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R Jakobs

Publications and source records attributed to R Jakobs.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Heavy diarrhea by low malignant B cell lymphoma].

A 52-year old female presented with a low, malignant centroblastic-centrocytic lymphoma. After splenectomy and under steroid therapy it came to the eruption of a latent Strongyloides stercoralis infection, which the patient had presumably been suffering from for several years. Due to the immunodeficient condition and under continued steroid therapy even three courses of high dose anthelmintic therapy could not eradicate the parasites. The patient died of fulminant sepsis.

Animals↗
PubMed2004

cagA-positive Helicobacter pylori strains and gastro-oesophageal reflux disease: still puzzling?

Gastro-oesophageal reflux disease (GORD) and Helicobacter pylori infection are both common in Western countries. A recently published meta-analysis has shown an association between an absence of H. pylori infection and GORD symptoms. Infection with cagA-positive H. pylori strains is a causative factor for the development of duodenal ulcer and is a risk factor for gastric cancer. Data about a protective role of cagA-positive H. pylori strains against more severe reflux oesophagitis are documented in several studies, but questioned by some other studies. There is a need for further studies to clear the definite role of cagA-positive H. pylori strains in severe reflux oesophagitis and their possible effect on the development of Barrett's adenocarcinoma. The role of Helicobacter pylori in gastro-oesophageal reflux disease (GORD) is still discussed controversially. Different factors might be responsible for the remarkably heterogeneous results of previously performed studies (e.g. location, environmental factors and different virulence factors of H. pylori strains). A very recently published meta-analysis has shown a significant association between the absence of H. pylori infection and GORD symptoms, and a positive correlation between anti-H. pylori therapy and the occurrence of both de-novo and rebound/exacerbated GORD. The results of this meta-analysis are questioned by some authors because of single larger trials and geographical variations of the studies analysed. Data on the role of the cytotoxic-associated antigen (cagA)-positive H. pylori strains are contradictory. Several studies have provided evidence supporting the protecting role of cagA-positive H. pylori strains against GORD, but these results were not confirmed by all studies. A multitude of patients suffer from H. pylori infection and GORD, simultaneously. Therefore, further studies are needed to clearly answer the question whether infection with cagA-positive H. pylori strains, which bear a well-documented risk for gastric cancer and gastro-duodenal ulcer, is really helpful against more severe reflux oesophagitis and, in consequence, perhaps protective against Barrett's oesophagus and Barrett's adenocarcinoma.

Antigens, Bacterial↗
PubMed2003

[Endoscopic drainage of symptomatic pancreatic pseudocysts. An efficient and safe therapy in the clinical routine?].

BACKGROUND AND OBJECTIVE: Clinical studies have demonstrated excellent success and low complication rates of endoscopic therapy of pancreatic pseudocysts. But it is not known, if these results can be reached in gastroenterological centers outside clinical studies. PATIENTS AND METHODS: We investigated the outcome of endoscopic therapy in 21 patients (15 male, 6 female, age 40 - 81) with pancreatic pseudocysts treated in our clinic between 1997 and 2002. A follow-up examination was included. RESULTS: Similar to the results of reported clinical studies the initial clinical success rate was 18/21 with symptomatic recurrences in two patients. All therapy-induced complications were successfully treated conservatively. CONCLUSION: Excellent results of endoscopic therapy of pancreatic pseudocysts can be reached in a gastroenterological center. Surgical treatment can be reserved for cases, when endoscopic therapy fails.

Adult↗
PubMed2003

[Cholangioscopy after successful treatment of complicated choledocholithiasis. Is stone free really stone free?].

BACKGROUND AND OBJECTIVE: After successful percutaneous or endoscopic therapy of complicated choledocholithiasis (requiring more than one therapeutic intervention or lithotripsy), radiological visualization of the bile duct is the standard to determine if any stone fragments are left. It is unknown how often stone fragments, which might be the cause for another period of symptomatic choledocholithiasis, are missed. PATIENTS AND METHODS: We performed cholangioscopy in 31 consecutive patients (age 42 - 85; 14 male, 17 female) with complicated choledocholithiasis after successful therapy when there were no stone fragments left radiographically. RESULTS: Cholangioscopy revealed retained stone fragments in four female patients. Two of these had a benign stricture of the common bile duct. CONCLUSIONS: Cholangioscopy after successful endoscopic or percutaneous therapy of complicated choledocholithiasis seems to be useful, because in bile ducts radiographically free of stones, cholangioscopy detects stone fragments in some patients. Further studies are needed to demonstrate if cholangioscopy can reduce the rate of symptomatic relapse after treatment of complicated choledocholithiasis.

