Hans Seifert - Academia.edu (original) (raw)
Papers by Hans Seifert
Gastroenterologie up2date, 2009
Gut, Apr 3, 2017
Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosec... more Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent...
Der Chirurg
Endoscopically, approximately 85% of all bile duct stones can be removed immediately after succes... more Endoscopically, approximately 85% of all bile duct stones can be removed immediately after successful papillotomy. For the remaining cases, complete clearance of the bile duct is achieved by lithotripsy techniques. Due to the lower risks, endoscopic treatment is preferable.
Bildgebung = Imaging
Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 5... more Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 50% were of lasting success. The authors' approach is explained with a review of the literature on various drainage techniques. We consider the puncture of a pseudocyst justified only on clinical grounds: the patient's complaints rather than morphological criteria lead to the decision to perform a drainage procedure. Obligatory in the therapeutic concept are ERCP and endosonography. Visualization of a pancreatico-cystic communication leads to the attempt of transpapillary drainage as the therapy of choice. Visualization of anatomic details, namely vessels, lowers the risk of punctures. Direct punctures even in difficult anatomical conditions can be attempted under direct endosonographic control. In our hands, drainage of pseudocysts is a part of the endoscopic treatment concept for chronic pancreatitis and is generally preferred to surgical techniques.
Zentralblatt für Chirurgie
In chronic pancreatitis obstruction of the pancreatic ductal system by strictures, stones or pseu... more In chronic pancreatitis obstruction of the pancreatic ductal system by strictures, stones or pseudocysts seems to play an important part in pathogenesis. Therefore, therapeutic efforts are directed mainly towards reestablishing a free flow of pancreatic secretion. Endoscopic techniques allow decompression of the organ by stenting or stone extraction, as well as evacuation and drainage of pseudocysts. Thus, interventional endoscopy offers safe and long lasting therapy for many patients suffering from chronic pancreatitis. This paper gives a review of the literature and reports on own clinical data.
Endoscopy
The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has ... more The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has made fine-needle aspiration biopsy (FNAB) under direct endosonographic guidance possible. Because the imaging and instrumentation planes overlap, the operator can visualize a biopsy needle lengthwise as it enters the sector-shaped sound field. We performed EUS-guided FNAB of lymph nodes in seven patients who met the following criteria: (1) Lymph node size over > 1 cm; (2) no endoscopic or endosonographic evidence for tumor involvement of bowel wall interposed between the lymph node and the transducer; and (3) absence of coagulopathy or thrombocytopenia. A positive tissue yield was obtained in six patients, of whom five had malignant cells identified on cytology. The patient with an inadequate yield had a dry aspirate, possibly related to prior irradiation treatment for esophageal carcinoma. No procedure-related complications were observed. We conclude that EUS-guided FNAB of lymph nodes is technically feasible, provides a high diagnostic yield, and appears to be safe. Further studies to determine the sensitivity and specificity of this novel procedure are warranted.
Zentralblatt für Chirurgie
Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for e... more Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for esophageal carcinoma. However, the treatment of high cervical tumors using commercially available plastic prostheses is problematic. We modified the design and implantation techniques of the Celestin prosthesis to accommodate high cervical tumors and report our results in 38 patients. Over a 7 year period 42 modified Celestin prostheses were implanted in 38 patients with high cervical esophageal tumors. 15 had stenosis only, 22 had a stenosis and fistula, and one had a fistula without stenosis. Graduated bouginage up to 38 Fr or 42 Fr for large prostheses was performed prior to stent placement in an average of 2.3 sessions. There were no procedure-related complications. Only in one case the prosthesis had to be withdrawn after reimplantation because of intolerable painful foreign body sensation. Improvement of dysphagia was achieved in 34 patients. The fistulas could be adequately bridged and sealed in 17 of 23 patients. Prostheses migrated in 11 cases (proximally, n = 6; distally, n = 5). Mean patient survival in 28 patients followed until death was 86 days (range 5-338 days).
Erkrankungen des Pankreas, 2013
Zeitschrift für Gastroenterologie, 2010
Zeitschrift für Gastroenterologie, 2013
Journal of Gastrointestinal Surgery, 2013
Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal ca... more Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC). Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kappa statistics. For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: -/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients. EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.
