Werner Dolak - Academia.edu (original) (raw)
Papers by Werner Dolak
Zeitschrift für Gastroenterologie, 2008
Zeitschrift für Gastroenterologie, 2013
Japan Gastroenterological Endoscopy Soaciety, Mar 24, 2014
Investigative Radiology, Mar 1, 2016
The aim of this study was to compare 18 F-fluorodeoxyglucose (FDG) positron emission tomography (... more The aim of this study was to compare 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) (with and without diffusion-weighted imaging [DWI]) to 18 F-FDG PET/computed tomography (CT), with regard to the assessment of nodal and extranodal involvement, in patients with Hodgkin lymphoma and non-Hodgkin lymphoma, without restriction to FDG-avid subytpes. Materials and Methods: Patients with histologically proven lymphoma were enrolled in this prospective, institutional review board-approved study. After a single 18 F-FDG injection, patients consecutively underwent 18 F-FDG PET⁄CT and 18 F-FDG PET/MR on the same day for staging or restaging. Three sets of images were analyzed separately: 18 F-FDG PET/CT, 18 F-FDG PET/MR without DWI, and 18 F-FDG PET/MR with DWI. Region-based agreement and examination-based sensitivity and specificity were calculated for 18 F-FDG PET/CT, 18 F-FDG PET/MR without DWI, and 18 F-FDG PET/MR DWI. Maximum and mean standardized uptake values (SUV max , SUV mean) on 18 F-FDG PET/CT and 18 F-FDG PET/MR were compared and correlated with minimum and mean apparent diffusion coefficients (ADC min , ADC mean). Results: Thirty-four patients with a total of 40 examinations were included. Examination-based sensitivities for 18 F-FDG PET/CT, 18 F-FDG PET/MR, and 18 F-FDG PET/MR DWI were 82.1%, 85.7%, and 100%, respectively; specificities were 100% for all 3 techniques; and accuracies were 87.5%, 90%, and 100%, respectively. 18 F-FDG PET/CTwas false negative in 5 of 40 examinations (all with mucosa-associated lymphoid tissue lymphoma), and 18 F-FDG PET/MR (without DWI) was false negative in 4 of 40 examinations. Region-based percentages of agreement were 99% (κ, 0.95
First, 18F-FDG-PET/CTwas performed from the vertex to the ORIGINAL ARTICLEpermissible to download... more First, 18F-FDG-PET/CTwas performed from the vertex to the ORIGINAL ARTICLEpermissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.lyzed tissue samples obtained by biopsy or surgery, according to the World Health Organization classification of hematological and lymphoid malignancies, were included. Pregnancy, general contra-indications to MRI (eg, implantable medical devices, claustropho-bia), elevated glucose levels (>150 mg/dL), and known adverse reactions to ionized contrast media, comprised the exclusion criteria. of interest with regard to the study or its results.
Cancers, 2020
There is no clear therapeutic algorithm for mucosa-associated lymphoid tissue (MALT) lymphoma bey... more There is no clear therapeutic algorithm for mucosa-associated lymphoid tissue (MALT) lymphoma beyond Helicobacter pylori eradication and while chemotherapy-based regimens are standard for MALT lymphoma patients in need of systemic treatment, it appears of interest to also investigate chemotherapy-free strategies. We have retrospectively assessed MALT lymphoma patients undergoing upfront systemic treatment, classified either as chemotherapy (=classical cytostatic agents +/− rituximab) or immunotherapy (=immunomodulatory agents or single anti-CD20 antibodies) at the Medical University Vienna 1999–2019. The primary endpoint was progression-free survival (PFS). In total, 159 patients were identified with a median follow-up of 67 months. The majority of patients had extragastric disease (80%), but we also identified 32 patients (20%) with Helicobacter pylori negative or disseminated gastric lymphoma. Regarding the type of first line treatment and outcome, 46% (74/159) received a chemothe...