Adult↗
PubMed2003

Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal bleeding.

BACKGROUND: Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of capsule endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. METHODS: Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using capsule endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using capsule endoscopy and push enteroscopy. RESULTS: On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before capsule endoscopy was used. Definitive bleeding sites were diagnosed by push enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push enteroscopy localised an additional bleeding source in comparison with capsule endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. DISCUSSION: The present study shows that capsule endoscopy had the highest diagnostic yield and was superior to push enteroscopy in patients with chronic gastrointestinal bleeding. By using the capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.

Adolescent↗
PubMed2003

Self-expandable metal mesh stents for common bile duct stenosis in chronic pancreatitis: retrospective evaluation of long-term follow-up and clinical outcome pilot study.

BACKGROUND: Symptomatic common bile duct strictures are frequently seen in the course of severe chronic pancreatitis with a reported incidence of 10-30%. The exact role of endoscopic stenting with metal prostheses as definitive treatment has not yet been clearly defined. METHODS: Six patients with symptomatic distal common bile duct stricture in the setting of chronic pancreatitis were treated with a self-expandable metal stent in an attempt to achieve permanent drainage. All cases were approached non-operatively and underwent prior unsuccessful treatment with plastic prostheses. RESULTS: The patients received a self-expandable metal Wall stent after a median follow-up of 14 months of plastic stenting. The median follow-up time was 58 months and the stents remained open for a median time of 20 months, respectively. Overall, in 2 of 6 cases the metal stent therapy was successful while 4 of 6 patients required additional endoscopic procedures. CONCLUSIONS: Self-expandable metal stents could be useful and adequate in patients who suffer from symptomatic obstructive jaundice due to chronic pancreatitis. However, they provide acceptable dilation of the common bile duct for only a limited period of time. Overall, endoscopic stenting with self-expandable metal stents seems to be an advantageous treatment only for a subgroup of patients who are unfavorable candidates for surgical drainage. To clarify the role of the endoscopic approach, prospective trials with homogeneous and larger patient numbers are necessarily in the future.

Adult↗
PubMed2003

Schwannoma of the common bile duct: a rare cause of obstructive jaundice.

The endoscopic diagnosis of bile duct lesions has improved over recent years through the introduction of cholangioscopy and intraductal ultrasound. Combining this with biopsies examined using routinely administered immunohistochemical markers, the diagnosis of tumors of the extrahepatic bile duct can be improved substantially. We report a rare case of a schwannoma of the bile duct causing obstructive jaundice.

Adult↗
PubMed2003

[Endoscopic and radiological interventional therapy of benign and malignant bile duct stenoses].

Since the development of therapeutic endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage, two non-interventional therapeutic options are available for the treatment of benign and malignant bile duct stenosis. Stenosis of different aetiology, which can be classified as benign after completion of the diagnoses, can be treated with good long-term dilation success in 50 to 90 % of all cases. The aim of palliative drainage therapy of malignant bile duct stenosis is the improvement of quality of life by removing the jaundice and the pruritus. In addition, the development of cholangitis as well as impending deterioration of the hepatic function can be prevented. By photodynamic therapy it seems possible to achieve an improvement of quality of life and of the prognosis in cholangiocarcinoma.

Aged↗
PubMed2003

[Mirizzi Syndrome without Cholecystolithiasis].

