Christian Jenssen - Academia.edu (original) (raw)

Papers by Christian Jenssen

Research paper thumbnail of Erkrankungen des Magens

Research paper thumbnail of „Knobology“ in Doppler Ultrasound

Medical Ultrasonography, 2021

Ultrasonography is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Du... more Ultrasonography is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Due to modern equipment and automatic image optimization, nowadays the introduction of ultrasound imaging requires only little technical and physical knowledge. However, profound knowledge of the device function repertoire and underlying mechanisms are essential foroptimal image adjustment and documentation. From a medical as well as an aesthetic point of view, the goal should always be to achieve the best possible image quality. This article provides an overview of handling of ultrasound systems, fundamental adjustments and their optimization in Doppler ultrasound.

Research paper thumbnail of Die neue Gallenstein-Leitlinie: Grenzen überwinden

Zeitschrift für Gastroenterologie, 2018

Research paper thumbnail of Artefakte in der Sonografie und ihre Bedeutung für die internistische und gastroenterologische Diagnostik – Teil 2: Artefakte im Farb- und Spektraldoppler

Zeitschrift für Gastroenterologie, 2016

Artifacts in ultrasonographic diagnostics are a result of the physical properties of the ultrasou... more Artifacts in ultrasonographic diagnostics are a result of the physical properties of the ultrasound waves and are caused by interaction of the ultrasound waves with biological structures and tissues of the body and with foreign materials. On the one hand, they may be diagnostically helpful. On the other hand, they may be distracting and may lead to misdiagnosis. Profound knowledge of the causes, avoidance, and interpretation of artifacts is a necessary precondition for correct clinical appraisal of ultrasound images. Part 1 of this review commented on the physics of artifacts and described the most important B-mode artifacts. Part 2 focuses on the clinically relevant artifacts in Doppler and color-coded duplex sonography. Problems and pitfalls of interpretation arising from artifacts, as well as the diagnostic use of Doppler and colour-coded duplex sonography, are discussed.

Research paper thumbnail of Clinical value of imaging for lymph nodes evaluation with particular emphasis on ultrasonography

Zeitschrift für Gastroenterologie, 2016

Enlarged or irregular lymph nodes (LNs) are clinical and imaging findings in a large variety of m... more Enlarged or irregular lymph nodes (LNs) are clinical and imaging findings in a large variety of malignant and non-malignant diseases. A comprehensive diagnostic work up is usually necessary in order to differentiate the benign or the malignant nature of the altered LNs. The diagnosis has to be made using all clinical information and, if necessary, assessed LNs need to be biopsied and further, histologically or microbiologically characterized. However, imaging techniques, and particularly ultrasonography (US), are essential on the way to the final diagnosis, from initial detection and characterization to follow-up of biopsy guidance. Computed-tomography (CT) and/or magnetic resonance imaging (MRI) are of great value for oncological diseases staging and treatment monitoring. Imaging techniques are helpful in distinguishing between benign and malignant LNs disease as well as between LNs metastases and lymphoma in most cases. Furthermore, imaging can define the extent and distribution of malignant diseases. It may assist, through the use of particular techniques such as elastography, to identify the most suspicious LN to be biopsied and to guide targeted biopsies from the most suspicious areas. It also serves as the main tool for the evaluation of treatment response in malignant diseases. The quality of LNs imaging has remarkably improved in recent years. New methods, such as contrast-enhanced ultrasonography (CEUS), elastography, positron emission tomography (PET)/PET-CT, as well as diffusion weighted imaging (DWI) in MRI, have already led to substantial changes in clinical practice. This review describes the most recent imaging techniques for LNs assessment, and their particular clinical value, with a special emphasis on the role of US techniques. Strengths and weaknesses of different imaging tools are discussed comprehensively, highlighting the importance of a corroborative attitude for successful management of each particular case.

Research paper thumbnail of Kapitel 25 – Spezielle bildgebende Verfahren: Farbdopplersonografie, CE-EUS, Elastografie, 3-D

Kursbuch Endosonografie, 2014

Research paper thumbnail of S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie (Kurzversion), AWMF Register Nr. 021–022

Zeitschrift für Gastroenterologie, 2015

Research paper thumbnail of EUS Characterization of Focal Pancreatic Masses

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

Research paper thumbnail of Commentary on the World Federation for Ultrasound in Medicine and Biology Project “Incidental Findings”

Ultrasound in Medicine & Biology

Research paper thumbnail of An international, multi-institution survey on performing EUS-FNA and fine needle biopsy

Endoscopic Ultrasound

Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine... more Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results: ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50–200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion: This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.

