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Biomedical subjects

K F Binmoeller

Publications and source records attributed to K F Binmoeller.

At least 19 recordsLinked to original sources
PubMed2002

Impact of endoscopic ultrasound for evaluation of submucosal lesions in gastrointestinal tract.

BACKGROUND: Endoscopic ultrasound is widely used following endoscopy for evaluation of suspected submucosal lesions and may guide further management of patients. PATIENTS AND METHOD: A total of 181 consecutive patients with suspected submucosal lesion in the upper gastrointestinal tract were diagnosed by endoscopic ultrasound between 1990-97. We evaluated: 1) the potential of endoscopic ultrasound criteria to predict histological type of submucosal lesions in 69 patients with available histology, 2) the ability of endoscopic ultrasound alone or with clinical presentation, to predict malignancy in 86 patients with available histology or follow-up of >12 months. RESULTS: Sensitivity and specificity for diagnosing 44 gastrointestinal stromal tumours were 95 and 72%, respectively, while 25 miscellaneous lesions were diagnosed correctly in only 56% by endoscopic ultrasound. Diagnosis of malignancy, using any two of three endoscopic ultrasound criteria (heterogeneous echotexture, size >3 cm, irregular margins) showed a sensitivity of 80% and specificity of 77%, giving accurate endoscopic ultrasound diagnosis in 16/20 malignant and 51/66 benign submucosal lesion. Heterogeneous echotexture, size >3 cm, and irregular margins showed a relative risk of 7.2, 5.4 and 4.6, respectively, for presence of malignancy. The presence of symptoms, potentially suggesting malignancy (dysphagia, gastrointestinal bleeding, pain and weight loss), had a relative risk of 4.2, however this did not increase the accuracy of diagnosing malignancy based on endoscopic ultrasound criteria alone. CONCLUSION: The accuracy of endoultrasound is high in diagnosing gastrointestinal stromal tumours, which show a significant potential of malignancy. Endoscopic ultrasound morphology appears to be helpful in selection of patients for surgical or conservative treatment. The accuracy of endoscopic ultrasound in differential diagnosis of non-gastrointestinal stromal tumour lesions is limited.

Adolescent↗
PubMed2002

Argon plasma coagulation for the treatment of colonic varices.

Various individually tailored endoscopic treatment modalities have been described for bleeding colorectal varices. We describe a case of a 65-year-old man, in whom argon plasma coagulation successfully eradicated ectopic varices at the ileocolonic anastomosis; bleeding could be stopped.

Aged↗
PubMed2001

Endoscopic management of bile duct stones.

The advantages of endoscopic retrograde cholangiopancreatography (ERCP) over open surgery make it the predominant method of treating choledocholithiasis. Today, technologic advances such as magnetic resonance cholangiopancreatography and laparoscopic surgery are challenging ERCP's primacy in the management of common bile duct (CBD) stones. This article reviews the current status of endoscopic treatment of biliary stones and examines this in relation to laparoscopic management. The techniques and safety of endoscopic sphincterotomy and balloon sphincteroplasty are reviewed. Balloon sphincteroplasty should be limited to study protocols because of safety questions and inherent limitations. After sphincterotomy, 85% to 90% of CBD stones can be removed with a Dormia basket or balloon catheter. These techniques are described as having both advantages and disadvantages. Methods for managing "difficult stones" include mechanical lithotripsy, intraductal shock wave lithotripsy, extracorporeal shock wave lithotripsy, chemical dissolution, and biliary stenting. These approaches are presented along with data supporting their use in specific situations. Laparoscopic cholecystectomy has emerged as the preferred alternative to open cholecystectomy. Parallel advances in the endoscopic and laparoscopic management of CBD stones have made the issue regarding the optimal treatment strategy complex. Three approaches to the management of choledocholithiasis in the laparoscopic era are presented as follows: strict therapeutic splitting, flexible therapeutic splitting, and strict laparoscopic management. The optimal approach needs to be defined in prospective comparative trials. For now, preoperative endoscopic stone extraction should still be recommended as the approach of choice in patients suspected to have CBD stones based on clinical, biochemical, and imaging parameters. Primary laparoscopic evaluation and management is reasonable in patients who have a low-to-moderate probability of having CBD stones.

Catheterization↗
PubMed2000

Variceal bleeding and portal hypertension.

