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J J Bergman

Publications and source records attributed to J J Bergman.

At least 19 recordsLinked to original sources
PubMed2006

Autofluorescence imaging and narrow-band imaging for the detection of early neoplasia in patients with Barrett's esophagus.

High-resolution endoscopy (HRE), magnifying endoscopy, auto-fluorescence endoscopy, and narrow-band imaging (NBI) are promising techniques that could improve the detection of early neoplasia and the efficacy of endoscopic surveillance in patients with Barrett's esophagus. HRE improves the detection of lesions by white light, and video autofluorescence imaging (AFI) may have additional value in terms of sensitivity. The strengths ofAFI are its high sensitivity and a high negative predictive value,while potential limitations are its moderate specificity and positive predictive value. NBI enhances the mucosal and vascular patterns (i. e. the mucosal morphology) without the need for chromoendoscopy. The mucosal morphology features may be used to distinguish early neoplasia from nondysplastic Barrett's esophagus. Magnification is required for optimal use of NBI,which is a limitation of this technique. NBI with magnifying endoscopy could, however, be used for targeted inspection of lesions detected first by HRE or AFI. This approach has been shown to reduce the false-positive rate associated with AFI while maintaining its high sensitivity. To date, AFI and NBI have been used separately in two different prototypes, but a prototype endoscope that incorporates all of these techniques has recently become available. It is expected that future refinement of the autofluorescence and narrow-band modules may further increase their diagnostic value and ultimately improve the effectiveness of surveillance of Barrett's esophagus.

Barrett Esophagus↗
PubMed2006

Potential impact of EUS-FNA staging of proximal lymph nodes in patients with distal esophageal carcinoma.

BACKGROUND AND STUDY AIMS: Distal esophageal carcinomas can be resected using transthoracic esophagectomy or transhiatal esophagectomy. Accurate diagnosis of subcarinal and supracarinal lymph-node metastases is important for selecting the surgical strategy. The impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on the preoperative diagnosis of subcarinal and supracarinal lymph-node metastases in patients with distal esophageal carcinoma was therefore investigated. PATIENTS AND METHODS: Patients with a resectable distal esophageal carcinoma and subcarinal and/or supracarinal lymph nodes visualized on preoperative EUS were prospectively included. The lymph nodes were sampled using EUS-FNA, and if they were found to have metastases, transthoracic resection was offered; by contrast, patients without metastases were offered a transhiatal resection. RESULTS: Lymph-node metastases were found with EUS-FNA in 11 of the 48 patients included (23 %). Thirteen patients had suspicious nodes on EUS, in four of whom (31 %) the diagnosis was changed into nonmalignant nodes with FNA. Thirty-five patients had nonsuspicious nodes on EUS, in three of whom (9 %) the FNA procedure revealed malignant cells. CONCLUSIONS: EUS with the addition of the FNA procedure has a significant impact on decision-making in patients with esophageal carcinoma in whom transhiatal esophagectomy would otherwise be planned.

Biopsy, Needle↗
PubMed2004

[Giant diverticulum of the sigmoid].

A 77-year-old woman who had been examined 8 months previously because of chronic abdominal pain and an altered pattern of defecation presented to the emergency department with complaints of nausea, vomiting and acute pain in the abdomen. Her appetite was diminished and she had lost 10 kg in the past year. The abdominal X-ray showed a balloon-like, gas-filled intra-abdominal configuration, which proved to be a giant diverticulum of the sigmoid. She was treated by resection of the diverticulum and the sigmoid. A giant diverticulum is a rare complication of diverticulosis, a frequently occurring condition that is encountered most often in the sigmoid; the complication can easily be missed. The presenting symptoms can vary from an acute abdomen to chronic non-specific abdominal complaints. The most important complications of a giant diverticulum are perforation, obstruction or a volvulus. In view of the severity of these complications, resection of that part of the intestine in which the giant diverticulum arises is the treatment of choice.

Abdominal Pain↗
PubMed2004

Outcome of patients with esophageal carcinoma and suspicious celiac lymph nodes as determined by endoscopic ultrasonography.

