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Biomedical subjects

H Neuhaus

Publications and source records attributed to H Neuhaus.

At least 19 recordsLinked to original sources
PubMed2006

Endotherapy of Zenker's diverticulum using the needle-knife technique: long-term follow-up.

BACKGROUND AND STUDY AIMS: Endotherapy of Zenker's diverticulum by mucomyotomy of the bridge between the diverticulum and the esophageal lumen has been introduced as a promising alternative to surgical techniques. However the data on long-term clinical outcome are limited. After poor results in four patients treated by argon plasma coagulation, we studied the efficacy and the long-term outcome of dissection using a needle-knife in a consecutive series of patients. PATIENTS AND METHODS: Between December 2001 and November 2004, 31 consecutively treated symptomatic patients (18 men; median age 69 years; range 52-92) with Zenker's diverticulum were enrolled into this retrospective study. In all cases mucomyotomy was performed with a needle-knife with the patient under conscious sedation. The procedure was repeated in the case of incomplete relief from dysphagia or of recurrent symptoms during follow-up. All patients completed questionnaires on the frequency and severity of dysphagia, using a numeric analogue scale, ranging from 0 (never/none/excellent) to 10 (each time of swallowing/very severe/very bad). RESULTS: Endoscopic mucomyotomy was achieved in all 31 patients, with initial symptomatic improvement. Repeat treatment was required in 10 patients after a mean of 5.3 months, due to recurrence of symptoms. During a mean follow-up period of 26 months (range 14-49), 26 patients (84%) had long-term success of variable degree (65% with no or minimal remaining symptoms); four patients (13%) had insufficient relief and wanted a repeat treatment; and one patient (3%) underwent surgery. The success rate in the entire group was 84% (26/31) including those with repeat treatment, and 61% (19/31) if only success following a single treatment session was counted. Minor complications such as subcutaneous or mediastinal emphysema were observed in 23% and were conservatively managed. There were no major complications. CONCLUSIONS: A single needle-knife mucomyotomy procedure can achieve long-term symptomatic improvement in about two out of three cases of Zenker's diverticulum. The success rate can be increased to above 80% by repeated sessions. Minor complications occur frequently but they can be conservatively managed. Major complications were not observed. Further long-term studies are warranted to elucidate the role of endoscopy as a definitive single treatment, with determination of prognostic parameters for a successful long-term outcome.

Aged↗
PubMed2006

Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the "R-scope").

BACKGROUND AND STUDY AIM: Endoscopic submucosal dissection (ESD) allows en bloc resection of lesions > 2 cm in diameter. However the procedure is difficult because of limited visualization of the cutting area. The aim of this study was to evaluate a new endoscope (the "R-scope") for ESD; this provides a second flexible section for improved positioning capability and two instrumentation channels for vertical lifting of the targeted mucosal area and horizontal cutting of the submucosa. METHODS: The R-scope was tested first for ESD of 17 predetermined gastric areas in eight anesthetized pigs. Clinical experience was then prospectively obtained in 10 patients with early gastric neoplasia. In both instances, dye-stained saline solution was used for repeated submucosal injection. Various types of knives were available for circumferential cutting of the mucosa to isolate the targeted lesion. The specimen was then lifted and the submucosal layer was dissected with the appropriate type of knife to achieve en bloc resection. RESULTS: ESD succeeded in 14/17 animal cases (82 %), remained incomplete in two cases and failed in one because of an intractable perforation; a further two small perforations were clipped. In 10 patients (with nine early carcinomas and one adenoma, with a median diameter of 22 mm), lesions were completely resected in six cases. Surgery was necessary in two patients due to early and delayed perforation. Three other patients with small amounts of free air were conservatively managed but elective surgery was performed in two of these patients because of incomplete resection or deep submucosal tumor infiltration. CONCLUSIONS: The R-scope facilitated ESD of large gastric areas in live animal testing and in a small series of patients However the procedure is technically demanding and time-consuming. It was also associated with a high risk of perforation; this may be related to an insufficient volume of solution being injected submucosally, excessively forceful lifting of the specimen, or the short learning period.

Aged↗
PubMed2005

[Endoscopic therapy methods for gastroesophageal reflux].

Gastroesophageal reflux disease (GERD) is prevalent in 10% of the population. In addition to the established therapy, endoscopic antireflux procedures have been developed to improve the gastroesophageal reflux barrier. This can achieved by endoscopically placed sutures, application of radio frequency energy, or injection of biocompatible materials. These new techniques might be effective in some patients with GERD. To date, there are limited data on the effectiveness and safety of these methods. During a follow-up of 1-2 years, subjective parameters improved in 70-75% of the test patients such that no antisecretory treatment was required. Further, randomized, placebo-controlled studies are needed for objective evaluation of these promising new methods.