Within the short span of half a century, the treatment of variceal bleeding has become highly differentiated, with multiple treatment options. Pharmacological therapy with beta-blockers is well established for preventing the first variceal bleeding. The utility of adding a vasodilator to beta-blockers needs to be studied further. Octreotide is widely used as an adjuvant to standard endoscopic treatment to prevent variceal rebleeding, and the utility of this approach has been validated in several randomized controlled trials. Band ligation is well established, and its popularity has increased with the introduction of multiple ligation devices. The technical simplicity and safety of band ligation has sparked interest in using this technique for primary prophylaxis of variceal bleeding. However, randomized trials have not shown any advantage for band ligation over beta-blocker therapy, and the high variceal recurrence rate after band ligation may eliminate any theoretical advantage. A synchronous combination of band ligation and sclerotherapy has not been shown to improve the results of band ligation alone, but a metachronous approach using sclerotherapy to treat recurrent varices after band ligation has shown beneficial results. Histoacryl remains the best treatment option for gastric varices, but band ligation and loop ligation have shown promising results, and should be considered when Histoacryl is not available. Balloon-occluded retrograde transvenous obliteration is a new radiological modality for gastric varices, and one that sounds promising. TIPS is well established as an alternative to elective endoscopic treatment. Compared with endoscopic treatment, TIPS has been shown to improve the survival rate in one randomized trial. However, the cost and complications of TIPS have restricted its use. The use of endoscopic ultrasound for Doppler studies of blood flow in portal hypertension is currently investigational, but it may gain a role in selecting the optimal treatment approach for the individual patient.

Adrenergic beta-Antagonists↗
PubMed2000

Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery.

BACKGROUND: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. METHODS: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. RESULTS: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. CONCLUSIONS: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.

Adult↗
PubMed2000

Endoscopic retrograde cholangiopancreatography in the next millennium.

Rapid technologic advances in radiologic imaging and laparoscopic surgery are redefining the indications for endoscopic retrograde cholangiopancreatography (ERCP). The diagnostic role of ERCP continues to diminish in favor of newer imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography. Laparoscopic surgery recaptures some of the indications for therapeutic intervention. The spectrum of diagnostic and therapeutic applications of ERCP, however, continues to expand, enabling a more differentiated diagnosis and treatment of biliopancreatic disease. These applications include ongoing developments of cholangioscopy, pancreatoscopy, and molecular analysis of biliary and pancreatic secretions, photodynamic therapy, and gene therapy.

Bile↗
PubMed1999

New haemostatic techniques: histoacryl injection, banding/endoloop ligation and haemoclipping.

New endoscopic modalities for the haemostasis of upper gastrointestinal bleeding include cyanoacrylate tissue glue injection for oesophageal and gastric varices, ligation using bands and loops for variceal and non-variceal bleeding, and clips for non-variceal bleeding. These new modalities aim to improve primary and secondary haemostasis rates and the safety of endoscopic treatment. Preliminary experience using these modalities has been encouraging, but prospective randomized trials using adequate patient numbers are still needed to validate their efficacy and safety. The choice of treatment will depend on the clinical context and the anatomy of the bleeding lesion. Cyanoacrylate injection, which achieves rapid haemostasis and obliteration of the treated varix, is ideally suited to acute variceal bleeding and the obliteration of large gastric varices. Bands and loops are used in conjunction with a transparent cap attachment for the elective treatment of oesophageal varices. The clip is most effective when a vessel from a non-variceal bleeding source can be identified.

Enbucrilate↗
PubMed1999

Stent retriever for dilation of pancreatic and bile duct strictures. brand@uke.uni-hamburg.de.