BACKGROUND: Mirizzi syndrome is a rare cause of biliary symptoms and jaundice. It describes an obstruction of the common hepatic bile duct by external compression caused by an impacted gallstone in the gallbladder neck or cystic duct. This setting is usually associated with cholecystolithiasis. CASE REPORT: A 64-year-old caucasian woman with intermittent abdominal pain and newly diagnosed jaundice was admitted to our clinic. An ERC was performed a few weeks earlier because of similar complaints without jaundice. At that time there was no evidence of choledocholithiasis. Now ERC surprisingly showed a gallstone impacted in the cystic duct, leading to an external compression of the common hepatic bile duct (Mirizzi syndrome). Since an endoscopic stone extraction failed, surgical intervention was performed. A laparoscopic cholecystectomy was performed without trans-cystic stone removal. After removal of the bile duct drainage it became evident that the impacted stone was still located in the remaining part of the cystic duct. After successful endoscopic extraction of the impacted stone the patient remained free of symptoms without recurrent jaundice. CONCLUSION: In rare cases Mirizzi syndrome without cholecystolithiasis can cause biliary symptoms. A close interdisciplinary cooperation is necessary in order to guarantee an excellent therapeutic management.

Bile Duct Diseases↗
PubMed2002

Pancreatic endoscopic sphincterotomy in patients with chronic pancreatitis: a single-center experience in 171 consecutive patients.

BACKGROUND AND STUDY AIMS: In recent years, interest in endoscopic therapy techniques for pancreatic diseases has been constantly increasing. The aim of the present study was to assess the technical success, technique, and complications of endoscopic pancreatic sphincterotomy (EPS) in patients with chronic pancreatitis. PATIENTS AND METHODS: A total of 171 patients with chronic pancreatitis and abdominal complaints were identified in whom at least one attempt at EPS was carried out. During the procedure, sphincterotomy was carried out using a guide-wire sphincterotome or a needle-knife papillotome. Patients were followed up after EPS for at least 24 h, including clinical symptoms and laboratory data (pancreatic enzymes and hemoglobin/hematocrit). RESULTS: EPS was performed in 167 of the 171 patients (technical success rate: 97.7 %). In 24 patients (14 %), a precut technique was necessary using a needle-knife sphincterotome. Sphincterotomy-related complications were observed in seven of the 171 patients (4.1 %), including three cases of bleeding, three patients with mild pancreatitis, and one with retroduodenal perforation. All complications were managed medically. There was no treatment-related mortality. CONCLUSIONS: Endoscopic sphincterotomy of the pancreatic duct in patients with chronic pancreatitis is a fairly safe procedure with a high technical success rate.

Adolescent↗
PubMed2002

Does the insertion depth in push enteroscopy depend on the working length of the enteroscope?

BACKGROUND AND STUDY AIMS: Using push enteroscopy, the small bowel can only be investigated in part. This preliminary prospective randomized study examined whether increasing the length of the enteroscope can have a beneficial effect on the insertion depth. PATIENTS AND METHODS: Between August 1999 and December 1999, 28 consecutive patients were investigated using push enteroscopy and were randomly assigned to two groups. One group was investigated using the Olympus push enteroscope SIF-100 (working length 2200 mm). In the other group, the Olympus push enteroscope SIF-Q140 (working length 2500 mm) was used. All investigations were carried out using an overtube. The insertion depth was estimated by counting the folds in the small bowel. In addition, the insertion length was estimated in centimeters by withdrawing the instrument to the pylorus after straightening. RESULTS: The two groups were comparable in terms of age, sex distribution, indication for enteroscopy, investigation time, and pathological findings. There were no significant differences in the insertion length between the two types of instrument. With the SIF-100, the median number of folds was 95 (range 30 - 213) and the insertion length was 72.5 cm (range 40 - 110 cm); and with the SIF-Q140, the median number of folds was 79 (range 18 - 203) and the insertion length was 70.0 cm (range 20 - 140 cm). CONCLUSIONS: As there was no significant difference in the insertion depth between the shorter instrument (Olympus SIF-100) and the longer one (Olympus SIF-Q140), it can be concluded from this preliminary study that there is no advantage in using a longer enteroscope. To document a significant difference, further studies with a larger numbers of patients would be necessary.

Adult↗
PubMed2002

Impact of gallbladder status on the outcome in patients with retained bile duct stones treated with extracorporeal shockwave lithotripsy.