Gastrointestinal Endoscopy, 2007
abstract china long eigenvector endoscopic eus guided-fna german hilt neonate pancreatic piles (3... more abstract china long eigenvector endoscopic eus guided-fna german hilt neonate pancreatic piles (3) post-grouting sphincterotomy 内窥镜内窥镜检查呼吸窘迫综合征治疗结果结局螺旋钻孔灌注桩桩端压力注浆工艺桩端压力注浆桩techno... 西方dragon 龙
Gastrointestinal Endoscopy, 1995
Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor ste... more Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas. Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire). The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively. The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.
Gastrointestinal Endoscopy, 1994
Gastrointestinal Endoscopy, 1996
Background: Endoscopic treatment of giant colorectal polyps remains controversial because of conc... more Background: Endoscopic treatment of giant colorectal polyps remains controversial because of concerns regarding coexistent malignancy, incomplete resection, and safety. Methods: We reviewed the clinical course after removal of 176 benign-appearing large (>3 cm) colorectal polyps, which were removed by endoscopic snare resection in 170 patients. These were termed "giant" polyps. Sessile polyps (n = 129) were removed piecemeal and pedunculated polyps (n = 47) transected at the stalk. Results: Bleeding was the only complication in 24% of polypectomy procedures (procedural in 58, immediate in 3, delayed in 6 patients). Except for one conservatively treated delayed bleed, all bleeds were treated endoscopically. Histology of resected polyps showed coexistent malignancy in 12%. Eight patients had malignant polyps that met "unfavorable" criteria and underwent surgery. Following complete endoscopic resection, 16 patients were lost to follow-up and 124 patients had follow-up of at least 6 months (117 benign and 7 "favorable" malignant polyps). Nineteen patients with benign polyps developed recurrences (18 benign, 1 malignant); one patient with a favorable malignant polyp had a malignant recurrence and underwent surgery. Conclusion: Endoscopic resection of benign-appearing giant colorectai polyps is feasible and safe. Complete excision is possible in patients with benign and favorable malignant polyps, but recurrence rates are high. Close surveillance to detect and treat recurrence is required. (Gastrointest Endosc 1996;43:183-8.)
Gastrointestinal Endoscopy, 1995
Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment opti... more Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.
Gastrointestinal Endoscopy, 1996
Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cann... more Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05). Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.
Gastroenterology, 2000
lymphocytes were examined by flow cytometry and ELISA. Results: More than one autoantibody was ob... more lymphocytes were examined by flow cytometry and ELISA. Results: More than one autoantibody was observed in all 20 patients. Serum antinuclear antibody was detected in 15 of 20 patients, anti-LF antibody in 15, anti-CA-II antibody in 12, rheumatoid factor in 7, anti-smooth muscle antibody in 5, but anti-mitochondrial antibody in none. The serum levels of anti-CA-II and LF antibody were not correlated. The ratios of HLA-DR+CD3+ (30.2±10.7 %), HLA-DR+CD4+ (17.0±4.5 %) and HLA-DR +CD8+ (25.6±4.8 %) PBLs in AlP (n= 13) were significantly higher than those in control patients (HLA-DR+CD3+, 15.3±3.0 %; HLA-DR+CD4+, 8.5±1.5 %; HLA-DR+CD8+, 1O.2±3.6 %). CD4+CD45RO+ (33.2±3.3 %) and CD8+CD45RO+ memory cells (22.2±4.9 %) in AlP tended to be increased compared with those in control pancreatitis patients (CD4+CD45RO+, 24.4±3.7 %; CD8 + CD45RO + , 15.8±2.7 %). A flow cytometric analysis of intracellular cytokines showed that the ratios of CD4 positive cells producing IFN-yin AlP (l6.4±5.6 %) were significantly higher than those in control patients (7.5±2.7 %). However, the ratios of CD4 positive cells producing IL-4 were not different between AlP and controls. The levels of IFN-')'by the stimulated lymphocytes of AlP (196 ±56 pg/ml) were significantly higher than those in the controls ( 35 ± 23 pg/ml) . However, IL-4 secretion in both groups were below detectable levels (10 pg/ml). Conclusion: An autoimmune mechanism against CA-II or LF, and Thl-type of the immune response may be involved in AlP.