Gastrointestinal Endoscopy, 2018
Background & aim: Fecal immunochemical test (FIT) and sigmoidoscopy have been used for colorectal... more Background & aim: Fecal immunochemical test (FIT) and sigmoidoscopy have been used for colorectal cancer (CRC) screening worldwide. However, the limitations are poorer test sensitivity for advanced neoplasia (AN) and isolated detection in distal colon, respectively. Through this prospective multicenter trial, we compared the detection rate of AN between FIT plus sigmoidoscopy (SIG) based colonoscopy (FITS group) and colonoscopy (COLO group). Methods: From October 2012 to March 2017, asymptomatic average subjects in the age of 45 to 75 who did not undergo screening colonoscopy or who have a history of colonoscopy at least 5 years before or a history of SIG 3 years before were enrolled at 13 tertiary hospitals. Eligible subjects were randomized to FITS group or COLO group. In FITS group, FIT was performed before endoscopy date and then, sigmoidoscopy was followed by colonoscopy on the same date. If FIT was over the threshold or any adenomas were found by SIG, the test was considered as positive. We calculated FIT and FITS based program sensitivity (ST), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) under the assumption that colonoscopy should be performed only in subjects with positive FIT or positive SIG. We defined an AN as an adenoma more than 10 mm in size or having villous components or high grade dysplasia or cancer. Results: Among 3,658 subjects enrolled, data from 3,651 were completely filled up and were analyzed (FITS: 1,821 vs. COLO: 1,830). In FITS group, positive rate of FIT was 5.0% (86/1,731) with threshold of 100 ng/Ml and positive rate of SIG was 15.1% (273/1,821). In FITS group, FIT based colonoscopy program could find only 13 of 137 ANs (ST 9.5%, SP 95.4%, PPV 15.1%, NPV 92.5%, respectively). Also, SIG based colonoscopy program could find only 45.9% (67/146) of ANs. Even though we applied combined FIT and SIG based colonoscopy strategy, we could only increase ANs detection rate up to 47.9% (70/146). Finally, among all subjects, 70 ANs (3.8%, 70/1,821) were supposed to be found in FITS based colonoscopy program, whereas 143 ANs were found (7.9%, 143/1830) in COLO group, which was significantly higher than those found by FITS strategy (p<0.001). Conclusion: Compared to direct colonoscopy, FIT plus SIG based colonoscopy program could only find about half number of ANs, suggesting colonoscopy priority under the circumstances of high adherence rate to CRC screening program.
Endoscopy is an important diagnostic and therapeutic tool for managing gastroesophageal reflux di... more Endoscopy is an important diagnostic and therapeutic tool for managing gastroesophageal reflux disease (GERD) and Barrett’s esophagus. Endoscopic findings such as erosive esophagitis, luminal narrowing, and metaplastic turnover of the epithelium are indicatives for GERD. Endoscopic fundoplication methods have been developed, some showed promising results, many left the market already. Biopsy sampling in GERD should be limited to cases with suspicion of Barrett’s metaplasia of at least 1 cm extension into the distal esophagus and withheld in case of massive inflammation. Surveillance of Barrett’s esophagus aims to detect early neoplasia. Advanced endoscopic imaging like chromoendoscopy or narrow-band imaging (NBI) can help to identify and characterize neoplastic lesions. Endoscopic treatment by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or radiofrequency ablation (RFA) aims to prevent progression into (advanced) esophageal cancer.
Journal für Gastroenterologische und Hepatologische Erkrankungen, 2021
ZusammenfassungDie Post-ERCP-Pankreatitis ist die häufigste Komplikation einer ERCP und wird durc... more ZusammenfassungDie Post-ERCP-Pankreatitis ist die häufigste Komplikation einer ERCP und wird durch eine Vielzahl an Faktoren beeinflusst. Zu deren Prophylaxe ist eine strenge Indikationsstellung zur ERCP erforderlich. Sofern keine Gegenanzeigen bestehen, sollen die Patienten vor, während und nach der Untersuchung eine forcierte i.v.-Flüssigkeitszufuhr mit Ringer-Laktat erhalten (in unserer Praxis wird beispielsweise ein Liter Ringer-Laktat vor Beginn der Untersuchung angehängt und zumindest ein weiterer Liter während oder nach der Untersuchung nachgegeben). Vor jeder ERCP sollen ferner 100 mg Diclofenac oder Indometacin rektal verabreicht werden, sofern keine Kontraindikationen bestehen. Je nach Eingriffsart und zusätzlichen intraprozeduralen Risikofaktoren kann schließlich die Platzierung eines Pankreasschutzstents erforderlich sein, um das Risiko weiter minimieren zu können.