Research paper thumbnail of A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence

Medical Ultrasonography

Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and... more Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany. Material and methods: In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analyse...

Research paper thumbnail of Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide

Endoscopic Ultrasound

Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, med... more Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.

Research paper thumbnail of EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization – Position Statement

Ultraschall in der Medizin - European Journal of Ultrasound

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tom... more The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.

Research paper thumbnail of Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part I

Medical Ultrasonography

The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonogr... more The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonographic competence. This “pictorial essay” is intended to illustrate eye-catching examples of relevant “clinical-sonographic visual diagnoses” of LNs. We provide typical images and take-home messages of eye-catching features to illustrate the featured publications.The first part includes “important differential diagnoses of eye-catching features of suspected lymphadenopathy” and “benign lymphadenopathy”. The second part will include “Eye-catching features of malignant lymphadenopathy, both carcinoma and lymphoma”

Research paper thumbnail of Duplexsonography of the mesenteric vessels – a critical evaluation of inter observer variability

Zeitschrift für Gastroenterologie

INTRODUCTION The number of publications concerning mesenteric Doppler sonography (mesDS) is immen... more INTRODUCTION The number of publications concerning mesenteric Doppler sonography (mesDS) is immense and does not correlate with the frequency of its use in clinical practice. This is astonishing since it provides real time blood flow (perfusion) information without side effects. Despite uncontrollable parameters like the technical limitations in some situations the optimization of (possibly) controllable parameters like standardization, production of normal values and reduction of the investigator variability by evaluating stable parameters could change the situation. PATIENTS AND METHODS 10 investigators experienced in abdominal sonography ("DEGUM-Seminarleiter") performed mesenteric Doppler sonography in 5 healthy subjects with 5 different machines. RESULTS The portal vein at the confluence and the common hepatic artery provide a significant portion of investigations with intromission angles of more than 60°. Values of diameter, resistance index and pulsatility index of the celiac trunc could be obtained with inter-observer variability values below 25 %. The proper and the common hepatic artery show no differences in inter-observer variability values, whereas the intrahepatic measure point of the portal vein showed a higher reproducibility. DISCUSSION We define frame conditions for future mesenteric Doppler studies: the portal vein should be investigated at the intrahepatic measure point. Pathophysiological studies should refrain from velocity parameters except in the case of larger vessels running in a straight course towards the probe.

Research paper thumbnail of Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Endoscopy

Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; h... more Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting. Methods Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection. Results 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of ...

Research paper thumbnail of Editorial: Sonografie in der Zeitschrift für Gastroenterologie

Zeitschrift für Gastroenterologie

Research paper thumbnail of Evaluation von Akzeptanz und Trainingseffekt strukturierter Endosonografie-Trainingskurse nach dem GATE-Kurskonzept

Ultraschall in der Medizin - European Journal of Ultrasound

Research paper thumbnail of Phlegmonöse Gastritis – eine seltene Komplikation der Magenschleimhautbiopsie mit charakteristischen (endo-)sonographischen Befunden