BACKGROUND AND STUDY AIMS: The management of patients with esophageal cancer with malignant celiac lymph nodes (CLNs) is controversial. In this study we evaluated the management and survival of patients with positive CLN findings on endoscopic ultrasonography (EUS) and compared the outcome in surgically treated patients with that of nonsurgically treated patients. PATIENTS AND METHODS: The EUS database of the Academic Medical Center was retrospectively searched for patients with esophageal carcinoma and EUS-positive CLN. Follow-up comprised the review of medical charts and contact with general practitioners. RESULTS: From 1993 through 2000, 78 patients with esophageal carcinoma and suspicious CLN were eligible for inclusion in this study. The median survival of patients with CLN size < 2 cm was 13.5 months vs. 7.0 months for patients with CLN size >2 cm ( P = 0.01). In a multivariate model, CLN size was the only predictive factor for poor patient survival. Of the 78 study patients, 13 underwent a surgical resection and 65 received nonsurgical treatment. The surgical group was significantly younger and all patients in this group had CLN size < 2 cm. The median survival for the surgical group was 13.7 months vs. 13.5 months for the nonsurgical group with CLN size < 2 cm ( P = 0.63). CONCLUSIONS: In this retrospective study, CLN size was a significant predictor for poor survival. The surgically treated patients had a medium-term survival similar to that of nonsurgically treated patients with a CLN size < 2 cm. These findings underline the prognostic value of CLN size in patients with esophageal carcinoma.

Aged↗
PubMed2003

[Barrett's esophagus: new developments in endoscopic surveillance].

The current surveillance strategies for patients with a Barrett's oesophagus are hampered by the poor endoscopic visibility of early neoplastic lesions, the sampling error of random biopsies, the subjectivity of the histological evaluation, and the low incidence of carcinoma. New endoscopic techniques are available for a more reliable evaluation of a Barrett's oesophagus: high-resolution endoscopy, chromoendoscopy, fluorescence endoscopy and optical coherence tomography. The use of molecular markers will probably lead to a better risk stratification of patients. Detection of aneuploid cell populations and assessment of an increase of the number of cells in the S- and G2-phase are possible with DNA flow cytometry; flow cytometric abnormalities may be a more reliable predictor of carcinoma than histological assessment. A combined approach with the new endoscopic techniques and molecular markers may lead to a more efficient and cost-effective surveillance programme.

Barrett Esophagus↗
PubMed2003

[Barrett's esophagus: endoscopic treatment of high-grade dysplasia and early cancer].

In a Barrett's oesophagus without dysplasia, endoscopic control every 3-5 years is sufficient. If low-grade dysplasia is encountered in the surveillance biopsies, then endoscopy should be repeated within 3-6 months and yearly thereafter if the low-grade dysplasia persists. Antacid medication must be prescribed in cases with extensive inflammation. The endoscopic treatment of patients with high-grade dysplasia and/or early cancer of the mucosa in a Barrett's oesophagus (tissue ablation and/or mucosa resection) seems a promising alternative to surgery in view of the combination of effectiveness, limited invasiveness compared to surgical resection, and the preservation of a functional oesophagus. Data from long-term follow-up are still limited. Strict endoscopic surveillance will probably detect metachronic abnormalities in an early and still curable stage, creating a new opportunity for endoscopic treatment.

Barrett Esophagus↗
PubMed2003

Stimulus-dependent translocation of egg-laying hormone encoding mRNA into the axonal compartment of the neuroendocrine caudodorsal cells.

To get insight into the stimulus-dependent translocation of mRNA encoding neuropeptides to the axonal compartment of neurons, we investigated this process in the egg-laying hormone producing caudodorsal cells of the mollusk Lymnaea stagnalis. The axonal compartment including the nerve terminals of these neurons harbors high amounts of mRNA encoding the egg-laying hormone precursor. We determined how a sensory stimulus, that results in egg-laying, affected the amount of egg-laying hormone encoding transcripts in the axon endings. Four hours after stimulation high amounts of transcripts were detected in the axonal compartment and maximum values were reached after 8 h. Transcript levels in the somata were affected in a similar fashion, although the increase was not as pronounced as in the axons. Next, we investigated the ultrastructural localization of egg-laying hormone encoding transcripts in axons and axon terminals by means of electron microscopic in situ hybridization and showed that transcripts were localized in the axoplasm. By means of conventional electron microscopy we showed that axon terminals of egg-laying hormone producing neurons contained large amounts of polyribosomes. Together, these data support the notion that egg-laying hormone encoding transcripts are translated in the axonal compartment.

Animals↗
PubMed2001

Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk for pancreatitis or a higher rate of hyperamylasemia?