Advanced Endoscopic Imaging for Early Stages of Gastrointestinal Tumors. Many new technologies ha... more Advanced Endoscopic Imaging for Early Stages of Gastrointestinal Tumors. Many new technologies have contributed to the diagnostic spectrum of endoscopic procedures for the detection and characterization of early gastrointestinal tumors. Among them are improvements of endoscopic optics such as highdefinition or magnification endoscopy as well as chromoendoscopic methods such as conventional dye spraying, or filter-based systems known as narrow-band imaging. New technologies like confocal laser endomicroscopy, endocytoscopy, autofluorescence endoscopy, or optical coherence tomography provide histological characteristics in vivo and are therefore essential amending tools for further diagnostic and therapeutic decisions. This article deals with the most important endoscopic novelties and discusses their utility in the context of documented applications. J Gastroenterol Hepatol Erkr 2012; 10 (1): 26–30.
NOTES 2.0 - How Japan and Chi- na are taking over the (endoscopic) world. About ten years after t... more NOTES 2.0 - How Japan and Chi- na are taking over the (endoscopic) world. About ten years after the first hype, natural or- ifice translumenal endoscopic surgery (NOTES) has become part of endoscopic routine. Trans- mural necrosectomy, for example, is an impor- tant technique among minimal invasive treat- ment options for acute necrotizing pancreatitis. In Japan and China, "peroral endoscopic myoto- my" (POEM), "submucosal tunneling endoscopic resection" (STER) and "full thickness endoscop- ic resection" (FTER) as newer NOTES-methods are standard techniques at high-end endoscop- ic centers meanwhile. The high patient volume due to the big population is an important factor for innovation that helped to develop and refine these techniques. Recently, G-POEM ("G" stands for "gastric") is available for myotomy of the py- lorus in patients with refractory gastroparesis. However, its therapeutic role has not yet been de- fined. Anyway, endo...
Gastroenterology, 2021
BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (... more BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (CP). Endotherapy using multiple plastic stents (MPS) or a fully covered self-expanding metal stent (FCSEMS) are acceptable treatment options for biliary obstructive symptoms in these patients. METHODS Patients with symptomatic CP-associated BBS enrolled in a multicenter randomized noninferiority trial comparing 12-month treatment with MPS versus FCSEMS. Primary outcome was stricture resolution status at 24 months, defined as absence of restenting and 24-month serum alkaline phosphatase not exceeding twice the level at stenting completion. Secondary outcomes included crossover rate, numbers of ERCPs and stents, and stent- or procedure-related serious adverse events (SAEs). RESULTS Eighty-four patients were randomized to MPS and 80 to FCSEMS. Baseline technical success was 97.6% for MPS and 98.6% for FCSEMS. Eleven patients crossed over from MPS to FCSEMS, and 10 from FCSEMS to MPS. For MPS vs. FCSEMS respectively, stricture resolution status at 24 months was 77.1% (54/70) vs. 75.8% (47/62) (P=0.008 for noninferiority ITT analysis), mean number of ERCPs was 3.9±1.3 vs. 2.6±1.3 (P<0.001, ITT), and mean number of stents placed was 7.0±4.4 vs. 1.3±0.6 (P<0.001, as-treated). SAEs occurred in 16 (19.0%) MPS and 19 (23.8%) FCSEMS patients (P=0.568), including cholangitis/fever/jaundice (9 vs. 7 patients respectively), abdominal pain (5 vs. 5), cholecystitis (1 vs. 3) and post-ERCP pancreatitis (0 vs. 2). No stent- or procedure-related deaths occurred. CONCLUSIONS Endotherapy of CP-associated BBS has similar efficacy and safety for 12-month treatment using MPS compared to a single FCSEMS, with FCSEMS requiring fewer ERCPs over 2 years. (ClinicalTrials.gov, Number: NCT01543256).
Digestive Diseases, 2019
Background: The frequency of endoscopically apparent gastrointestinal tract (GI) involvement in p... more Background: The frequency of endoscopically apparent gastrointestinal tract (GI) involvement in patients with mantle cell lymphoma (MCL) at diagnosis is thought to be in the range of 30%. While reports on GI involvement in MCL patients exist, most series lack a strict GI assessment due to the often asymptomatic nature of GI involvement. Owing to the standardized staging routine at our institution including GI assessment at diagnosis, we have analyzed the rate and prognostic impact of GI involvement in MCL. Methods: In this retrospective single-center evaluation, we have investigated GI involvement in 85 consecutive patients with MCL. All data were collected from clinical records. Results: MCL with and without endoscopically detectable GI involvement was reported in 29 (34%) patients and 56 patients (66%), respectively. The colon was involved in 21 (72%) and the stomach in 8 (28%). Eight of 29 patients (28%) had symptomatic GI involvement, and the primary diagnosis had been establish...