Ultraschall in der Medizin - European Journal of Ultrasound

Research paper thumbnail of Choledocho- und Cholezystolithiasis

Der Gastroenterologe, 2016

ZusammenfassungHintergrundEtwa 10–20 % der deutschen Bevölkerung sind Gallensteinträger, davon en... more ZusammenfassungHintergrundEtwa 10–20 % der deutschen Bevölkerung sind Gallensteinträger, davon entwickelt bis zu einem Viertel während ihrer Lebenszeit Symptome oder Komplikationen.FragestellungDie Übersicht stellt auf der Grundlage aktueller Leitlinien die evidenzbasierte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis dar.Material und MethodenDie relevanten Empfehlungen der zur Publikation anstehenden aktualisierten S3-Leitlinie zur Diagnostik und Therapie von Gallensteinen werden kommentiert und Weiterentwicklungen zur im Jahr 2007 publizierten Fassung aufgezeigt. Ergänzend werden auch Empfehlungen der S2k-Leitlinie zu Qualitätsanforderungen an die gastrointestinale Endoskopie und der Leitlinien der European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) zur interventionellen Sonographie bei Patienten mit Gallensteinleiden aufgegriffen.ErgebnisseAuf der Grundlage aktueller Evidenz sind die Leitlinienempfehlungen zur Diagnostik und Therapie von Patienten mit Cholezysto- und Choledocholithiasis präzisiert worden. Die Anforderungen an eine frühzeitige operative Versorgung von Patienten mit akuter Cholezystitis (24 h), an das zeitgerechte Management von Patienten mit akuter Cholangitis und biliärer Pankreatitis (abhängig vom Schweregrad) und an die sequenzielle Therapie von Patienten mit simultaner Cholezysto- und Choledocholithiasis (laparoskopische Cholezystektomie innerhalb von 72 h nach endoskopischer Gangsanierung) steigen.SchlussfolgerungenDie aktuelle leitliniengerechte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis ist interdisziplinär und erfordert integrierte viszeralmedizinische Betreuungskonzepte, die zusammenfassend in einem Algorithmus dargestellt werden.AbstractBackgroundGallstones are present in approximately 10–20 % of the German population. Up to one fourth of them will develop symptoms or complications during their lifetime.ObjectiveBased on recent guidelines, this paper reviews the evidence-based management of patients with gallstone disease.Materials and methodsMost relevant recommendations of the updated S3 guidelines on the diagnosis and treatment of gallstone disease are provided. Developments are depicted in relation to the 2007 version of these guidelines. Complementary recommendations of the S2k guidelines on quality requirements for gastrointestinal endoscopy and of the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) guidelines on interventional ultrasound in gallstone disease are referred to.ResultsBased on recent scientific evidence, the guideline recommendations for diagnosis and treatment of patients with gallstone disease are presented. Requirements are rising for early surgical treatment of patients with acute cholecystitis (24 h), the timely management of patients with acute cholangitis and biliary pancreatitis (depending on severity) and on the sequential treatment of patients with simultaneous gallbladder and common bile duct stones (laparascopic cholecystectomy within 72 h after endoscopic bile duct clearance).ConclusionsUp-to-date guideline-based management of patients with gallstone disease is an interdisciplinary task and requires comprehensive management concepts. A guideline-based algorithm is introduced.

Research paper thumbnail of Erkrankungen des Magens

Research paper thumbnail of „Knobology“ in Doppler Ultrasound

Medical Ultrasonography, 2021

Ultrasonography is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Du... more Ultrasonography is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Due to modern equipment and automatic image optimization, nowadays the introduction of ultrasound imaging requires only little technical and physical knowledge. However, profound knowledge of the device function repertoire and underlying mechanisms are essential foroptimal image adjustment and documentation. From a medical as well as an aesthetic point of view, the goal should always be to achieve the best possible image quality. This article provides an overview of handling of ultrasound systems, fundamental adjustments and their optimization in Doppler ultrasound.

Research paper thumbnail of Die neue Gallenstein-Leitlinie: Grenzen überwinden

Zeitschrift für Gastroenterologie, 2018

Research paper thumbnail of Artefakte in der Sonografie und ihre Bedeutung für die internistische und gastroenterologische Diagnostik – Teil 2: Artefakte im Farb- und Spektraldoppler

Zeitschrift für Gastroenterologie, 2016

Artifacts in ultrasonographic diagnostics are a result of the physical properties of the ultrasou... more Artifacts in ultrasonographic diagnostics are a result of the physical properties of the ultrasound waves and are caused by interaction of the ultrasound waves with biological structures and tissues of the body and with foreign materials. On the one hand, they may be diagnostically helpful. On the other hand, they may be distracting and may lead to misdiagnosis. Profound knowledge of the causes, avoidance, and interpretation of artifacts is a necessary precondition for correct clinical appraisal of ultrasound images. Part 1 of this review commented on the physics of artifacts and described the most important B-mode artifacts. Part 2 focuses on the clinically relevant artifacts in Doppler and color-coded duplex sonography. Problems and pitfalls of interpretation arising from artifacts, as well as the diagnostic use of Doppler and colour-coded duplex sonography, are discussed.