BACKGROUND AND STUDY AIMS: We studied the rate of pancreatitis and asymptomatic hyperamylasemia after endoscopic balloon dilation (EBD) and endoscopic sphincterotomy (EST) for removal of bile duct stones. PATIENTS AND METHODS: Patients with bile duct stones of all sizes were randomly allocated to undergo EBD (8-mm dilation balloon) or EST. Pancreatitis was defined as epigastric pain combined with at least a threefold rise in serum amylase at 24 hours after the endoscopic retrograde cholangiopancreatography (ERCP). Asymptomatic hyperamylasemia was defined as a threefold rise in serum amylase without epigastric pain. RESULTS: There were 180 patients (67 men, 113 women; mean age 67, SD 16.2) available for analysis. Complete stone removal after a single ERCP was achieved in 82 (88%) of 93 EBD patients and in 81 (93%) of 87 EST patients (P = 0.38). Mechanical lithotripsy was used more frequently in the EBD group (31% vs. 13%, P = 0.005). Early complications occurred in 16 EBD patients (17%) and in 19 EST patients (22%) (P = 0.46). Pancreatitis was observed in seven patients in each group (8%). Logistic regression identified no significant predictors for the occurrence of pancreatitis. Asymptomatic hyperamylasemia occurred in 21 EBD patients (23%) vs seven EST patients (8%) (P = 0.008). Logistic regression identified EBD as the only significant predictor for asymptomatic hyperamylasemia: odds ratio 2.9 (95% confidence interval (CI) 1.1 to 7.3, R2 = 0.02). CONCLUSIONS: We did not observe a difference in the rate of pancreatitis between EBD and EST. Asymptomatic hyperamylasemia was observed more frequently after EBD. Although asymptomatic hyperamylasemia is not a clinical entity, this finding may indicate that EBD causes more irritation of the pancreas than EST.

Aged↗
PubMed2001

A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy.

BACKGROUND: A prior Billroth II gastrectomy renders endoscopic sphincterotomy (EST) more difficult in patients with bile duct stones. Endoscopic balloon dilation (EBD) is a relatively easy procedure that potentially reduces the risk of bleeding and perforation. METHODS: Thirty-four patients with bile duct stones and a previous Billroth II gastrectomy were randomized to EST or EBD. Complications were graded in a blinded fashion. Results were compared with those for a group of 180 patients with normal anatomy from a previously reported randomized trial of EBD versus EST. RESULTS: All stones were removed in 1 endoscopic retrograde cholangiopancreatography in 14 of 16 patients who underwent EBD versus 14 of 18 who had EST (p = 1.00). Mechanical lithotripsy was used in 3 EBD procedures versus 4 EST procedures (p = 1.00). Early complications occurred in 3 patients who had EBD versus 7 who underwent EST (p = 0.27). Three patients had bleeding after EST; 1 patient had mild pancreatitis after EBD. The median time required for stone removal was 30 minutes in both groups. Compared with patients with a normal anatomy, patients with a previous Billroth II gastrectomy had a significantly increased risk of bleeding after EST (17% vs. 2%, relative risk = 7.25, p < 0.05). CONCLUSIONS: A prior Billroth II gastrectomy renders EST more difficult and increases the risk of a complication. EBD in these patients is easy to perform and is not associated with an increased need for mechanical lithotripsy or a longer procedure time. The risk of bleeding is virtually absent after EBD and the risk of pancreatitis after EBD seems not significantly increased in these patients.

Adult↗
PubMed2001

Long-term follow-up after biliary stent placement for postoperative bile duct stenosis.

BACKGROUND: The outcome of temporary biliary stent placement for postoperative bile duct stenosis was retrospectively evaluated with the main aim of assessing long-term complications after stent removal. METHODS: ERCP was performed between 1981 and 1991 in 74 patients with postoperative bile duct stenoses. Two 10F stents were inserted for a maximum of 12 months with stent exchange every 3 months to avoid cholangitis caused by clogging. RESULTS: Stent insertion failed in 11 patients with complete and 4 patients with incomplete biliary obstruction. Early complications occurred in 14 patients (19%) including 2 deaths. Therefore 57 patients were included in the stent phase of the study. In 10 patients the referring physician did not adhere to the treatment protocol, and nonelective stent exchange for jaundice and/or cholangitis was necessary in 7 (70%). Of the 47 patients treated according to protocol, complications developed in 40% during the period with stents in situ. Stents were eventually removed in 44 patients who were subsequently followed for a median of 9.1 years. Late complications developed in 15 patients (34%) including recurrent stenosis in 9 (20%). All cases of recurrent stenosis occurred within 2 years of stent removal. CONCLUSIONS: Endoscopic treatment is feasible in 80% of patients who undergo an ERCP for postoperative bile duct stenosis. After stent insertion and during the time with stents in situ, complications occur at a significant rate but are usually mild or reflect the patient's underlying condition. After stent removal, recurrent stenosis develops in 20% of patients within 2 years of stent removal. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis.

