AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS: Brush cytology and forceps biopsy were routinely performed in patients with s...AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.展开更多
AIM: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy.
BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently bec...BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.AIM To evaluate the technical success and safety of the device in a multicenter setting.METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020and October 2021 for appropriate indications. Overall, 56 procedures were included in the study.We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies(33 transgastric, 4 transduodenal). In 70%of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent.The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces(range, 2-25pieces) of necrosis removed in a mean procedure time of 59 min(range, 15-120 min). In addition,the device has been used to remove blood clots(n = 6), to clear insufficiency cavities before endoluminal vacuum therapy(n = 5), and to remove foreign bodies from the upper gastrointestinal tract(n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.展开更多
AIM:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. METHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)w...AIM:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. METHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)with obstructive chronic pancreatitis who were admitted to the 2nd Medical Department of the Technical University of Munich.All patients presented severe chronic pancreatitis(stageⅢ°)according to the Cambridge classification.The majority of the patients suffered intermittent pain attacks.6 of 19 patients had strictures of the pancreatic duct;13 of 19 patients had strictures and stones.The first endoscopic retrograde pancreatography(ERP)included an endoscopic sphincterotomy, dilatation of the pancreatic duct,and stent placement.The first control ERP was performed 4 wk after the initial intervention,and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological conditions.Clinical follow-up was performed annually to document the course of pain and the management of relapse.The course of pain was assessed by a pain scale from 0 to 10.The date and choice of the therapeutic procedure were documented in case of relapse. RESULTS:Initial endoscopic intervention was successfully completed in 17 of 19 patients.All 17 patients reported partial or complete pain relief after endoscopic intervention.Endoscopic therapy failed in 2 patients. Both patients were excluded from further analysis.One failed patient underwent surgery,and the other patient was treated conservatively with pain medication.Seventeen of 19 patients were followed after the successful completion of endoscopic stent therapy.Three of 17 patients were lost to follow-up.One patient was not avail-able for interviews after the 1st year of follow-up.Two patients died during the 3rd year of follow-up.In both patients chronic pancreatitis was excluded as the cause of death.One patient died of myocardial infarction, and one patient succumbed to pneumonia.All three patients were excluded from follow-up analysis.Followup was successfully completed in 14 of 17 patients.4 patients at time point 3,2 patients at time point 4,3 patients at time point 5 and 2 patients at time point 6 and time point 7 used continuous pain medication after endoscopic therapy.No relapse occurred in 57%(8/14) of patients.All 8 patients exhibited significantly reduced or no pain complaints during the 5-year follow-up.Seven of 8 patients were completely pain free 5 years after endoscopic therapy.Only 1 patient reported continuous moderate pain.In contrast,7 relapses occurred in 6 of the 14 patients.Two relapses were observed during the 1st year,2 relapses occurred during the 2nd year,one relapse was observed during the 3rd year,one relapse occurred during the 4th year,and one relapse occurred during the 5th follow-up year.Four of these six patients received conservative treatment with endoscopic therapy or analgesics.Relapse was conservatively treated using repeated stent therapy in 2 patients.Analgesic treatment was successful in the other 2 patients. CONCLUSION:57%of patients exhibited long-term benefits after endoscopic therapy.Therefore,endoscopic therapy should be the treatment of choice in patients being inoperable or refusing surgical treatment.展开更多
AIM: To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility. METHODS: In the study period from January 2007 to February 2010, 76 consec...AIM: To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility. METHODS: In the study period from January 2007 to February 2010, 76 consecutive patients(33 men, 43 women; mean age 63 years old) were included in this pilot series. Endoluminal images and biopsies were obtained from 55 patients with indeterminate strictures, while 21 patients had fixed filling defects. The diagnostic accuracy of peroral cholangioscopy(POCS) in the visualization of strictures and tissue sampling was evaluated, and therapeutic success was monitored. Followup was performed over at least 9 mo. RESULTS: A total of 55 patients had indeterminate strictures. Using the criteria "circular stenosis" and "irregular surface or margins", POCS correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions(sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). Visually targeted forceps biopsies were performed in 55 patients. Tissue sampling during POCS revealed malignancy in 18 of 28 cases(sensitivity: 64.3%). In 21 patients with fixed filling defects, 10 patients with bile duct stones were successfully treated with conventional stone removal. Nine patients with difficult stones(5 giant stones and 4 intrahepatic stones) were treated with visually guided laser lithotripsy. Two patients in the group with unclear fixed filling defects had bile duct adenoma or papillary tumors and were surgically treated. CONCLUSION: The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tree, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.展开更多
BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation m...BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.展开更多
文摘AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.
