esophagus comprises three different methods: endoscopic mucosal resection (EMR), semiselective, athermal photodynamic therapy (PDT) and thermal techniques such as KTP- or Nd:YAG-laser and argon-plasma coagulation. All endoscopic methods have low morbidity and mortality rates compared to esophageal resection and therefore are an attractive alternative treatment option. Endoscopic mucosal resection is the treatment of choice for all localizable and circumscribed lesions, because the resected specimen can be classified with regard to the histopathological grading, complete resection and submucosal involvement, especially in view of patients who are surgical candidates. PDT is the best local treatment option for multifocal, not localizable or large superficial lesions, as large areas can be treated in a single therapeutic session. Thermal procedure are mainly auxiliary methods for the optimization of EMR or PDT. The shortterm and intermediate results of our studies appear to be promising in view of the high complete local remission rates in combination with the low morbidity and mortality.

Barrett Esophagus↗
PubMed2002

Endoscopic therapy for Zenkers's diverticulum by means of argon plasma coagulation.

We describe a 80-year-old man who presented with progressive dysphagia because of a Zenker's diverticulum. Barium swallow study revealed a large posterior diverticulum with a distal stenosis of the esophagus caused by compression. Because the patient was a poor candidate for surgery an endoscopic therapy was performed. The Zenker bridge was divided by argon plasma coagulation in two sessions without any complication to allow an overflow. The patient remained asymptomatic to date for a follow-up of 6 months.

Aged↗
PubMed2002

Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques.

BACKGROUND AND STUDY AIMS: In recent years, short-segment Barrett's esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation. PATIENTS AND METHODS: Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett's adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments. RESULTS: Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 +/- 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 +/- 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett's adenocarcinoma (this was the patient who underwent esophageal resection). CONCLUSIONS: The malignant potential of short-segment Barrett's esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett's esophagus.

Adenocarcinoma↗
PubMed2002

The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.

BACKGROUND AND STUDY AIMS: In chronic gastrointestinal bleeding (CGB), bleeding sites located in the small bowel are difficult to detect with conventional radiological or scintigraphic techniques. Push enteroscopy (PE) is at present considered to be the most effective diagnostic procedure. The aim of this prospective trial was to compare the efficacy of wireless capsule endoscopy (CE) with PE. PATIENTS AND METHODS: Between April and October 2001, 65 patients with CGB were referred to our unit. Complete conventional diagnostic work-up (including small-bowel enteroclysis, angiography, and scintigraphy), as well as PE and CE, were performed in 32 patients. RESULTS: On average, the patients had been suffering from CGB for 29 +/- 24 months (6 - 126); the lowest hemoglobin level varied between 3.0 and 9.9 g/dl (mean 5.9 +/- 1.4); 17 +/- 18 blood units (0 - 60) were transfused. Each patient underwent 6 +/- 7 (range 1 - 38) hospitalizations, with a mean of 14 +/- 9 diagnostic procedures before CE was used. Conventional diagnostic procedures revealed relevant pathological findings in five of the 32 patients (16 %). Definite bleeding sites diagnosed by PE in nine patients (28 %) included angiodysplasia (seven patients), small-bowel cancer (one patient) and lymphoma (one patient). CE detected the definite source in 21 of the 32 patients (66 %) ( P < 0.001). Definite bleeding sources included angiodysplasia (17 patients), malignant stenoses (two patients) and inflammatory small-bowel disease (two patients). Questionable bleeding sources were seen on PE in three additional patients (9 %), and using CE in a further seven patients (22 %). Both CE and PE were safe and were not associated with any morbidity. CONCLUSIONS: In the present trial in patients with CGB, wireless CE had the highest diagnostic yield and was significantly superior to PE. CE can help reduce the number of diagnostic procedures and could become the initial diagnostic choice in patients with CGB and negative upper and lower gastrointestinal endoscopy.

Adult↗
PubMed2002

[Infection with fasciola hepatica causing elevated liver-enzyme results and eosinophilia - serologic and endoscopic diagnosis and therapy].