BACKGROUND AND STUDY AIMS: Dilation of high grade strictures of pancreatic or biliary ducts using dilating or balloon catheters may fail. We evaluated the efficacy of the 7-Fr Soehendra Stent Retriever used as a dilator. PATIENTS AND METHODS: Following sphincterotomy, the stricture was first negotiated with a 260 cm long 0.032-inch J-type Terumo wire. Dilation was then attempted using a 7-Fr dilating catheter. If the stricture could not be traversed, the 7-Fr Stent Retriever was inserted over the Terumo wire to dilate the stricture. Between May 1996 and January 1997, the Stent Retriever was used for dilation in 32 patients with biliary or pancreatic duct strictures. RESULTS: The indication for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was symptomatic chronic pancreatitis in 21 patients (twelve men, nine women; mean age 45.7, range 26-70). The mean length (+/-SD) of the pancreatic duct strictures was 20mm+/-10 (range 3-55) with a prestenotic ductal diameter of 9mm+/-2 (range 2-15). Out of 21 patients, nine suffered from pancreaticolithiasis and were treated with extracorporeal shock wave lithotripsy. All but three patients underwent successful stenting in the same session. Another 11 patients (four men, seven women; mean age 67.4, range 47-85) had cholestasis because of benign or malignant bile duct strictures. The mean length of the strictures was 20mm+/-5 (range 3-40), and the mean prestenotic diameter was 10mm+/-5 (range 4-21). Stenting was easily done in all of these patients in the same session. Symptom relief was observed within the first week after stenting in all patients with a biliary or pancreatic stricture. In seven cases, material for cytological examination was obtained from the bile duct, which revealed malignancy in two cases. There was no complication associated with the use of the Stent Retriever. One subcapsular liver perforation was caused by the guide wire and occurred prior to the use of the Retriever. CONCLUSIONS: Tight pancreatic and bile duct strictures can be dilated successfully with the Stent Retriever. The procedure is of low risk. In addition, tissue sampling is possible in some cases.

Cholestasis↗
PubMed1999

[A new papillotome for cannulation, pre-cut or conventional papillotomy].

UNLABELLED: A new papillotome was designed to overcome certain drawbacks of the needle-knife, that is most commonly used for precut sphincterotomies. The intention was to develop an instrument at least as good as the needle-knife or the Erlangen-type precut papillotome for precut procedures. In addition, it had to be suitable for direct cannulation of the biliary or pancreatic duct. PATIENTS AND METHODS: According to a prospective protocol 54 patients in whom a papillotomy was indicated were examined with the new instrument. The protocol allowed three futile attempts to cannulate or two inadvertant cannulations of the pancreatic duct with a standard cannula and hydrophilic guide wire before a precut was performed. The new baby-papillotome has a diameter of only 1 mm and a short 10 mm cutting wire. Similar to a guide wire it is introduced via a 6F- or 7F-introducer catheter. RESULTS: Cannulation of the desired duct (the bile duct in 48 patients, the pancreatic duct in five patients, Billroth II anatomy in three patients) was successful within one session in 98% (53/54). In one patient, the bile duct was successfully cannulated in a second session using the baby-papillotome, resulting in an overall success rate of 100%. Primary cannulation using the new papillotome without precut was obtained in 24% (13/54). Complications were mild pancreatitis in one patient and nonsignificant bleeding in three (immediate endoscopic hemostasis in all, no transfusions, no drop of hematocrit). There were no serious complications. CONCLUSION: The new baby-papillotome is suitable for precut as well as for primary cannulation. In this first series, the desired duct was cannulated in 98% within the first session with a low complication rate. Further studies of the new instrument seem desirable.

Catheterization↗
PubMed1998

EUS-guided, fine-needle aspiration biopsy using a new mechanical scanning puncture echoendoscope.

BACKGROUND: A new mechanical sector scanning echoendoscope designed for EUS-guided, fine-needle aspiration biopsy (FNAB) was prospectively evaluated. The technical feasibility, safety, and histocytologic FNAB results are reported. METHODS: Eighty-six patients underwent 106 FNAB procedures. The new echoendoscope has a 2.8 mm accessory channel and an elevator. Target sites: pancreas 58, lymph nodes 43, and miscellaneous lesions 5. Lesions were punctured with a 0.7 mm needle and submitted for cytologic and histologic examination. Definitive diagnosis was by surgery or clinical follow-up. RESULTS: The wide scanning field (250 degrees) enabled easy sonographic orientation for FNAB. Longitudinal needle visibility was "good" in 93% and 71% of transesophageal and transgastric procedures, respectively, but were compromised during most transduodenal procedures. Needle penetration of indurated pancreatic lesions failed in two patients, and in four additional patients pancreatic sampling succeeded only after a second attempt using an automated spring-loaded device. The mean number of passes was three. Ten percent of FNAB specimens were "inadequate"; excluding these, the diagnostic accuracy rate was 97%; sensitivity for malignancy was 88.5% and specificity was 100%. CONCLUSION: EUS-guided FNAB is feasible, safe, and accurate using the new mechanical puncture echoendoscope. Needle visibility needs to be improved, particularly for transduodenal FNAB.

