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  • 1
    In: Obesity Surgery, Springer Science and Business Media LLC, Vol. 30, No. 8 ( 2020-08), p. 3263-3263
    Type of Medium: Online Resource
    ISSN: 0960-8923 , 1708-0428
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2087903-9
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  • 2
    In: Obesity Surgery, Springer Science and Business Media LLC, Vol. 30, No. 6 ( 2020-06), p. 2076-2084
    Abstract: The role of preoperative upper-gastrointestinal (GI) gastroscopy has been discussed with controversy in bariatric surgery. The aim of this study was to evaluate the incidence of upper-GI pathologies detected via endoscopy prior to bariatric surgery along with their clinical significance for patients’ management. Material and Methods In our single center prospectively established database of obese patients, who underwent bariatric surgery from January 2011 to December 2017, we retrospectively analyzed the perioperative endoscopic findings along with their influence on patients’ management. Results In total, 636 obese patients with median BMI (body mass index) of 49 kg/m 2 [range 31–92] received an upper-GI endoscopy prior to bariatric surgery. Among the surgical procedures, laparoscopic Roux-Y-gastric bypass (72.6%; n  = 462) was the most frequent operation. Endoscopically detected pathological conditions were peptic ulcer 3.5% (22/636), Helicobacter pylori (Hp) gastritis 22.4% (143/636), and gastric or duodenal polyps 6.8% (43/636). Reflux esophagitis could be detected in 139/636 patients (21.9%). Barrett’s esophagus (BE) was histologically diagnosed in 95 cases (15.0%), whereas BE was suspected endoscopically in 75 cases (11.3%) only. Esophageal adenocarcinomas were detected in 3 cases (0.5%). Change of the operative strategy due to endoscopically or histologically detected pathologic findings had to be performed in 10 cases (1.6%). Conclusion Preoperative upper-GI endoscopy identifies a wide range of abnormal endoscopic findings in obese patients, which may have a significant impact on decision-making, particularly regarding the most suitable bariatric procedure and the appropriate follow-up. Therefore, preoperative upper-GI endoscopy should be considered in all obese patients prior to bariatric procedure.
    Type of Medium: Online Resource
    ISSN: 0960-8923 , 1708-0428
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2087903-9
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  • 3
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2019
    In:  Zeitschrift für Gastroenterologie Vol. 57, No. 03 ( 2019-03), p. 317-326
    In: Zeitschrift für Gastroenterologie, Georg Thieme Verlag KG, Vol. 57, No. 03 ( 2019-03), p. 317-326
    Abstract: Der Barrett-Ösophagus (BE) stellt den wichtigsten Risikofaktor für das ösophageale Adenokarzinom dar. Derzeit ist kein hinreichend effizientes Screening-Programm verfügbar, um in der Gesamtpopulation Patienten mit einem hohen Risiko für ein ösophageales Adenokarzinom auf dem Boden eines Barrett-Ösophagus zu identifizieren. Das aktuelle endoskopische Screening zielt auf symptomatische Refluxpatienten, aus denen sich aber nur ein Teil der Risikopatienten rekrutiert. Derzeit werden verschiedene neue Verfahren untersucht, die die Effektivität des Screenings deutlich erhöhen könnten. Selektive Literaturrecherche in MEDLINE/PubMed unter Berücksichtigung deutscher und internationaler Leitlinien. Alternative Screening-Verfahren könnten zweistufig angelegt sein: Zunächst die Identifikation von Personen „at risk“ über eine Erfassung geeigneter biologischer Marker, dann deren gezielte endoskopisch-bioptische Abklärung, Risikostratifikation, Überwachung (Surveillance) und ggf. Therapie. Neue diagnostische Methoden wie der Cytosponge® in Kombination mit einer Auswertung von Markern für Barrett-Schleimhaut könnten einen wesentlichen Fortschritt darstellen. Barrett-Karzinome zeigen nach wie vor eine zunehmende Inzidenz und eine (trotz therapeutischer Fortschritte) ungünstige Prognose, wobei aber Patienten mit Barrett-Frühkarzinomen eine gute Prognose hinsichtlich Langzeitüberleben aufweisen. Eine verbesserte Früherkennung ist dringend wünschenswert, da bisher die meisten Patienten erst im fortgeschrittenen Stadium endoskopisch diagnostiziert werden, was eine kurative Therapie erschwert. Nur eine effiziente frühzeitige Identifizierung von Risikopatienten mit Barrett-Ösophagus durch ein praktikables Screening-Programm auf Populationsebene wird zur Verbesserung der Prognose beitragen können.