Catheter Ablation↗
PubMed2004

[Barrett's esophagus].

The diagnosis of Barrett's esophagus is rendered based on proof of intestinal metaplasia in the tubular portion of the esophagus. Barrett's develops in a percentage of patients with gastroesophageal reflux disease; risk factors include a long history of the disease, age over 40 years and Caucasian skin. Specifics about a genetic predisposition have not become known to date. Each year, around one out of every 200 patients with Barrett's epithelium develop adenocarcinoma of the esophagus, the incidence of which has risen dramatically over the past two decades. Apart from the early stages, the prognosis for this type of Barrett's carcinoma is extremely unfavorable, even after esophagectomy. It therefore appears sensible to examine patients with a long history of reflux and/or frequently recurrent reflux symptoms and to develop screening strategies for timely detection of persons with Barrett's esophagus along with subsequent monitoring. This would involve regular endoscopic studies accompanied by biopsies aimed at excluding or demonstrating the intraepithelial neoplasms that count as direct precursors to cancer. Treatment of nonneoplastic Barrett's esophagus can be symptomatic. Although theoretically logical, the benefits of normalizing esophageal acid exposure have not been proven. When high-grade intraepithelial neoplasms or mucosal carcinomas have been confirmed, local endoscopical resection and/or ablation appear sufficient, since the risk of lymph node metastasis is extremely low. Previous studies on this subject have been very promising, but should be continued and/or verified. Definitive therapy of more advanced tumor stages is currently given according to multimodal concepts established in an interdisciplinary manner.

Adenocarcinoma↗
PubMed2004

[Behçet's disease with gastrointestinal involvement without evidence for chronic inflammatory bowel disease].

A case of a 32-year-old male patient with lower gastrointestinal bleeding is reported as an initial manifestation of Behçet's disease. The early diagnosis of this chronic-systemic disease is often very difficult, in particular with regard to the differentiation from chronic inflammatory bowel diseases. In addition, lower gastrointestinal bleeding is a rare manifestation of Behçet's disease. An immunosuppressive therapy was initiated and the course of the disease with recurrent oral ulcerations gave evidence for the diagnosis. Further bleeding episodes or other gastrointestinal symptoms have not been observed during a follow-up period of 36 months. The diagnostic problems and the therapeutic management of the disease are discussed in relation to neighbouring entities.

Adult↗
PubMed2004

Therapeutic pancreatic endoscopy.

In view of increasingly accurate noninvasive diagnostic imaging modalities for pancreatic diseases, endoscopic retrograde cholangiopancreatography (ERCP) should be mainly restricted to therapeutic indications. Acute pancreatitis is still the most common complication of ERCP. Prevention measures should focus in particular on well-defined risk groups. Temporary pancreatic duct drainage, preferably using small-diameter endoprostheses, can reduce the incidence of post-ERCP pancreatitis in at-risk individuals. By contrast, pharmacological prevention does not appear to be effective. ERCP in conjunction with sphincter of Oddi manometry frequently reveals the diagnosis of undetermined causes of acute recurrent pancreatitis. Endoscopic sphincterotomy (EST) is the treatment of choice in patients with sphincter of Oddi dysfunction or papillary stenosis. For these indications, dual pancreaticobiliary sphincterotomy promises a lower early morbidity and a better long-term outcome than biliary EST alone. In patients with pancreatic divisum, the cannulation rate of the dorsal duct can be improved by methylene blue staining and/or stimulation of the pancreatic secretion. Papillotomy of the minor papilla with short-term stenting appears to be an effective and safe approach for associated acute recurrent pancreatitis. Large-scale trials indicate that the majority of symptomatic patients with chronic pancreatitis can be well managed in the long term by endoscopic interventions. There is still a lack of prospective randomized controlled trials on endotherapy for chronic pancreatitis; however, they are also lacking for the surgical approach. Endoscopic and/or endosonographically guided drainage has become the treatment of choice for the majority of symptomatic pancreatic pseudocysts. Transmural debridement of pancreatic abscesses and infected necroses is still investigational, but appears to offer a minimally invasive alternative to surgery in selected cases. Pancreatic endotherapy is technically demanding and potentially hazardous; these interventions should be restricted to high-volume centers with options for an interdisciplinary team approach. Methods that have not yet been established should be evaluated in carefully designed prospective trials.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2004

Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series.