Cancer biology & therapy, Jan 4, 2018
Attempts for identifying targeted therapy strategies in metastatic gastric and gastroesopheal jun... more Attempts for identifying targeted therapy strategies in metastatic gastric and gastroesopheal junction cancer (upper-GI) revealed that the inhibition of human epidermal growth factor receptor-2 (HER2) by monoclonal antibody trastuzumab improves survival of these patients. Hence, adding trastuzumab to doublet chemotherapy has become the standard treatment in this setting. Although the patient survival is extended among clinical trials, the knowledge on the real-time setting is limited. With this retrospective, single center analysis of the patient data of the Medical University of Vienna, we sought to investigate the clinical characteristics and outcome of patients, who received trastuzumab-based chemotherapy for metastatic upper-GI tumor. All patients, who received trastzumab at least once were included to the analysis. Clinical and pathological data were recorded. This search revealed 33 patients. The demographic data was comparable with that of the previous clinical trials. Progre...
Zeitschrift für Gastroenterologie, 2016
Background: Cystic fibrosis (CF) patients are at a higher risk of developing digestive tract diso... more Background: Cystic fibrosis (CF) patients are at a higher risk of developing digestive tract disorders, especially gastrointestinal (GI) cancer. However, optimal criteria, timing and screening interval for GI pathology is not yet established in this patient population. Aims/Methods: This prospective study aimed to evaluate the role of gastrointestinal endoscopic workup in transplanted CF patients. Study subjects underwent esophagogastroduodenoscopy and ileocolonoscopy with segmental biopsy assessment for cancer screening, regardless of presence or absence of GI symptoms (group A or group B). The diagnostic yield for clinically relevant findings (defined as those requiring medical intervention or endoscopic surveillance) was compared among groups (Fisher's exact test). Results: 25 CF patients (13 male, 12 female, median age 35 years) were included. All but one had undergone double lung transplantation. GI symptoms were present in 13 patients (group A), above all, abdominal pain (n = 11), 12 patients had no GI related symptoms (group B). The diagnostic yield was 6/13 in patients with GI symptoms (8 pathologies detected) and 7/12 in patients without GI symptoms (10 pathologies detected; 46 vs. 58%, OR 0.61, 95% CI 0.13 – 2.98; P = 0.70). Findings included four cases of non-dysplastic short-segment Barrett's esophagus, three cases of esophageal candidiasis, three cases of atrophic gastritis with intestinal metaplasia, two cases of erosive gastritis, one case of erosive esophagitis, three cases of colonic adenoma (tubulous: n = 2, tubulovillous: n = 1) and one case each of tubular adenoma of the terminal ileum and post-transplant lymphoproliferative disorder. The median Boston Bowel Preparation Scale was 1+2+3 = 6 (9), including four cases with fecaliths trapped in the appendiceal orifice. Conclusion: In this prospective study (pre-)malignant GI lesions were common in lung transplanted CF patients, irrespective of the presence of GI symptoms. These data further support the necessity of GI endoscopic screening in these patients. Prior to colonoscopy 2-days of bowel-cleansing is suggested.
Hematological Oncology, 2017
Digestive Endoscopy, 2017
Objectives Symptomatic cervical heterotopic gastric mucosa also addressed as cervical inlet patch... more Objectives Symptomatic cervical heterotopic gastric mucosa also addressed as cervical inlet patch (CIP) may present in varying shapes and causes symptoms of laryngopharyngeal reflux (LPR) like globus sensations, hoarseness and chronic cough. Unfortunately, argon plasma coagulation, standard treatment of small symptomatic CIP, is limited in large CIP mainly due to concerns of stricture formation. Therefore, we aimed to investigate radiofrequency ablation (RFA), a novel minimalinvasive ablation method, in the treatment of CIP focusing on large symptomatic patches. Methods Consecutive patients with macroscopic and histologic evidence of large (≥ 20mm diameter) heterotopic gastric mucosa were included in this prospective trial. Primary outcome was the complete macroscopic and histologic eradication rate of CIP. Secondary outcome measures were symptom improvement, quality of life, severity of LPR and adverse events.