Gastroenterologie up2date, 2009
Gut, Apr 3, 2017
Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosec... more Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent...
Der Chirurg
Endoscopically, approximately 85% of all bile duct stones can be removed immediately after succes... more Endoscopically, approximately 85% of all bile duct stones can be removed immediately after successful papillotomy. For the remaining cases, complete clearance of the bile duct is achieved by lithotripsy techniques. Due to the lower risks, endoscopic treatment is preferable.
Bildgebung = Imaging
Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 5... more Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 50% were of lasting success. The authors' approach is explained with a review of the literature on various drainage techniques. We consider the puncture of a pseudocyst justified only on clinical grounds: the patient's complaints rather than morphological criteria lead to the decision to perform a drainage procedure. Obligatory in the therapeutic concept are ERCP and endosonography. Visualization of a pancreatico-cystic communication leads to the attempt of transpapillary drainage as the therapy of choice. Visualization of anatomic details, namely vessels, lowers the risk of punctures. Direct punctures even in difficult anatomical conditions can be attempted under direct endosonographic control. In our hands, drainage of pseudocysts is a part of the endoscopic treatment concept for chronic pancreatitis and is generally preferred to surgical techniques.
Zentralblatt für Chirurgie
In chronic pancreatitis obstruction of the pancreatic ductal system by strictures, stones or pseu... more In chronic pancreatitis obstruction of the pancreatic ductal system by strictures, stones or pseudocysts seems to play an important part in pathogenesis. Therefore, therapeutic efforts are directed mainly towards reestablishing a free flow of pancreatic secretion. Endoscopic techniques allow decompression of the organ by stenting or stone extraction, as well as evacuation and drainage of pseudocysts. Thus, interventional endoscopy offers safe and long lasting therapy for many patients suffering from chronic pancreatitis. This paper gives a review of the literature and reports on own clinical data.
Endoscopy
The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has ... more The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has made fine-needle aspiration biopsy (FNAB) under direct endosonographic guidance possible. Because the imaging and instrumentation planes overlap, the operator can visualize a biopsy needle lengthwise as it enters the sector-shaped sound field. We performed EUS-guided FNAB of lymph nodes in seven patients who met the following criteria: (1) Lymph node size over > 1 cm; (2) no endoscopic or endosonographic evidence for tumor involvement of bowel wall interposed between the lymph node and the transducer; and (3) absence of coagulopathy or thrombocytopenia. A positive tissue yield was obtained in six patients, of whom five had malignant cells identified on cytology. The patient with an inadequate yield had a dry aspirate, possibly related to prior irradiation treatment for esophageal carcinoma. No procedure-related complications were observed. We conclude that EUS-guided FNAB of lymph nodes is technically feasible, provides a high diagnostic yield, and appears to be safe. Further studies to determine the sensitivity and specificity of this novel procedure are warranted.
Zentralblatt für Chirurgie
Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for e... more Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for esophageal carcinoma. However, the treatment of high cervical tumors using commercially available plastic prostheses is problematic. We modified the design and implantation techniques of the Celestin prosthesis to accommodate high cervical tumors and report our results in 38 patients. Over a 7 year period 42 modified Celestin prostheses were implanted in 38 patients with high cervical esophageal tumors. 15 had stenosis only, 22 had a stenosis and fistula, and one had a fistula without stenosis. Graduated bouginage up to 38 Fr or 42 Fr for large prostheses was performed prior to stent placement in an average of 2.3 sessions. There were no procedure-related complications. Only in one case the prosthesis had to be withdrawn after reimplantation because of intolerable painful foreign body sensation. Improvement of dysphagia was achieved in 34 patients. The fistulas could be adequately bridged and sealed in 17 of 23 patients. Prostheses migrated in 11 cases (proximally, n = 6; distally, n = 5). Mean patient survival in 28 patients followed until death was 86 days (range 5-338 days).
Erkrankungen des Pankreas, 2013
Zeitschrift für Gastroenterologie, 2010
Zeitschrift für Gastroenterologie, 2013
Journal of Gastrointestinal Surgery, 2013
Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal ca... more Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC). Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kappa statistics. For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: -/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients. EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.