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) of early gastrointestinal cancers has been shown to be effective in treating mucosal malignancies, but en bloc resection (where the entire tumor is removed in one piece) is often not achieved using conventional cap EMR. Other techniques, developed in Japan, include the application of different types of knife such as the insulated-tip instrument. We report our preliminary experience of the use of this knife, in conjunction with other techniques, in attempting en bloc resection of early mucosal cancers and adenomas and in the removal of submucosal tumors (SMTs) of the upper gastrointestinal tract. PATIENTS AND METHODS: A total of 37 patients (26 men, 11 women, age range 53 - 86) were included in the study; 23 patients had 24 mucosal lesions amenable to EMR, and 14 patients had SMTs shown on endosonography to spare the muscularis propria. Lesions were located in the esophagus (n = 13), the stomach (n = 24), and the duodenum (n = 1); 40 % of the mucosal lesions were 20 mm or larger (mean size 18mm), whereas the mean size of the submucosal lesions was 23 mm. After submucosal saline injection, circumcision and dissection of the mucosal lesions was attempted with the aim of achieving en bloc resection. For SMTs, cap mucosectomy of the overlying mucosa was done first, and the tumors were then freed using saline injection, and finally resected using snare polypectomy. RESULTS: The strict aim of the study, i. e. complete tumor removal in a single piece, was achieved in only 25 % of the mucosal lesions (some failures were due to unrecognized submucosal infiltration) and 36 % of the SMTs. When a more liberal definition of success was assumed, this rate increased to 65 % for mucosal lesions (piecemeal, no tumor found at surgery or follow-up endoscopy with biopsy) and 79 % for SMTs (piecemeal). No severe complications necessitating surgery or leading to major morbidity occurred. However, clinically significant complications were found in six patients (minor perforation managed conservatively (n = 1), severe pain without perforation (n = 1), bleeding requiring reintervention (n = 3), and aspiration (n = 1)). CONCLUSIONS: Although we are convinced that methods of achieving en bloc resection of mucosal cancers and SMTs must be pursued, the insulated-tip knife in conjunction with conventional endoscopes still has limitations. Innovative endoscope design (double-channel scopes) as well as the development of new accessories will help to overcome the current limitations and further promote endoscopic tumor resection.

Adenoma↗
PubMed2003

A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD.

BACKGROUND AND STUDY AIMS: Unsedated esophagogastroduodenoscopy (EGD) has advantages over sedated EGD - e. g., prevention of side effects related to sedation, less patient monitoring, and less expense. This study compared the feasibility and tolerance of transnasal small-caliber (TSC-EGD) and peroral small-caliber EGD (PSC-EGD) with conventional EGD (C-EGD). PATIENTS AND METHODS: A total of 150 patients referred for diagnostic EGD were randomly allocated to undergo either TSC-EGD, PSC-EGD, or C-EGD under local anesthesia if they agreed to receive sedation only on demand or in case of intolerance. Patients, endoscopists, and nurses completed questionnaires on the tolerability and quality of the examinations using a visual analogue scale (VAS), ranging from 1 (best/nonexistent) to 10 (worst/unbearable) after EGD. Small-caliber EGD and C-EGD were performed with 5.9-mm and 9.8-mm video endoscopes (Olympus), respectively. RESULTS: The patients' age, sex, experience with EGD, and anxiety before EGD did not differ significantly between the three groups, each consisting of 50 patients. TSC-EGD failed in four of the 50 patients (8 %) because of a narrow nasal tract; they underwent PSC-EGD. Complete examinations, including the second part of the duodenum and biopsy sampling, were possible in all patients. Patients examined with an ultrathin instrument required sedation significantly less often (TSC-EGD 6 %, PSC-EGD 18 %, C-EGD 44 %; P < 0.01) and consequently spent less time in the recovery room. TSC-EGD was initially more painful on insertion, but caused less gagging (P<0.01) than peroral EGD during the whole procedure. TSC-EGD caused mild epistaxis in one case. CONCLUSIONS: TSC-EGD was carried out safely and completely in 92 % of the patients. TSC-EGD and PSC-EGD were better tolerated and required sedation less often than conventional EGD. Transnasal diagnostic EGD appears to be a promising alternative to peroral EGD, as it is associated with less gagging and a high level of patient satisfaction.

Adult↗
PubMed2003

Endoscopic and percutaneous treatment of difficult bile duct stones.

About 90 % of ductal stones can be extracted after endoscopic sphincterotomy (EST) with routine endoscopic maneuvers. The main reasons for failure are a difficult gastroduodenal or biliary anatomy, or impacted or excessively large stones which cannot be grasped with basket catheters. Various nonsurgical procedures complementary to endoscopic retrograde cholangiopancreatography (ERCP) are available for these selected cases. For each of these methods, risks and benefits must be weighed against a surgical common bile duct exploration.