Adult↗
PubMed1998

Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope.

BACKGROUND: Previous studies have reported on endoscopic ultrasound-guided, fine needle aspiration biopsy using 22- to 25-gauge needles. We evaluated the histologic and cytologic yield of endoscopic ultrasound-guided, fine needle aspiration biopsy of the pancreas using an 18-gauge, Menghini-type core needle. METHODS: Fine needle aspiration biopsy was performed in conjunction with a prototype 2.8 mm channel convex array echoendoscope. The core specimen was placed in formalin for cell block, and residual material was expelled on slides for cytology. Definitive diagnosis was established by surgery or clinical follow-up. RESULTS: Of 45 patients who underwent fine needle aspiration biopsy, the needle failed to penetrate indurated pancreatic lesions in five. An average of 2.6 passes were performed in the remaining patients. Sufficient material for a histologic and/or cytologic diagnosis was obtained in 40 patients (histologic and cytologic yield of 68% and 75%, respectively). Combining the results of histology and cytology, the sensitivity and specificity for detection of malignancy was 76% and 100%, respectively. Histology confirmed the cytologic findings in 35 patients, providing additional tissue specific information. In three cases histology established a diagnosis of malignancy where cytology was not conclusively malignant. However, in three cases of surgically confirmed malignancy histology failed to detect malignancy, whereas cytology showed suspicious or malignant cells. The sensitivity of histology and cytology alone in detecting malignancy was 53% and 70%, respectively. Mild pancreatitis occurred after pancreatic fine needle aspiration biopsy in one patient. CONCLUSION: Core specimens for histology can be safely obtained using an 18-gauge needle. Histology provides tissue-specific information that complements cytology, but histology is less sensitive than cytology in detecting malignancy.

Adenocarcinoma↗
PubMed1998

Improved endoscopic stenting for malignant dysphagia using Tygon plastic prostheses.

BACKGROUND AND STUDY AIMS: Endoscopic palliative treatment of malignant esophageal stenosis using conventional plastic stents has been reported to be associated with a considerable risk of perforation. Stenoses with a distance of less than 2cm from the upper esophageal sphincter (UES) have generally been excluded from treatment. Using self-expandable metal stents, procedure-related complications are rare. However, the rates of late complications necessitating retreatment appear to be as high as those of plastic stents. This study describes our stent placement technique and our results using a modified Tygon plastic stent. PATIENTS AND METHODS: Over a two-year period, 71 consecutive patients with incurable malignant esophageal stenosis were prospectively studied. Tygon plastic stents of diameter 9-14 mm were individually tailored according to length and location of the stenosis. Prior to stenting, stepwise bougienage was performed, if necessary over several sessions. After endoscopic placement of a guide wire, the stent was inserted over a bougie without fluoroscopic monitoring. RESULTS: A total of 71 patients (54 men and 17 women, median age 69, range 34-93), were treated with Tygon plastic stents (14 mm: 19 patients; 12 mm: 50 patients; 9 mm: 2 patients). Median length of the strictures and of the stents were 7 (range 2-18) and 10 (range 6-25) cm, respectively. Four patients had an associated esophago-respiratory fistula. After a median of 2 (range 1-5) bougienage sessions, stent insertion was technically successful in all patients. Forty-one stents were placed across the cardia, 13 were positioned 0.5-1 cm below the UES. Three patients had to undergo retreatment within 24 hours because of pain or stent migration and the stents were repositioned or exchanged. No procedure-related perforation, hemorrhage or respiratory problems were observed. During a median follow-up of 63 (range 2-388) days, 82% of the patients died. Improvement or stabilization of dysphagia allowing for oral nutrition could be achieved in 89%. Dislocation occurred in eight patients, bolus obstruction in five patients and tumor overgrowth in four patients. Three of the four fistulas could be covered by the stent. In one patient with a fistula located at the level of the UES, a stent was placed but migrated after 5 days. Overall, 27 patients (38%) required reinterventions, mainly for dysphagia or nutritional problems. CONCLUSIONS: In our experience, Tygon plastic stents with a diameter of 9-14 mm can be safely placed after stepwise, less extensive bougienage. Effective palliation is possible even for lesions located close to the UES. Perforation can be avoided. Reintervention rates seem to be comparable to those seen with self-expanding metal stents.

Aged↗