    Type of Medium: Online Resource
    ISSN: 0044-2771 , 1439-7803
    RVK:
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 4
    In: Visceral Medicine, S. Karger AG, Vol. 37, No. 5 ( 2021), p. 426-433
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a challenging operation. Especially the mobilization of the pouch into the pelvis can be complex. Adequate perfusion of the pouch is required for optimal healing and functioning. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 With hyperspectral imaging (HSI) wavelengths between 500 and 1,000 nm can be analyzed in addition to visible light and by reflecting patterns. This intraoperative procedure is non-invasive, contact-free, and no contrast medium is needed. Fifteen patients undergoing IPAA were examined prospectively, and the pouch was evaluated by HSI intraoperatively. HSI was measured in standardized fashion at 4 defined locations of the J-pouch. Each measurement took about 10 s. The clinical postoperative course was assessed in all patients and correlated to the intraoperative HSI findings. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Mean near-infrared perfusion and oxygenation of patients showed values ≥74% for all defined pouch areas, revealing good blood supply. Three minor anastomotic leaks were detected by standard pouchoscopy in the postoperative course, which could be treated conservatively with endosponge therapy. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 HSI values of perfusion and oxygenation of the IPAA were high. The leak rate is associated with redo procedures. This is reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation. HSI has proved itself as a quick and effective new intraoperative tool to evaluate pouch perfusion objectively and quantitatively.
    Type of Medium: Online Resource
    ISSN: 2297-4725 , 2297-475X
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 2850734-4
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  • 5
    In: European Journal of Cancer, Elsevier BV, Vol. 164 ( 2022-03), p. 18-29
    Type of Medium: Online Resource
    ISSN: 0959-8049
    RVK:
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1120460-6
    detail.hit.zdb_id: 1468190-0
    detail.hit.zdb_id: 82061-1
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  • 6
    In: Laryngo-Rhino-Otologie, Georg Thieme Verlag KG, Vol. 102, No. 10 ( 2023-10), p. 742-753
    Abstract: Ösophagusmotilitätsstörungen sind Erkrankungen, bei denen es aufgrund einer Veränderung der neuromuskulären Strukturen zu Fehlfunktionen des Schluckakts kommt. Das Leitsymptom ist daher die Dysphagie für feste und/oder flüssige Speisen, häufig begleitet von Symptomen wie Thoraxschmerz, Regurgitation, Sodbrennen und Gewichtsverlust. Die Ösophagusmanometrie ist der Goldstandard in der Diagnostik. Endoskopie und Radiologie dienen dem Ausschluss entzündlicher oder maligner Veränderungen. Durch die Einführung der hochauflösenden Ösophagusmanometrie (HRM) hat sich die Diagnostik der Ösophagusmotilitätsstörungen verbessert und mit der Chicago-Klassifikation zu einer neuen Einteilung geführt, die im letzten Jahrzehnt mehrfach modifiziert wurde, zuletzt 2021 mit der Chicago-Klassifikation v4.0. Verglichen mit der Vorversion v3.0 finden sich einige wichtige Änderungen, die anhand der im klinischen Alltag wichtigsten Ösophagusmotilitätsstörungen vorgestellt werden.
    Type of Medium: Online Resource
    ISSN: 0935-8943 , 1438-8685
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2037508-6
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  • 7
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2020
    In:  Laryngo-Rhino-Otologie Vol. 99, No. 04 ( 2020-04), p. 214-223
    In: Laryngo-Rhino-Otologie, Georg Thieme Verlag KG, Vol. 99, No. 04 ( 2020-04), p. 214-223
    Abstract: Der Barrett-Ösophagus (BE) stellt den wichtigsten Risikofaktor für das ösophageale Adenokarzinom dar. Derzeit ist kein hinreichend effizientes Screening-Programm verfügbar, um in der Gesamtpopulation Patienten mit einem hohen Risiko für ein ösophageales Adenokarzinom auf dem Boden eines Barrett-Ösophagus zu identifizieren. Das aktuelle endoskopische Screening zielt auf symptomatische Refluxpatienten, aus denen sich aber nur ein Teil der Risikopatienten rekrutiert. Derzeit werden verschiedene neue Verfahren untersucht, die die Effektivität des Screenings deutlich erhöhen könnten. Selektive Literaturrecherche in MEDLINE/PubMed unter Berücksichtigung deutscher und internationaler Leitlinien. Alternative Screening-Verfahren könnten 2-stufig angelegt sein: Zunächst die Identifikation von Personen „at risk“ über eine Erfassung geeigneter biologischer Marker, dann deren gezielte endoskopisch-bioptische Abklärung, Risikostratifikation, Überwachung (Surveillance) und ggf. Therapie. Neue diagnostische Methoden wie der Cytosponge® in Kombination mit einer Auswertung von Markern für Barrett-Schleimhaut könnten einen wesentlichen Fortschritt darstellen. Barrett-Karzinome zeigen nach wie vor eine zunehmende Inzidenz und eine (trotz therapeutischer Fortschritte) ungünstige Prognose, wobei aber Patienten mit Barrett-Frühkarzinomen eine gute Prognose hinsichtlich Langzeitüberleben aufweisen. Eine verbesserte Früherkennung ist dringend wünschenswert, da bisher die meisten Patienten erst im fortgeschrittenen Stadium endoskopisch diagnostiziert werden, was eine kurative Therapie erschwert. Nur eine effiziente frühzeitige Identifizierung von Risikopatienten mit Barrett-Ösophagus durch ein praktikables Screening-Programm auf Populationsebene wird zur Verbesserung der Prognose beitragen können.