Gallstones↗
PubMed2003

A prospective, randomized multicenter trial comparing DoubleLayer and polyethylene stents for malignant distal common bile duct strictures.

BACKGROUND AND STUDY AIMS: Endoscopic biliary stenting is an established treatment for malignant obstructive jaundice. Stent clogging continues to be a major problem with plastic stents. The aim of this study was to carry out a prospective comparison of two stents with different materials and shapes: the Olympus DoubleLayer stent (DLS; perfluoro alkoxy, without sideholes) and the standard polyethylene (PE) stent (with sideholes). PATIENTS AND METHODS: A total of 120 patients (70 women; mean age 71, range 36 - 91) with jaundice due to malignant strictures of the middle to distal third of the common bile duct were randomly assigned to receive either DLS (n = 60) or PE (n = 60) biliary stents. Patients with cholangitis, hemobilia, previous biliary drainage, hilar stricture, or ampullary cancer were excluded. RESULTS: In all, 28 DLS patients (47 %) and 17 PE stent patients (29 %) died without clinical evidence of stent occlusion after a mean of 114 and 105 days, respectively ( P < 0.05). Twenty-six DLS patients (43 %) and 38 PE stent patients (63 %) had symptoms of stent clogging after a mean of 144 and 99 days, respectively ( P < 0.05). Stent dysfunction (stent orifice impacted on the bile duct or duodenal wall, stent migration) was recorded in six DLS patients (10 %) and five PE patients (8 %) (n. s.). Kaplan-Meier analysis of DLS and PE stent clogging-free survival showed a significantly longer patency period with the DLS stents (P = 0.0005). CONCLUSIONS: These results show that DoubleLayer stents have a longer patency period than PE stents. Patients who received PE stents had a higher risk of stent occlusion (relative risk 3.05; 95 % CI, 1.57 - 5.89) before death than DLS patients.

Adult↗
PubMed2002

Therapeutic pancreatic endoscopy.

Pharmacological treatment and/or temporary pancreatic stenting can reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography. Potential candidates are patients who are at high risk for this complication. Extensive diagnostic work-up is needed for patients with acute recurrent pancreatitis before treatment can be planned. Endoscopic pancreatic sphincterotomy or temporary stenting, or both, appear to be beneficial in idiopathic recurrent pancreatitis. Short-term stent placement in the dorsal duct, with or without papillotomy of the minor papilla, is a promising approach in patients with symptomatic pancreas divisum, particularly if it is associated with acute recurrent pancreatitis. Endoscopic treatment of chronic obstructive pancreatitis is technically effective and safe, but the indication remains controversial, mainly due to a lack of controlled trials. Endoscopic transmural drainage of pancreatic pseudocysts or abscesses is very effective, and should be considered as a primary approach in symptomatic patients. The endoscopic ultrasonography-guided technique extends the options for obtaining access to fluid collections in difficult locations, and may further increase the safety of the procedure. Many of these procedures are technically demanding, and should be restricted to high-volume centers; there is a continuing need for further evaluation and comparison with alternative strategies.

Acute Disease↗
PubMed2002

Evaluation of a new immunochromatographic based whole blood near patient test for the diagnosis of Helicobacter pylori infection.

BACKGROUND: Infection with H pylori is very common and may cause chronic gastritis, predisposes to gastric and duodenal ulcers, leads in some cases to gastric lymphoma and has been recognised as a class I gastric carcinogen. Rapid, inexpensive, reliable tests are needed to facilitate the diagnosis. METHODS: This prospective clinical study was undertaken to evaluate a new whole blood antibody test (helicoCare) in correlation to three tests for diagnosis of H pylori infection (histology, ELISA and rapid urease test). 304 patients (mean age 56.5 years, range of 11-93 years) referred for esophagogastroduodenoscopy were included in this uni-centric study over a nine-month period. According to the guidelines for clinical trials in H pylori infection, patients with at least two positive tests were classified as positive for H pylori. RESULTS: 132 patients (43.4 %) were positive for H pylori, of which helicoCare identified 118 missing one gastric and one duodenal ulcer. 172 patients (56.6 %) were H pylori negative, of which helicoCare identified 163. Sensitivity was proven to be 89.4 % and specificity 94.8 %. In a special subgroup of 75 patients younger or equal to 45 years, 28 patients were positive for H pylori (37.3 %). In this group a sensitivity of 85.7 % and a specificity of 97.9 % was found for the helicoCare. CONCLUSIONS: The helicoCare test showed sufficient sensitivity and satisfying specificity for H pylori diagnosis similar to or better than those of rapid urease test or ELISA. The helicoCare whole blood test may be useful for in-office H pylori diagnosis especially in patients under 45 years.

Adolescent↗