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Biomedical subjects

C Ell

Publications and source records attributed to C Ell.

At least 55 records · Page 3Linked to original sources
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↗
PubMed2001

[Neck swelling as the major symptom of lymph node and intestinal tuberculosis].

BACKGROUND: Gut tuberculosis appears to be a rare diagnosis in Central Europe. The main diagnostic method is endoscopy with biopsy in order to win histology and a culture. By means of endoscopy the differential diagnosis to Crohn's disease is sometimes difficult. Computertomography and/or ultrasound can facilitate the diagnosis of gut tuberculosis. CASE REPORT: A 64-year-old woman presented in our hospital with cervical lymph nodes and ulcerations in the cecum and near the ileocecal valve. Major symptoms were abdominal pain, loss of weight, diarrhea and febrile temperature. Histology and culture revealed tuberculosis. The common antituberculotic therapy had to be stopped due to severe allergic reaction. After desensitization the patient could be treated successfully with a triple antituberculotic therapy without further complication. CONCLUSION: Beside the early treatment with tuberculotic drugs it is very important to consider the differentiation of a gut tuberculosis.

Antitubercular Agents↗
PubMed2001

Lower intestinal bleeding.

Lower gastrointestinal tract bleeding is a frequent cause of physician consultations and hospital admissions. Clinical presentation is predictable and significantly influences subsequent patient management. Controversy surrounding diagnosis and treatment of lower gastrointestinal bleeding results from a surprising lack of prospective controlled data. Thus, selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithm approach. Advances in endoscopic, radiological and surgical equipment and techniques offer promising new diagnostic and therapeutic modalities, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. The present chapter will address clinical presentation, aetiology, diagnosis and treatment of lower gastrointestinal tract bleeding.

Colitis↗
PubMed2001

Management of Barrett's oesophagus, dysplasia and early adenocarcinoma.

There has been a dramatic increase in recent years in the incidence of Barrett's oesophagus and the oesophageal adenocarcinoma associated with it. Adequate monitoring strategies and improved diagnostic procedures are therefore essential. Alongside conventional video-endoscopy with four-quadrant biopsies, many additional diagnostic procedures are now available to improve monitoring. These allow the early diagnosis of dysplastic areas and early carcinomas. Both thermal procedures (argon plasma coagulation, multipolar electrocoagulation and KTP laser and Nd&ratio;YAG laser treatment) and non-thermal ablation procedures (photodynamic therapy) are used for the endoscopic ablation of Barrett's mucosa without dysplasia, being employed in addition to acid suppression treatment. On the basis of the data currently available, it is, however, not yet possible to offer a general recommendation in favour of endoscopic ablation. Alongside surgical treatment for high-grade dysplasia and early carcinoma, endoscopic treatment procedures, which have a much lower complication and mortality rate, will probably play an important role in the future. Endoscopic mucosal resection and photodynamic therapy are particularly promising. Long-term results with these procedures are, however, still awaited.

Adenocarcinoma↗
PubMed2001

Gastrointestinal bleeding in the elderly.

Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of gastrointestinal bleeding, the selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithmic approach. Advances in endoscopic, medical, radiological and surgical treatment modalities offer promising new diagnostic and therapeutic tools, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. This chapter will address clinical presentation, aetiology, diagnosis and treatment of both upper and lower gastrointestinal bleeding in the elderly.

Aged↗
PubMed2001

The AMOR study: a randomized, double-blinded trial of omeprazole versus ranitidine together with amoxycillin and metronidazole for eradication of Helicobacter pylori.

BACKGROUND: Besides antibiotics, additionally effective acid inhibition is necessary for the eradication of Helicobacter pylori. OBJECTIVE: To assess the significance of acid suppression and, in particular, treatment with proton pump inhibitors (PPIs) compared with H2 receptor antagonists (H2 RAs). The primary target parameter for the study was H. pylori eradication. In addition, the ulcer healing rate, speed of pain reduction, score for gastritis in the antrum and gastric body, and rate of side effects were recorded. DESIGN: Randomized, double-blinded, multicentre study. PARTICIPANTS: A total of 456 patients between the ages of 18 and 80 years with H. pylori-positive duodenal ulcers were included in the study. METHODS: Using a randomization list, patients were assigned either to a treatment group receiving omeprazole 40 mg once daily, amoxycillin 750 mg three times a day, and metronidazole 500 mg three times a day (OAM), or to a group receiving ranitidine 300 mg once daily, amoxycillin 750 mg three times a day, and metronidazole 500 mg three times a day (RAM). The treatment period was 7 days in both groups. Long-term acid-suppressant treatment was not given. RESULTS: The eradication rate was 87.1% (169/194, intention to treat [ITT]) in the OAM group and 77% (137/ 178, ITT) in the RAM group. The difference of 10.1% (95% CI 2.5-18%) is statistically significant (P= 0.0104). The ulcer healing rate was 93.3% in the OAM group (181/194, ITT) and 92.1% in the RAM group (164/178, ITT, NS). With regard to the speed and intensity of pain reduction, the OAM group was superior to the RAM group. In patients in whom H. pylori eradication was successful, the reduction in the antral and gastric body gastritis score was significantly greater than in patients without eradication. In the OAM group, 39.1% of the patients (n = 90) reported one or more side effects, compared with 44.7% (n = 101) in the RAM group (P= 1.5449, NS). CONCLUSION: Omeprazole (40 mg once daily in the morning) is significantly more effective than ranitidine (300 mg once daily in the morning) with respect to H. pylori eradication when used together with amoxycillin (750 mg three times a day) and metronidazole (500 mg three times a day) for a 7-day treatment period.

Adolescent↗