Gastrointestinal Endoscopy, 2007
abstract china long eigenvector endoscopic eus guided-fna german hilt neonate pancreatic piles (3... more abstract china long eigenvector endoscopic eus guided-fna german hilt neonate pancreatic piles (3) post-grouting sphincterotomy 内窥镜内窥镜检查呼吸窘迫综合征治疗结果结局螺旋钻孔灌注桩桩端压力注浆工艺桩端压力注浆桩techno... 西方dragon 龙
Gastrointestinal Endoscopy, 1995
Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor ste... more Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas. Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire). The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively. The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.
Gastrointestinal Endoscopy, 1994
Gastrointestinal Endoscopy, 1996
Background: Endoscopic treatment of giant colorectal polyps remains controversial because of conc... more Background: Endoscopic treatment of giant colorectal polyps remains controversial because of concerns regarding coexistent malignancy, incomplete resection, and safety. Methods: We reviewed the clinical course after removal of 176 benign-appearing large (>3 cm) colorectal polyps, which were removed by endoscopic snare resection in 170 patients. These were termed "giant" polyps. Sessile polyps (n = 129) were removed piecemeal and pedunculated polyps (n = 47) transected at the stalk. Results: Bleeding was the only complication in 24% of polypectomy procedures (procedural in 58, immediate in 3, delayed in 6 patients). Except for one conservatively treated delayed bleed, all bleeds were treated endoscopically. Histology of resected polyps showed coexistent malignancy in 12%. Eight patients had malignant polyps that met "unfavorable" criteria and underwent surgery. Following complete endoscopic resection, 16 patients were lost to follow-up and 124 patients had follow-up of at least 6 months (117 benign and 7 "favorable" malignant polyps). Nineteen patients with benign polyps developed recurrences (18 benign, 1 malignant); one patient with a favorable malignant polyp had a malignant recurrence and underwent surgery. Conclusion: Endoscopic resection of benign-appearing giant colorectai polyps is feasible and safe. Complete excision is possible in patients with benign and favorable malignant polyps, but recurrence rates are high. Close surveillance to detect and treat recurrence is required. (Gastrointest Endosc 1996;43:183-8.)
Gastrointestinal Endoscopy, 1995
Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment opti... more Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.
Gastrointestinal Endoscopy, 1996
Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cann... more Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05). Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.
Gastroenterology, 2000
lymphocytes were examined by flow cytometry and ELISA. Results: More than one autoantibody was ob... more lymphocytes were examined by flow cytometry and ELISA. Results: More than one autoantibody was observed in all 20 patients. Serum antinuclear antibody was detected in 15 of 20 patients, anti-LF antibody in 15, anti-CA-II antibody in 12, rheumatoid factor in 7, anti-smooth muscle antibody in 5, but anti-mitochondrial antibody in none. The serum levels of anti-CA-II and LF antibody were not correlated. The ratios of HLA-DR+CD3+ (30.2±10.7 %), HLA-DR+CD4+ (17.0±4.5 %) and HLA-DR +CD8+ (25.6±4.8 %) PBLs in AlP (n= 13) were significantly higher than those in control patients (HLA-DR+CD3+, 15.3±3.0 %; HLA-DR+CD4+, 8.5±1.5 %; HLA-DR+CD8+, 1O.2±3.6 %). CD4+CD45RO+ (33.2±3.3 %) and CD8+CD45RO+ memory cells (22.2±4.9 %) in AlP tended to be increased compared with those in control pancreatitis patients (CD4+CD45RO+, 24.4±3.7 %; CD8 + CD45RO + , 15.8±2.7 %). A flow cytometric analysis of intracellular cytokines showed that the ratios of CD4 positive cells producing IFN-yin AlP (l6.4±5.6 %) were significantly higher than those in control patients (7.5±2.7 %). However, the ratios of CD4 positive cells producing IL-4 were not different between AlP and controls. The levels of IFN-')'by the stimulated lymphocytes of AlP (196 ±56 pg/ml) were significantly higher than those in the controls ( 35 ± 23 pg/ml) . However, IL-4 secretion in both groups were below detectable levels (10 pg/ml). Conclusion: An autoimmune mechanism against CA-II or LF, and Thl-type of the immune response may be involved in AlP.