Adult↗
PubMed2001

Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis.

OBJECTIVE: To assess the impact of bile duct injury (BDI) sustained during laparoscopic cholecystectomy on physical and mental quality of life (QOL). SUMMARY BACKGROUND DATA: The incidence of BDI during laparoscopic cholecystectomy has decreased but remains as high as 1.4%. Data on the long-term outcome of treatment in these patients are scarce, and QOL after BDI is unknown. METHODS: One hundred six consecutive patients (75 women, median age 44 +/- 14 years) were referred between 1990 and 1996 for treatment of BDI sustained during laparoscopic cholecystectomy. Outcome was evaluated according to the type of treatment used (endoscopic or surgical) and the type of injury. Objective outcome (interventions, hospital admissions, laboratory data) was evaluated, a questionnaire was filled out, and a QOL survey was performed (using the SF-36). Risk factors for a worse outcome were calculated. RESULTS: Median follow-up time was 70 months (range 37-110). The objective outcome of endoscopic treatment (n = 69) was excellent (94%). The result of surgical treatment (n = 31) depended on the timing of reconstruction (overall success 84%; in case of delayed hepaticojejunostomy 94%). Five patients underwent interventional radiology with a good outcome. Despite this excellent objective outcome, QOL appeared to be both physically and mentally reduced compared with controls (P <.05) and was not dependent on the type of treatment used or the severity of the injury. The duration of the treatment was independently prognostic for a worse mental QOL. CONCLUSIONS: Despite the excellent functional outcome after repair, the occurrence of a BDI has a great impact on the patient's physical and mental QOL, even at long-term follow-up.

Adult↗
PubMed2001

Positive peritruncal nodes for esophageal carcinoma. not always a dismal prognosis.

BACKGROUND/AIMS: For esophageal carcinoma, positive truncal nodes are considered distant metastases, and might be a contraindication for potentially curative surgery. With the development of new diagnostic tools more/smaller peritruncal nodes may be found positive preoperatively. We evaluate whether it is justified to exclude all patients with positive peri-truncal nodes from curative surgery. METHODS: Retrospective study of all patients undergoing transhiatal resection for a mid-/distal esophageal carcinoma between 1993 and 1997. RESULTS: 110 patients underwent transhiatal resection for esophageal carcinoma. Sixteen patients had tumor-positive, resectable peritruncal lymph nodes not identified preoperatively, changing preoperative stage III into postoperative stage IV (M1a). After follow-up of 2.9 years (0.07-7.6), 49 patients (45%) were alive. On multivariate analysis radicality and lymph node status were independent prognostic factors. There was no significant difference in survival between stage III and stage IV (M1a) tumors: 1.7 and 1.5 years, respectively (p = 0.87). At the end of follow-up, 4/16 patients (25%) with stage IV (M1a) disease were alive without evidence of disease. CONCLUSION: The presence of malignant cells in small, resectable peritruncal nodes does not preclude long-term survival. The results of new diagnostic modalities should be interpreted cautiously, until firm criteria for irresectability/incurability of positive truncal nodes are established.

Adenocarcinoma↗
PubMed2000

[Gastro-intestinal surgery and gastroenterology. V. Chronic pancreatitis: gastroenterologic aspects].

Chronic pancreatitis causes irreversible damage to the pancreatic parenchyma and ultimately leads to exo- and endocrine insufficiency. In the Western world, alcohol is the main cause of chronic pancreatitis; part of the patients with idiopathic or alcoholic pancreatitis conceivably have a raised sensitivity to the toxic effects of alcohol because of a certain genetic predisposition. The most striking symptom, severe recurrent or persistent pain is often difficult to manage. Various forms of imaging examination provide complementary information on lesions of the pancreatic parenchyma, the pancreatic duct, the bile ducts and adjacent structures; ultrasonoscopy is the technique of first choice in case of suspicion of a pancreatic disorder. Endoscopic therapies are booming: sphincterotomy, calculus extraction, insertion of an endoprosthesis in the pancreatic duct and drainage of pseudocysts (transpapillary or through the jejunum or stomach).

Alcoholism↗
PubMed2000

[Diagnosis and treatment of cholelithiasis].