Research paper thumbnail of Clinical value of imaging for lymph nodes evaluation with particular emphasis on ultrasonography

Zeitschrift für Gastroenterologie, 2016

Enlarged or irregular lymph nodes (LNs) are clinical and imaging findings in a large variety of m... more Enlarged or irregular lymph nodes (LNs) are clinical and imaging findings in a large variety of malignant and non-malignant diseases. A comprehensive diagnostic work up is usually necessary in order to differentiate the benign or the malignant nature of the altered LNs. The diagnosis has to be made using all clinical information and, if necessary, assessed LNs need to be biopsied and further, histologically or microbiologically characterized. However, imaging techniques, and particularly ultrasonography (US), are essential on the way to the final diagnosis, from initial detection and characterization to follow-up of biopsy guidance. Computed-tomography (CT) and/or magnetic resonance imaging (MRI) are of great value for oncological diseases staging and treatment monitoring. Imaging techniques are helpful in distinguishing between benign and malignant LNs disease as well as between LNs metastases and lymphoma in most cases. Furthermore, imaging can define the extent and distribution of malignant diseases. It may assist, through the use of particular techniques such as elastography, to identify the most suspicious LN to be biopsied and to guide targeted biopsies from the most suspicious areas. It also serves as the main tool for the evaluation of treatment response in malignant diseases. The quality of LNs imaging has remarkably improved in recent years. New methods, such as contrast-enhanced ultrasonography (CEUS), elastography, positron emission tomography (PET)/PET-CT, as well as diffusion weighted imaging (DWI) in MRI, have already led to substantial changes in clinical practice. This review describes the most recent imaging techniques for LNs assessment, and their particular clinical value, with a special emphasis on the role of US techniques. Strengths and weaknesses of different imaging tools are discussed comprehensively, highlighting the importance of a corroborative attitude for successful management of each particular case.

Research paper thumbnail of Kapitel 25 – Spezielle bildgebende Verfahren: Farbdopplersonografie, CE-EUS, Elastografie, 3-D

Kursbuch Endosonografie, 2014

Research paper thumbnail of S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie (Kurzversion), AWMF Register Nr. 021–022

Zeitschrift für Gastroenterologie, 2015

Research paper thumbnail of EUS Characterization of Focal Pancreatic Masses

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

Research paper thumbnail of Commentary on the World Federation for Ultrasound in Medicine and Biology Project “Incidental Findings”

Ultrasound in Medicine & Biology

Research paper thumbnail of An international, multi-institution survey on performing EUS-FNA and fine needle biopsy

Endoscopic Ultrasound

Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine... more Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results: ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50–200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion: This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.

Research paper thumbnail of A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence

Medical Ultrasonography

Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and... more Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany. Material and methods: In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analyse...

Research paper thumbnail of Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide

Endoscopic Ultrasound

Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, med... more Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.

Research paper thumbnail of EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization – Position Statement

Ultraschall in der Medizin - European Journal of Ultrasound

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tom... more The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.

Research paper thumbnail of Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part I

Medical Ultrasonography

The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonogr... more The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonographic competence. This “pictorial essay” is intended to illustrate eye-catching examples of relevant “clinical-sonographic visual diagnoses” of LNs. We provide typical images and take-home messages of eye-catching features to illustrate the featured publications.The first part includes “important differential diagnoses of eye-catching features of suspected lymphadenopathy” and “benign lymphadenopathy”. The second part will include “Eye-catching features of malignant lymphadenopathy, both carcinoma and lymphoma”

Research paper thumbnail of Duplexsonography of the mesenteric vessels – a critical evaluation of inter observer variability

Zeitschrift für Gastroenterologie

INTRODUCTION The number of publications concerning mesenteric Doppler sonography (mesDS) is immen... more INTRODUCTION The number of publications concerning mesenteric Doppler sonography (mesDS) is immense and does not correlate with the frequency of its use in clinical practice. This is astonishing since it provides real time blood flow (perfusion) information without side effects. Despite uncontrollable parameters like the technical limitations in some situations the optimization of (possibly) controllable parameters like standardization, production of normal values and reduction of the investigator variability by evaluating stable parameters could change the situation. PATIENTS AND METHODS 10 investigators experienced in abdominal sonography ("DEGUM-Seminarleiter") performed mesenteric Doppler sonography in 5 healthy subjects with 5 different machines. RESULTS The portal vein at the confluence and the common hepatic artery provide a significant portion of investigations with intromission angles of more than 60°. Values of diameter, resistance index and pulsatility index of the celiac trunc could be obtained with inter-observer variability values below 25 %. The proper and the common hepatic artery show no differences in inter-observer variability values, whereas the intrahepatic measure point of the portal vein showed a higher reproducibility. DISCUSSION We define frame conditions for future mesenteric Doppler studies: the portal vein should be investigated at the intrahepatic measure point. Pathophysiological studies should refrain from velocity parameters except in the case of larger vessels running in a straight course towards the probe.