Journal of pediatric gastroenterology and nutrition, Jan 12, 2016
This Guideline refers to infants, children and adolescents aged 0-18 years. The areas covered inc... more This Guideline refers to infants, children and adolescents aged 0-18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileo-colonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangio-pancreatography and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) has been dealt with in other Guidelines [1-3] and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
Zeitschrift für Gastroenterologie, 2016
Background: Helicobacter pylori (H. pylori) causes a diversity of gastric diseases. Rapid urease ... more Background: Helicobacter pylori (H. pylori) causes a diversity of gastric diseases. Rapid urease tests (RUT) are well established for the point-of-care, invasive diagnosis of H. pylori infection. The study aimed to evaluate the diagnostic performance of a new liquid RUT, the preOx-HUT, within a prospective cohort of treatment-naïve patients. Methods: The multicenter prospective clinical trial was conducted at nine Austrian centers for gastrointestinal endoscopy. Patients referred for a diagnostic upper gastrointestinal endoscopy underwent gastric biopsy sampling for routine histological evaluation, and in parallel, the preOx-HUT. Histology served as reference standard to evaluate the diagnostic performance of the preOx-HUT. Results: From January 2015 to January 2016, a total of 183 consecutive patients (54 males and 129 females, median age 50 years) were included. Endoscopy revealed pathological findings in 149/183 cases (81%), which were mostly gastritis (59%) and gastro-esophageal reflux disease (27%). H. pylori infection was detected by histology in 41/183 (22%) cases. In relation to histology, the preOx-HUT had a sensitivity of 85%, a specificity of 94%, a positive predictive value of 80% and a negative predictive value of 96%. Performance of preOx-HUT was not affected significantly by concomitant PPI-use as present in 15% of cases (P = 0.73). Conclusions: This was the first study evaluating the preOx-HUT in a prospective, multicenter clinical setting. We found a high diagnostic accuracy for the point-of-care, invasive diagnostic test of H. pylori infection. Hence, this test may be a valuable diagnostic adjunct to the clinical presentation of patients with suspected H. pylori infection.
Zeitschrift für Gastroenterologie, 2008
Zeitschrift für Gastroenterologie, 2013
Japan Gastroenterological Endoscopy Soaciety, Mar 24, 2014
Investigative Radiology, Mar 1, 2016
The aim of this study was to compare 18 F-fluorodeoxyglucose (FDG) positron emission tomography (... more The aim of this study was to compare 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) (with and without diffusion-weighted imaging [DWI]) to 18 F-FDG PET/computed tomography (CT), with regard to the assessment of nodal and extranodal involvement, in patients with Hodgkin lymphoma and non-Hodgkin lymphoma, without restriction to FDG-avid subytpes. Materials and Methods: Patients with histologically proven lymphoma were enrolled in this prospective, institutional review board-approved study. After a single 18 F-FDG injection, patients consecutively underwent 18 F-FDG PET⁄CT and 18 F-FDG PET/MR on the same day for staging or restaging. Three sets of images were analyzed separately: 18 F-FDG PET/CT, 18 F-FDG PET/MR without DWI, and 18 F-FDG PET/MR with DWI. Region-based agreement and examination-based sensitivity and specificity were calculated for 18 F-FDG PET/CT, 18 F-FDG PET/MR without DWI, and 18 F-FDG PET/MR DWI. Maximum and mean standardized uptake values (SUV max , SUV mean) on 18 F-FDG PET/CT and 18 F-FDG PET/MR were compared and correlated with minimum and mean apparent diffusion coefficients (ADC min , ADC mean). Results: Thirty-four patients with a total of 40 examinations were included. Examination-based sensitivities for 18 F-FDG PET/CT, 18 F-FDG PET/MR, and 18 F-FDG PET/MR DWI were 82.1%, 85.7%, and 100%, respectively; specificities were 100% for all 3 techniques; and accuracies were 87.5%, 90%, and 100%, respectively. 18 F-FDG PET/CTwas false negative in 5 of 40 examinations (all with mucosa-associated lymphoid tissue lymphoma), and 18 F-FDG PET/MR (without DWI) was false negative in 4 of 40 examinations. Region-based percentages of agreement were 99% (κ, 0.95
First, 18F-FDG-PET/CTwas performed from the vertex to the ORIGINAL ARTICLEpermissible to download... more First, 18F-FDG-PET/CTwas performed from the vertex to the ORIGINAL ARTICLEpermissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.lyzed tissue samples obtained by biopsy or surgery, according to the World Health Organization classification of hematological and lymphoid malignancies, were included. Pregnancy, general contra-indications to MRI (eg, implantable medical devices, claustropho-bia), elevated glucose levels (>150 mg/dL), and known adverse reactions to ionized contrast media, comprised the exclusion criteria. of interest with regard to the study or its results.