BACKGROUND AND STUDY AIMS: The use of endoscopic therapy in combination with lithotripsy techniques has become increasingly common in patients with complicated common bile duct stones. In many units, although this is controversial, cholecystectomy is then performed, because of possible subsequent cholecystitis and recurrence of choledocholithiasis. The aim of this study was to investigate whether gallbladder status influences the long-term outcome in patients after extracorporeal shockwave lithotripsy (ESWL) of common bile duct stones. PATIENTS AND METHODS: Recruited for the study were 120 patients with an average age of 68 years (range 28 - 86). They were selected from 137 consecutive patients who presented to our department between January 1989 and June 1996 with complicated common bile duct stones, and in whom ESWL was necessary to achieve complete clearance of stones. Follow-up data were obtained from the patients and their general practitioners. RESULTS: The mean duration of follow-up was 4 years (range 3 - 9). A total of 37 patients had their gallbladder in situ (group A), while 83 had undergone cholecystectomy. Of these 83 patients, 27 had had a cholecystectomy after ESWL (group B), whereas 56 patients had already had the gallbladder removed when choledocholithiasis was diagnosed (group C). During follow-up, 36 patients (30 %) experienced some biliary symptoms. There were no significant differences in the incidence of recurrent biliary symptoms between the three groups. Re-exploration of the bile duct by endoscopic retrograde cholangiopancreatography (ERCP) revealed 28 cases of recurrent bile duct stones. Recurrence developed more often in groups B and C, who had undergone cholecystectomy, without reaching statistical significance ( P = 0.077). In patients with an intact gallbladder (group A), there was no difference in the rate of recurrent biliary symptoms or stones between the patients with or without cholecystolithiasis. Operations were necessary in 28 patients; in only ten was this for biliary reasons. CONCLUSION: The intact gallbladder is not a risk factor for recurrent biliary complications after ESWL of common bile duct stones; therefore, as far as patients with complicated bile duct stones which require additional lithotripsy techniques are concerned, elective cholecystectomy after endoscopic clearance of the bile duct no longer seems appropriate.

Adult↗
PubMed2002

Endoscopic laser palliation for rectal cancer-- therapeutic outcome and complications in eighty-three consecutive patients.

OBJECTIVE: The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer. METHODS: Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser. RESULTS: The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patients had to undergo surgery on their rectal cancer because of treatment failures (most of them recurrent obstruction) or complications (long-term success rate: 86.7 % (72 of 83 pts.)). The median survival period was nine months. Patients treated for obstruction had more treatment sessions and had a higher rate of surgical palliation in comparison to those pts. therapied for bleeding. Major complications were seen in three patients (3.6 %). One patient died after rectal perforation following bougienage before laser treatment (overall mortality: 1.2 %). CONCLUSION: Laser therapy is effective for the palliation of advanced rectal cancer with a high short-term and long-term success rate and only few complications. Laser treatment therefore is still a valuable alternative to newer endoscopic techniques and surgery.

Aged↗
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↗
PubMed2001

[Gallstones--therapy].

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Angioplasty, Balloon, Coronary↗
PubMed2001

[DNA cytometric studies of Barrett mucosa].

BACKGROUND: Barrett's esophagus predisposes to cancer development. The diagnosis of dysplastic precursor lesions is impaired by problems of subjectivity. In the present study, DNA ploidy results of patients with Barrett's esophagus were related to the grade of dysplasia and to the progress of the disease. PATIENTS AND METHODS: In 61 patients with Barrett's esophagus, DNA ploidy was determined by image cytometry on imprints. All biopsies (n = 145) were histologically examined for dysplasia distinguishing between low- and high-grade dysplasia, and dysplasia-negative. RESULTS: A significant correlation (p < 0.001) between DNA ploidy and the grade of dysplasia was found, with 81% euploid DNA results in biopsies negative for dysplasia and 86% abnormal DNA patterns in biopsies with high-grade dysplasia. The subgroup of low-grade dysplasia showed a heterogeneous DNA ploidy. It is important to note that nearly 20% of biopsies classified dysplasia-negative contained abnormal single cells or abnormal stemlines regarding DNA content. In several cases, suspect DNA results caused a modified reclassification of dysplasia, and there were cases in which patients negative for dysplasia but positive for abnormal DNA ploidy developed dysplasia later on. CONCLUSION: In patients with Barrett's esophagus, DNA ploidy by image cytometry is a suitable additive method for histological evaluation of dysplasia. It seems to be helpful in identifying patients at risk, perhaps before the development of clear dysplasia.

Aneuploidy↗