Research paper thumbnail of Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study

Endoscopy

Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; h... more Background The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting. Methods Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection. Results 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of ...

Research paper thumbnail of Editorial: Sonografie in der Zeitschrift für Gastroenterologie

Zeitschrift für Gastroenterologie

Research paper thumbnail of Evaluation von Akzeptanz und Trainingseffekt strukturierter Endosonografie-Trainingskurse nach dem GATE-Kurskonzept

Ultraschall in der Medizin - European Journal of Ultrasound

Research paper thumbnail of Phlegmonöse Gastritis – eine seltene Komplikation der Magenschleimhautbiopsie mit charakteristischen (endo-)sonographischen Befunden

Ultraschall in der Medizin - European Journal of Ultrasound

Research paper thumbnail of Choledocho- und Cholezystolithiasis

Der Gastroenterologe, 2016

ZusammenfassungHintergrundEtwa 10–20 % der deutschen Bevölkerung sind Gallensteinträger, davon en... more ZusammenfassungHintergrundEtwa 10–20 % der deutschen Bevölkerung sind Gallensteinträger, davon entwickelt bis zu einem Viertel während ihrer Lebenszeit Symptome oder Komplikationen.FragestellungDie Übersicht stellt auf der Grundlage aktueller Leitlinien die evidenzbasierte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis dar.Material und MethodenDie relevanten Empfehlungen der zur Publikation anstehenden aktualisierten S3-Leitlinie zur Diagnostik und Therapie von Gallensteinen werden kommentiert und Weiterentwicklungen zur im Jahr 2007 publizierten Fassung aufgezeigt. Ergänzend werden auch Empfehlungen der S2k-Leitlinie zu Qualitätsanforderungen an die gastrointestinale Endoskopie und der Leitlinien der European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) zur interventionellen Sonographie bei Patienten mit Gallensteinleiden aufgegriffen.ErgebnisseAuf der Grundlage aktueller Evidenz sind die Leitlinienempfehlungen zur Diagnostik und Therapie von Patienten mit Cholezysto- und Choledocholithiasis präzisiert worden. Die Anforderungen an eine frühzeitige operative Versorgung von Patienten mit akuter Cholezystitis (24 h), an das zeitgerechte Management von Patienten mit akuter Cholangitis und biliärer Pankreatitis (abhängig vom Schweregrad) und an die sequenzielle Therapie von Patienten mit simultaner Cholezysto- und Choledocholithiasis (laparoskopische Cholezystektomie innerhalb von 72 h nach endoskopischer Gangsanierung) steigen.SchlussfolgerungenDie aktuelle leitliniengerechte Versorgung von Patienten mit Cholezysto- und Choledocholithiasis ist interdisziplinär und erfordert integrierte viszeralmedizinische Betreuungskonzepte, die zusammenfassend in einem Algorithmus dargestellt werden.AbstractBackgroundGallstones are present in approximately 10–20 % of the German population. Up to one fourth of them will develop symptoms or complications during their lifetime.ObjectiveBased on recent guidelines, this paper reviews the evidence-based management of patients with gallstone disease.Materials and methodsMost relevant recommendations of the updated S3 guidelines on the diagnosis and treatment of gallstone disease are provided. Developments are depicted in relation to the 2007 version of these guidelines. Complementary recommendations of the S2k guidelines on quality requirements for gastrointestinal endoscopy and of the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) guidelines on interventional ultrasound in gallstone disease are referred to.ResultsBased on recent scientific evidence, the guideline recommendations for diagnosis and treatment of patients with gallstone disease are presented. Requirements are rising for early surgical treatment of patients with acute cholecystitis (24 h), the timely management of patients with acute cholangitis and biliary pancreatitis (depending on severity) and on the sequential treatment of patients with simultaneous gallbladder and common bile duct stones (laparascopic cholecystectomy within 72 h after endoscopic bile duct clearance).ConclusionsUp-to-date guideline-based management of patients with gallstone disease is an interdisciplinary task and requires comprehensive management concepts. A guideline-based algorithm is introduced.