文摘AIM: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy.
文摘BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.AIM To evaluate the technical success and safety of the device in a multicenter setting.METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020and October 2021 for appropriate indications. Overall, 56 procedures were included in the study.We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies(33 transgastric, 4 transduodenal). In 70%of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent.The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces(range, 2-25pieces) of necrosis removed in a mean procedure time of 59 min(range, 15-120 min). In addition,the device has been used to remove blood clots(n = 6), to clear insufficiency cavities before endoluminal vacuum therapy(n = 5), and to remove foreign bodies from the upper gastrointestinal tract(n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.
文摘AIM:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. METHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)with obstructive chronic pancreatitis who were admitted to the 2nd Medical Department of the Technical University of Munich.All patients presented severe chronic pancreatitis(stageⅢ°)according to the Cambridge classification.The majority of the patients suffered intermittent pain attacks.6 of 19 patients had strictures of the pancreatic duct;13 of 19 patients had strictures and stones.The first endoscopic retrograde pancreatography(ERP)included an endoscopic sphincterotomy, dilatation of the pancreatic duct,and stent placement.The first control ERP was performed 4 wk after the initial intervention,and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological conditions.Clinical follow-up was performed annually to document the course of pain and the management of relapse.The course of pain was assessed by a pain scale from 0 to 10.The date and choice of the therapeutic procedure were documented in case of relapse. RESULTS:Initial endoscopic intervention was successfully completed in 17 of 19 patients.All 17 patients reported partial or complete pain relief after endoscopic intervention.Endoscopic therapy failed in 2 patients. Both patients were excluded from further analysis.One failed patient underwent surgery,and the other patient was treated conservatively with pain medication.Seventeen of 19 patients were followed after the successful completion of endoscopic stent therapy.Three of 17 patients were lost to follow-up.One patient was not avail-able for interviews after the 1st year of follow-up.Two patients died during the 3rd year of follow-up.In both patients chronic pancreatitis was excluded as the cause of death.One patient died of myocardial infarction, and one patient succumbed to pneumonia.All three patients were excluded from follow-up analysis.Followup was successfully completed in 14 of 17 patients.4 patients at time point 3,2 patients at time point 4,3 patients at time point 5 and 2 patients at time point 6 and time point 7 used continuous pain medication after endoscopic therapy.No relapse occurred in 57%(8/14) of patients.All 8 patients exhibited significantly reduced or no pain complaints during the 5-year follow-up.Seven of 8 patients were completely pain free 5 years after endoscopic therapy.Only 1 patient reported continuous moderate pain.In contrast,7 relapses occurred in 6 of the 14 patients.Two relapses were observed during the 1st year,2 relapses occurred during the 2nd year,one relapse was observed during the 3rd year,one relapse occurred during the 4th year,and one relapse occurred during the 5th follow-up year.Four of these six patients received conservative treatment with endoscopic therapy or analgesics.Relapse was conservatively treated using repeated stent therapy in 2 patients.Analgesic treatment was successful in the other 2 patients. CONCLUSION:57%of patients exhibited long-term benefits after endoscopic therapy.Therefore,endoscopic therapy should be the treatment of choice in patients being inoperable or refusing surgical treatment.
文摘AIM: To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility. METHODS: In the study period from January 2007 to February 2010, 76 consecutive patients(33 men, 43 women; mean age 63 years old) were included in this pilot series. Endoluminal images and biopsies were obtained from 55 patients with indeterminate strictures, while 21 patients had fixed filling defects. The diagnostic accuracy of peroral cholangioscopy(POCS) in the visualization of strictures and tissue sampling was evaluated, and therapeutic success was monitored. Followup was performed over at least 9 mo. RESULTS: A total of 55 patients had indeterminate strictures. Using the criteria "circular stenosis" and "irregular surface or margins", POCS correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions(sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). Visually targeted forceps biopsies were performed in 55 patients. Tissue sampling during POCS revealed malignancy in 18 of 28 cases(sensitivity: 64.3%). In 21 patients with fixed filling defects, 10 patients with bile duct stones were successfully treated with conventional stone removal. Nine patients with difficult stones(5 giant stones and 4 intrahepatic stones) were treated with visually guided laser lithotripsy. Two patients in the group with unclear fixed filling defects had bile duct adenoma or papillary tumors and were surgically treated. CONCLUSION: The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tree, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.
文摘BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