Cancers, 2020
There is no clear therapeutic algorithm for mucosa-associated lymphoid tissue (MALT) lymphoma bey... more There is no clear therapeutic algorithm for mucosa-associated lymphoid tissue (MALT) lymphoma beyond Helicobacter pylori eradication and while chemotherapy-based regimens are standard for MALT lymphoma patients in need of systemic treatment, it appears of interest to also investigate chemotherapy-free strategies. We have retrospectively assessed MALT lymphoma patients undergoing upfront systemic treatment, classified either as chemotherapy (=classical cytostatic agents +/− rituximab) or immunotherapy (=immunomodulatory agents or single anti-CD20 antibodies) at the Medical University Vienna 1999–2019. The primary endpoint was progression-free survival (PFS). In total, 159 patients were identified with a median follow-up of 67 months. The majority of patients had extragastric disease (80%), but we also identified 32 patients (20%) with Helicobacter pylori negative or disseminated gastric lymphoma. Regarding the type of first line treatment and outcome, 46% (74/159) received a chemothe...
Gastrointestinal Endoscopy, 2018
Background & aim: Fecal immunochemical test (FIT) and sigmoidoscopy have been used for colorectal... more Background & aim: Fecal immunochemical test (FIT) and sigmoidoscopy have been used for colorectal cancer (CRC) screening worldwide. However, the limitations are poorer test sensitivity for advanced neoplasia (AN) and isolated detection in distal colon, respectively. Through this prospective multicenter trial, we compared the detection rate of AN between FIT plus sigmoidoscopy (SIG) based colonoscopy (FITS group) and colonoscopy (COLO group). Methods: From October 2012 to March 2017, asymptomatic average subjects in the age of 45 to 75 who did not undergo screening colonoscopy or who have a history of colonoscopy at least 5 years before or a history of SIG 3 years before were enrolled at 13 tertiary hospitals. Eligible subjects were randomized to FITS group or COLO group. In FITS group, FIT was performed before endoscopy date and then, sigmoidoscopy was followed by colonoscopy on the same date. If FIT was over the threshold or any adenomas were found by SIG, the test was considered as positive. We calculated FIT and FITS based program sensitivity (ST), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) under the assumption that colonoscopy should be performed only in subjects with positive FIT or positive SIG. We defined an AN as an adenoma more than 10 mm in size or having villous components or high grade dysplasia or cancer. Results: Among 3,658 subjects enrolled, data from 3,651 were completely filled up and were analyzed (FITS: 1,821 vs. COLO: 1,830). In FITS group, positive rate of FIT was 5.0% (86/1,731) with threshold of 100 ng/Ml and positive rate of SIG was 15.1% (273/1,821). In FITS group, FIT based colonoscopy program could find only 13 of 137 ANs (ST 9.5%, SP 95.4%, PPV 15.1%, NPV 92.5%, respectively). Also, SIG based colonoscopy program could find only 45.9% (67/146) of ANs. Even though we applied combined FIT and SIG based colonoscopy strategy, we could only increase ANs detection rate up to 47.9% (70/146). Finally, among all subjects, 70 ANs (3.8%, 70/1,821) were supposed to be found in FITS based colonoscopy program, whereas 143 ANs were found (7.9%, 143/1830) in COLO group, which was significantly higher than those found by FITS strategy (p<0.001). Conclusion: Compared to direct colonoscopy, FIT plus SIG based colonoscopy program could only find about half number of ANs, suggesting colonoscopy priority under the circumstances of high adherence rate to CRC screening program.
Endoscopy is an important diagnostic and therapeutic tool for managing gastroesophageal reflux di... more Endoscopy is an important diagnostic and therapeutic tool for managing gastroesophageal reflux disease (GERD) and Barrett’s esophagus. Endoscopic findings such as erosive esophagitis, luminal narrowing, and metaplastic turnover of the epithelium are indicatives for GERD. Endoscopic fundoplication methods have been developed, some showed promising results, many left the market already. Biopsy sampling in GERD should be limited to cases with suspicion of Barrett’s metaplasia of at least 1 cm extension into the distal esophagus and withheld in case of massive inflammation. Surveillance of Barrett’s esophagus aims to detect early neoplasia. Advanced endoscopic imaging like chromoendoscopy or narrow-band imaging (NBI) can help to identify and characterize neoplastic lesions. Endoscopic treatment by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or radiofrequency ablation (RFA) aims to prevent progression into (advanced) esophageal cancer.