    Type of Medium: Online Resource
    ISSN: 0935-8943 , 1438-8685
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2037508-6
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  • 8
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 132-132
    Abstract: Inflammation is a common in esophageal adenocarcinoma (EAC). The response of EAC to common chemotherapeutic regimes is relatively low and the 5-years-survival is poor. The influence of acidic reflux on the viability of esophageal adenocarcinoma cells is unknown. Methods We investigated the influence of acidified medium conditions (pH3; pH3.5; pH4) in a Barrett's cell culture model, using six cell lines representing the Barrett's sequence from normal esophageal epithelium (EPC1 and EPC2), metaplasia (CP-A), dysplasia (CP-B) and EAC (OE33 and OE19) for their tolerability against an acid pulse of 15 and 30 min as well as expression profile of the Nrf2-Keap1-signalling pathway and their downstream targets. Results The Barrett's sequence was characterized by an increase of acid tolerability in the more advanced cells of this sequence. The squamous epithelium cell line EPC1 has shown the highest susceptibility with a decrease of 75% of cell viability, when treated with pH4 medium for 15min, while dysplastic and EAC cells had shown only a decrease of 10–25%. The lowest susceptibility was observed in the EAC cell line OE33, which had also 90% living cell in pH3 medium after 15min and had almost 30% living cells after 30min, when all other investigated cell lines showed no more living cells. Additionally, treatment with acidified medium was accompanied with an increase of the Nrf2 target gene hemeoxygensae-1. Conclusion We could show an increased tolerability against acidified medium (pH3) in cells representing advanced Barrett's esophagus stages, accompanied by an activation of Keap1-Nrf2-signalling pathway. However, acidic reflux may influence inflammation and chemo-sensitivity of the EAC. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2004949-3
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  • 9
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2018
    In:  Diseases of the Esophagus Vol. 31, No. Supplement_1 ( 2018-09-01), p. 136-137
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 136-137
    Abstract: Curcumin naturally occurring in curry powder from Curcuma longa is an anti-inflammatory and anti-proliferative agent. It represses NFκB activation and induces apoptosis in cancer cells. Because, inflammation favours the onset of an intestinal metaplasia in esophageal squamous epithelial cells and esophageal carcinoma cells, a reduction of such processes may contribute to establish a stable disease and/or sensitization for chemotherapeutic approaches. Methods Curcumin receptivity was investigated in metaplastic (CP-A), dysplastic (CP-B), adenocarcinoma (OE19, OE33), and esophageal fibroblast (FFE3) cell lines, which were treated with 10 or 25 μM Curcumin for 48h or 72h. Response to Curcumin was measured by proliferation assays as well as by induction of apoptosis and Akt activation by western blot analyses. Results The EAC cell lines OE33 and OE19 show a decrease of proliferation with raising curcumin concentration with an IC50 of 9.6 and 14.8 μM, respectively. While the metaplastic and dysplastic cell lines showed a comparable IC50 of 7.7 and 11.6 μM to the EAC cell lines, the FEF3 cell showed a higher IC50 of approx. 20μM. The phosphorylation of Akt was decreased and apoptosis was induced, showing cleaved PARP, when treated with 25μM curcumin after 48h and 72h. Conclusion Metaplastic, dysplastic and EAC cells show a higher receptivity to curcumin than esophageal fibroblasts cells. This constrains the NFκB activation and its contribution in the manifestation of the Barrett's esophagus. The usage of curcumin to generate an anti-inflammatory microenvironment will potentially help to develop a stable disease or to reverse the development of the Barrett's esophagus. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 10
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2017
    In:  Digestive Diseases and Sciences Vol. 62, No. 12 ( 2017-12), p. 3391-3401
    In: Digestive Diseases and Sciences, Springer Science and Business Media LLC, Vol. 62, No. 12 ( 2017-12), p. 3391-3401
    Type of Medium: Online Resource
    ISSN: 0163-2116 , 1573-2568
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2015102-0
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