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Biomedical subjects

R Schöfl

Publications and source records attributed to R Schöfl.

At least 19 recordsLinked to original sources
PubMed2006

Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures.

BACKGROUND AND STUDY AIMS: Strictures are a substantial cause of morbidity in patients with Crohn's disease. Endoscopic balloon dilation is a therapeutic option in limited strictures to avoid intestinal surgery, although there have been few reports regarding the long-term outcome. PATIENTS AND METHODS: Balloon dilation was scheduled for 46 patients (26 women, 20 men; median age 34) with Crohn's-associated symptomatic and radiographically confirmed intestinal stenosis. The study plan envisaged up to four consecutive treatments within the first 2 months until relief of symptoms, and thereafter dilations depending on clinical requirements. RESULTS: Dilation was not possible in seven of the 46 patients (15 %), due to technical problems (n = 2), internal fistulas (n = 3), or absence of a stenosis (n = 2). Thirty-nine patients received at least one treatment. The site of obstruction was the ileocolonic anastomosis in 23 of the 39 patients (59 %) and surgically untreated areas in 16 patients (41 %). After the initial dilation series (median 1, interquartile range 1-2), strictures were traversed in 37 of the 39 patients (95 %). During a median follow-up period of 21 months (range 3-98 months), 24 of the 39 patients (62 %) underwent a repeat intervention, including 12 (31 %) with repeat dilation, 11 (28 %) with surgical resection, and one patient who received an intestinal stent. The cumulative percentages of patients without a repeat intervention or surgery at 6, 12, 24, and 36 months were 68 %, 48 %, 36 %, and 31 %, and 97 %, 91 %, 84 % and 75 %, respectively. Two perforations and one case of severe bleeding were seen in the 73 dilation procedures (4 %) performed. CONCLUSIONS: Endoscopic balloon dilation is a safe and effective method that allows surgery to be avoided in approximately 75 % of patients with Crohn's-associated short intestinal strictures. However, recurrent symptoms frequently make it necessary to repeat the procedure.

Adult↗
PubMed2005

Diagnostic endoscopic retrograde cholangiopancreatography.

Although diagnostic endoscopic retrograde cholangiopancreatography (ERCP) has been replaced in many fields by magnetic resonance cholangiopancreatography (MRCP), considerable amounts of research are still ongoing. Major fields of interest include ways of reducing the incidence of post-ERCP pancreatitis, new ways of improving the yield of tissue sampling, and the diagnosis of sphincter of Oddi dysfunction. In addition, there are new data comparing the diagnostic accuracy of ERCP with that of MRCP and endoscopic ultrasonography.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2003

Diagnostic cholangiopancreatography.

As in recent years, the articles on diagnostic endoscopic retrograde cholangiopancreatography (ERCP) published between July 2001 and June 2002 again reflect a defensive attitude and are mainly concerned with magnetic resonance cholangiopancreatography (MRCP) and the complications associated with the new imaging method. Diagnostic ERCP is declining in importance and has held its position mainly due to new advances in tissue sampling, pressure measurement, and the use of echo probes and miniature endoscopes. Problems of training in ERCP have still not yet been resolved, due to the contradictions inherent in low case loads, the desire to offer a wide spectrum of training, and issues of quality assurance.

Biliary Tract Diseases↗
PubMed2002

Endoscopic ultrasound in the follow up and response assessment of patients with primary gastric lymphoma.

BACKGROUND: Endoscopic ultrasound (EUS) is considered the best technique for local staging of primary gastric lymphomas. Its role in the follow up of patients with gastric lymphoma following organ conserving strategies has not been established. AIM: To compare endosonographic response assessment with results of histological evaluation. PATIENTS AND METHODS: Thirty three patients with primary gastric lymphomas underwent pretreatment EUS and were followed endosonographically every 3-6 months after administration of organ conserving treatment modalities. A wall thickness of <or=4 mm with preserved five layer structure and the absence of suspicious lymph nodes was defined as endosonographic remission. Decrease in wall thickness, increase in echogenicity, and regression of lymph nodes were tested for their value to predict histological remission. RESULTS: A total of 158 endosonographies were performed (median 4; range 2-12). Within a median follow up period of 15 months (range 3-48), 27 (82%) patients achieved complete histological remission while endosonographic remission was found in 21 (64%) patients. Eighteen patients achieved both forms of remission, with endosonographic remission occurring later (35.1 (11-212.9) weeks v 17.6 (11-97.9) weeks; median (range); p<0.02) than histological remission. A further three patients demonstrated a false negative remission on EUS. Histological relapse was paralleled by endosonographic relapse in only one of five patients. None of the tested endosonographic parameters was able to predict histological remission. CONCLUSIONS: In view of the inferior accuracy of EUS when compared with histology, gastroscopy with biopsy seems sufficient for the routine follow up of patients with gastric lymphoma.

Adolescent↗
PubMed2001

Diagnostic endoscopic retrograde cholangiopancreatography.