Journal für Gastroenterologische und Hepatologische Erkrankungen, 2021
ZusammenfassungDie Post-ERCP-Pankreatitis ist die häufigste Komplikation einer ERCP und wird durc... more ZusammenfassungDie Post-ERCP-Pankreatitis ist die häufigste Komplikation einer ERCP und wird durch eine Vielzahl an Faktoren beeinflusst. Zu deren Prophylaxe ist eine strenge Indikationsstellung zur ERCP erforderlich. Sofern keine Gegenanzeigen bestehen, sollen die Patienten vor, während und nach der Untersuchung eine forcierte i.v.-Flüssigkeitszufuhr mit Ringer-Laktat erhalten (in unserer Praxis wird beispielsweise ein Liter Ringer-Laktat vor Beginn der Untersuchung angehängt und zumindest ein weiterer Liter während oder nach der Untersuchung nachgegeben). Vor jeder ERCP sollen ferner 100 mg Diclofenac oder Indometacin rektal verabreicht werden, sofern keine Kontraindikationen bestehen. Je nach Eingriffsart und zusätzlichen intraprozeduralen Risikofaktoren kann schließlich die Platzierung eines Pankreasschutzstents erforderlich sein, um das Risiko weiter minimieren zu können.
Advanced Endoscopic Imaging for Early Stages of Gastrointestinal Tumors. Many new technologies ha... more Advanced Endoscopic Imaging for Early Stages of Gastrointestinal Tumors. Many new technologies have contributed to the diagnostic spectrum of endoscopic procedures for the detection and characterization of early gastrointestinal tumors. Among them are improvements of endoscopic optics such as highdefinition or magnification endoscopy as well as chromoendoscopic methods such as conventional dye spraying, or filter-based systems known as narrow-band imaging. New technologies like confocal laser endomicroscopy, endocytoscopy, autofluorescence endoscopy, or optical coherence tomography provide histological characteristics in vivo and are therefore essential amending tools for further diagnostic and therapeutic decisions. This article deals with the most important endoscopic novelties and discusses their utility in the context of documented applications. J Gastroenterol Hepatol Erkr 2012; 10 (1): 26–30.
NOTES 2.0 - How Japan and Chi- na are taking over the (endoscopic) world. About ten years after t... more NOTES 2.0 - How Japan and Chi- na are taking over the (endoscopic) world. About ten years after the first hype, natural or- ifice translumenal endoscopic surgery (NOTES) has become part of endoscopic routine. Trans- mural necrosectomy, for example, is an impor- tant technique among minimal invasive treat- ment options for acute necrotizing pancreatitis. In Japan and China, "peroral endoscopic myoto- my" (POEM), "submucosal tunneling endoscopic resection" (STER) and "full thickness endoscop- ic resection" (FTER) as newer NOTES-methods are standard techniques at high-end endoscop- ic centers meanwhile. The high patient volume due to the big population is an important factor for innovation that helped to develop and refine these techniques. Recently, G-POEM ("G" stands for "gastric") is available for myotomy of the py- lorus in patients with refractory gastroparesis. However, its therapeutic role has not yet been de- fined. Anyway, endo...
Gastroenterology, 2021
BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (... more BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (CP). Endotherapy using multiple plastic stents (MPS) or a fully covered self-expanding metal stent (FCSEMS) are acceptable treatment options for biliary obstructive symptoms in these patients. METHODS Patients with symptomatic CP-associated BBS enrolled in a multicenter randomized noninferiority trial comparing 12-month treatment with MPS versus FCSEMS. Primary outcome was stricture resolution status at 24 months, defined as absence of restenting and 24-month serum alkaline phosphatase not exceeding twice the level at stenting completion. Secondary outcomes included crossover rate, numbers of ERCPs and stents, and stent- or procedure-related serious adverse events (SAEs). RESULTS Eighty-four patients were randomized to MPS and 80 to FCSEMS. Baseline technical success was 97.6% for MPS and 98.6% for FCSEMS. Eleven patients crossed over from MPS to FCSEMS, and 10 from FCSEMS to MPS. For MPS vs. FCSEMS respectively, stricture resolution status at 24 months was 77.1% (54/70) vs. 75.8% (47/62) (P=0.008 for noninferiority ITT analysis), mean number of ERCPs was 3.9±1.3 vs. 2.6±1.3 (P<0.001, ITT), and mean number of stents placed was 7.0±4.4 vs. 1.3±0.6 (P<0.001, as-treated). SAEs occurred in 16 (19.0%) MPS and 19 (23.8%) FCSEMS patients (P=0.568), including cholangitis/fever/jaundice (9 vs. 7 patients respectively), abdominal pain (5 vs. 5), cholecystitis (1 vs. 3) and post-ERCP pancreatitis (0 vs. 2). No stent- or procedure-related deaths occurred. CONCLUSIONS Endotherapy of CP-associated BBS has similar efficacy and safety for 12-month treatment using MPS compared to a single FCSEMS, with FCSEMS requiring fewer ERCPs over 2 years. (ClinicalTrials.gov, Number: NCT01543256).