A 36 year old man was diagnosed with eosinophilia and elevated liver-enzyme levels in a preoperative routine laboratory testing. In the course of the evaluation we found high levels of Fasciola hepatica specific antibodies which lead to an ERC with biliary aspiration after choleretic stimulation. The bile showed Fasciola eggs and subsequently we recovered a parasite from the bile duct. Abdominal CT- and MRI-Scans showed lesions of the liver consistent with hepatic fascioliasis. Focussed patient's history revealed ingestion of contaminated watercress in Turkey as the most likely source of infection. For patients with elevated liver-enzymes of unknown etiology with eosinophilia or in combination with a congruent patient's history even without eosinophilia serologic studies of Fasciola hepatica seem to be advisable. We suggest an ERC with biliary aspiration to prove the diagnosis in case of positive results, if the prepatency period of 4 months after the ingestion is over. Fasciola hepatica is rarely diagnosed in Germany probably due to the lack of awareness of the disease.

Adult↗
PubMed2002

Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up.

BACKGROUND AND STUDY AIMS: Endoscopic ductal decompression therapy has become an established method of treating patients with painful obstructive chronic pancreatitis. Smaller series, mostly with a medium-term follow-up period, have reported encouraging results. The present analysis presents long-term follow-up data from a large multicenter patient cohort. PATIENTS AND METHODS: Patients with painful chronic pancreatitis and with ductal obstruction due to either strictures and/or stones treated endoscopically at eight different centers underwent follow-up after 2 - 12 years (mean 4.9 years). The patients' clinical data, the rate of technical success, and complications were recorded from the charts. Follow-up data were prospectively obtained using structured questionnaires; the main parameter for evaluating treatment success was a significant reduction in pain (no pain or only weak pain). RESULTS: Follow-up data were obtained from 1018 of 1211 patients treated (84%) with mainly strictures (47%), stones (18%), or strictures plus stones (32%). At the long-term follow-up, 60% of the patients had their endotherapy completed, 16% were still receiving some form of endoscopic treatment, and 24% had undergone surgery. The long-term success of endotherapy was 86% in the entire group, but only 65% in an intention-to-treat analysis. There were no significant differences between the patient groups with regard to either strictures, stones, or both. Pancreatic function was not positively affected by endoscopic therapy. CONCLUSIONS: Endoscopic ductal decompression therapy offers relief of pain in two-thirds of the patients when it is used as the only form of treatment. One-quarter of the patients have to undergo surgery.

Adolescent↗
PubMed2002

Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: a prospective multicentre study.

AIMS: To determine whether an adequate histological diagnosis of gastric polyps can be attained on the basis of forceps biopsy. PATIENTS AND METHODS: In a prospective multicentre study, 194 patients with 222 endoscopically removable gastric polyps (>or=5 mm) underwent forceps biopsy and complete polypectomy. Patients with fundic gland polyps and polyposis syndrome were not included. Specimens were evaluated by primary and reference pathologists, and the complication rate of gastric polypectomy was also determined. RESULTS: Of the 222 polyps, histological examination of the polypectomy specimens revealed tumour-like lesions in 77% (10% focal foveolar hyperplasia, 59% hyperplastic polyps, 4% inflammatory fibroid polyps, 4% other polyps) and neoplasia in 19% (10% tubular adenoma, 2% tubulovillous adenoma, 1% high grade intraepithelial neoplasia, 6% adenocarcinoma). When biopsy results were compared, complete agreement was found in 124 cases (55.8%) and, in an additional 77 cases (34.7%), the clinically important differentiation between tumour-like lesions and neoplasia was possible. However, relevant differences were found by the reference pathologist in six cases (2.7%), the most common reason being failure of biopsy to reveal foci of carcinoma in hyperplastic polyps. Bleeding was observed after polypectomy in 16 patients (7.2%), in 15 of whom it was managed conservatively. CONCLUSIONS: We recommend complete removal by an experienced endoscopist of all epithelial gastric polyps larger than 5 mm after thorough individualised risk-benefit analysis.

Adult↗