Most patients with gallbladder stones are asymptomatic and do not require treatment. Biliary colics are the main indication for laparoscopic cholecystectomy: the treatment of choice for gallbladder stones. Dyspepsia is not an indication for treatment of gallstones. The indications for bile salt therapy and extracorporeal lithotripsy are limited. Acute cholecystitis should be treated with cholecystectomy à chaud whereas longstanding cholecystitis is preferably treated with cholecystectomy à froid. Bile duct stones are mainly treated endoscopically during endoscopic retrograde cholangiopancreatography (ERCP): pancreatitis, bleeding and perforation are the main complications. Prior to cholecystectomy, an ERCP is indicated in case of cholangitis, severe pancreatitis, persisting jaundice, bile duct stones on ultrasonography, or the combination of dilated ducts and abnormal liver function tests. After endoscopic stone removal, a cholecystectomy is indicated for patients < 50 years but a 'wait and see' policy is justified in elderly patients.

Acute Disease↗
PubMed2000

EUS imaging of the arteria lusoria: case series and review.

BACKGROUND: The arteria lusoria is an aberrant right subclavian artery that passes dorsally between the esophagus and spine after branching off from the aortic arch. The role of endoscopic ultrasonography (EUS) in the diagnosis of the arteria lusoria has not been established. The possibility of demonstrating this vascular anomaly with EUS and estimating its prevalence was assessed. METHODS: From December 1991 to September 1998, EUS of the upper gastrointestinal tract was performed in 3334 consecutive patients for various reasons. After imaging of the target organ(s), the echoendoscope was slowly pulled back while imaging the mediastinum proximally to the superior aspect of the aortic arch. In every patient, the area of the aortic arch was carefully inspected and special attention was given to vessels crossing from left to right between the esophagus and spine. RESULTS: During the study period, an arteria lusoria was discovered in 12 of 3334 patients (0.36%: 95% CI [0.16%, 0.56%]). There were 6 men and 6 women; mean age was 64+/-14.7 years. In all 12 patients the arteria lusoria passed between the esophagus and spine. In none of the patients could symptoms be attributed to the presence of this anatomic variant. CONCLUSIONS: An arteria lusoria can be detected with upper gastrointestinal EUS and was found in 0.36% of patients. EUS can accurately demonstrate this vascular anomaly.

Adult↗
PubMed1999

[Bile duct injuries after a laparoscopic cholecystectomy].

Eight years after the introduction of laparoscopic cholecystectomy a decrease of the incidence of bile duct injuries is reported in the literature. The incidence of a bile duct injury after laparoscopic cholecystectomy is now slightly higher than after open cholecystectomy. A minority of these injuries are detected during surgery. Most patients have a delayed identification of the bile duct injury, even after discharge from the hospital. An early diagnostic work-up with ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) is mandatory in every patient with persisting symptoms (more than 48 hours) after laparoscopic cholecystectomy. Still, one-third of the patients are subjected to a 'diagnostic' exploratory laparotomy without preoperative visualization of the biliary tract by ERCP or percutaneous transhepatic cholangiography. Minor lesions are mostly treated successfully by endoscopy with a stent. After transection of the bile duct surgical reconstruction by a hepaticojejunostomy has to be performed. A delayed elective reconstruction was associated with fewer complications than acute repair under suboptimal circumstances such as local inflammatory changes and bile leakage.

Adult↗
PubMed1999

Endoscopic ultrasonography in patients with gastro-esophageal cancer.

For patients with gastro-esophageal cancer ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumor infiltration and local lymph nodes status. EUS is especially important in the preoperative staging of patients with esophageal cancer and patients with proximal gastric cancer. Here it allows for the identification of those patients with advanced disease who are unlikely to benefit from surgery and in whom a conservative palliative treatment is indicated. In advanced gastric cancer the clinical implications of EUS less clear. Still preoperative EUS is indicated in every patient with cancer of the proximal stomach to assess tumor infiltration in the esophagus. Relatively new is the use of EUS in staging early cancers in order to select patients for local endoscopic treatment. High-frequency miniprobes are the instruments of choice for imaging these lesions. Strict criteria should be applied in the selection of patients for local endoscopic treatment of early gastro-esophageal cancers. EUS guided fine needle aspiration (EUS-FNA) is currently only indicated in patients with esophageal cancer and suspicious celiac lymph nodes. It may become more important if new treatment protocols demand more objective and reliable assessment of lymph node status.

Endosonography↗