Since the introduction of magnetic resonance cholangiopancreatography (MRCP), the focus in endoscopic retrograde cholangiopancreatography (ERCP) has shifted from diagnosis to treatment - a change that has organizational implications in relation to teaching and providing access to ERCP. Most of last year's papers on ERCP described refinements of the technique and indication, tissue sampling, and efforts to reduce complications. Many studies compared MRCP with various other imaging methods and with histopathological findings. Bile duct stones and strictures are still the main target, but new entities for evaluation with MRCP have been found: primary sclerosing cholangitis, choledochal cysts, chronic pancreatitis, pancreatic injury, and postoperative abnormalities. Helical computed-tomographic cholangiography is still attracting some interest. This review closes with a comparison of ERCP with MRCP with regard to availability, legal aspects, operator-dependency, and cost-effectiveness.

Cholangiography↗
PubMed2001

Diamond stents for palliation of malignant bile duct obstruction: a prospective multicenter evaluation.

BACKGROUND AND STUDY AIMS: Various types of self-expandable metal stents have been introduced for biliary drainage in patients with malignant jaundice, showing prolonged patency compared with plastic endoprostheses. However, there has only been prolonged experience with a meaningful number of patients using the Wallstent. We evaluated the Diamond stent, a self-expanding uncoated biliary metal stent, in a prospective uncontrolled multicenter setting. PATIENTS AND METHODS: The eligibility criterion was obstructive jaundice due to inoperable malignant disease. Between August 1995 and January 2000, 126 patients, who received a total of 134 Diamond stents in four European centers, were followed prospectively. RESULTS: Technical and clinical success rates were 96 % and 98 %, respectively. No major procedure-related complications occurred. The 30-day mortality rate was 13 %. Stent occlusion occurred in 28 patients (22 %). Overall median stent patency was 477 days; overall median survival was 173 days. Stent occlusion, confirmed by endoscopic retrograde cholangiopancreatography, was successfully treated with plastic stents in all patients. Cost analysis revealed estimated costs of 3440 euros per patient for palliative treatment with the Diamond stent. CONCLUSIONS: The Diamond stent compares favorably with other biliary metal stents for patients requiring biliary drainage of malignant jaundice.

Adult↗
PubMed1998

Stage-dependent therapy of rectal carcinoid tumors.

Although malignant behavior of rectal carcinoid tumors is rare, the risk of metastases and death does exist. Adaptation of therapy according to the estimated malignancy seems necessary. To develop a stage-dependent therapy, 31 patients with rectal carcinoid tumors measuring 5 to 50 mm in diameter were analyzed retrospectively. Malignancy was estimated according to tumor size, infiltration depth, and histopathology. There were 18 tumors within the mucosa and submucosa (T1), 7 tumors with muscularis propria invasion (T2), and carcinoid tumor penetrating the full rectal wall (T3) or spreading to surrounding tissue (T4) in 6 patients. Altogether 20 patients (65%) were treated with a minimally invasive intervention: endoscopic polypectomy (EP) in 12 and transanal excision (TE) in 8 patients. In 11 patients (35%) aggressive surgical procedures--anterior resection (AR) in 4 and abdominoperineal resection (APR) in 7--were performed. After a mean +/- SD follow-up of 86.0 +/- 61.3 months, tumor recurrence was not seen in any of the 20 patients with minimally invasive treatment, and all were still alive. No severe complications associated with surgical procedures were detected. In contrast, 5 of the 10 patients with advanced tumor stage died from their disease despite aggressive surgery (AR, APR). In conclusion, depending on tumor stage, treatment of rectal carcinoids includes EP, TE, or extended resection. Minimally invasive techniques are safe treatments for small to medium-size T1/T2 rectal carcinoids. Extended surgery cannot improve the overall survival of those with advanced tumors (T3/T4, N1, M1) but can be beneficial for preventing local complications.

Adult↗
PubMed1998

Bile duct adenocarcinoma mimicking veno-occlusive disease after autologous bone marrow transplantation for acute leukaemia.

A 52-year-old female underwent autologous BMT because of acute myeloid leukaemia FAB M4 in second remission. Since the patient had no HLA-identical sibling she received a purged autologous BM transplant. On day +5 she developed signs of a sepsis syndrome with fluid retention and was treated with broad-spectrum antibiotic therapy. However, her body weight remained high, ascites and an increase of total serum bilirubin and alkaline phosphatase developed. The icterus worsened to a total bilirubin level of 25 mg/100 ml. Sonographic and endoscopic imaging showed a dilated gall bladder but disclosed a post-hepatic cause for the icterus. A transjugular liver biopsy on day +71 revealed severe cholestasis and siderosis. The patient remained aplastic with constantly increased bilirubin levels. On day +73 septic shock syndrome occurred and the patient died of multiorgan failure 3 days later. At autopsy, a highly differentiated bile duct adenocarcinoma at the porta hepatis, so-called Klatskin tumour, was found, explaining the fatal course with intractable cholestasis.

Adenocarcinoma↗