Digestive Diseases, 2019
Background: The frequency of endoscopically apparent gastrointestinal tract (GI) involvement in p... more Background: The frequency of endoscopically apparent gastrointestinal tract (GI) involvement in patients with mantle cell lymphoma (MCL) at diagnosis is thought to be in the range of 30%. While reports on GI involvement in MCL patients exist, most series lack a strict GI assessment due to the often asymptomatic nature of GI involvement. Owing to the standardized staging routine at our institution including GI assessment at diagnosis, we have analyzed the rate and prognostic impact of GI involvement in MCL. Methods: In this retrospective single-center evaluation, we have investigated GI involvement in 85 consecutive patients with MCL. All data were collected from clinical records. Results: MCL with and without endoscopically detectable GI involvement was reported in 29 (34%) patients and 56 patients (66%), respectively. The colon was involved in 21 (72%) and the stomach in 8 (28%). Eight of 29 patients (28%) had symptomatic GI involvement, and the primary diagnosis had been establish...
Cancer biology & therapy, Jan 4, 2018
Attempts for identifying targeted therapy strategies in metastatic gastric and gastroesopheal jun... more Attempts for identifying targeted therapy strategies in metastatic gastric and gastroesopheal junction cancer (upper-GI) revealed that the inhibition of human epidermal growth factor receptor-2 (HER2) by monoclonal antibody trastuzumab improves survival of these patients. Hence, adding trastuzumab to doublet chemotherapy has become the standard treatment in this setting. Although the patient survival is extended among clinical trials, the knowledge on the real-time setting is limited. With this retrospective, single center analysis of the patient data of the Medical University of Vienna, we sought to investigate the clinical characteristics and outcome of patients, who received trastuzumab-based chemotherapy for metastatic upper-GI tumor. All patients, who received trastzumab at least once were included to the analysis. Clinical and pathological data were recorded. This search revealed 33 patients. The demographic data was comparable with that of the previous clinical trials. Progre...
Zeitschrift für Gastroenterologie, 2016
Background: Cystic fibrosis (CF) patients are at a higher risk of developing digestive tract diso... more Background: Cystic fibrosis (CF) patients are at a higher risk of developing digestive tract disorders, especially gastrointestinal (GI) cancer. However, optimal criteria, timing and screening interval for GI pathology is not yet established in this patient population. Aims/Methods: This prospective study aimed to evaluate the role of gastrointestinal endoscopic workup in transplanted CF patients. Study subjects underwent esophagogastroduodenoscopy and ileocolonoscopy with segmental biopsy assessment for cancer screening, regardless of presence or absence of GI symptoms (group A or group B). The diagnostic yield for clinically relevant findings (defined as those requiring medical intervention or endoscopic surveillance) was compared among groups (Fisher's exact test). Results: 25 CF patients (13 male, 12 female, median age 35 years) were included. All but one had undergone double lung transplantation. GI symptoms were present in 13 patients (group A), above all, abdominal pain (n = 11), 12 patients had no GI related symptoms (group B). The diagnostic yield was 6/13 in patients with GI symptoms (8 pathologies detected) and 7/12 in patients without GI symptoms (10 pathologies detected; 46 vs. 58%, OR 0.61, 95% CI 0.13 – 2.98; P = 0.70). Findings included four cases of non-dysplastic short-segment Barrett's esophagus, three cases of esophageal candidiasis, three cases of atrophic gastritis with intestinal metaplasia, two cases of erosive gastritis, one case of erosive esophagitis, three cases of colonic adenoma (tubulous: n = 2, tubulovillous: n = 1) and one case each of tubular adenoma of the terminal ileum and post-transplant lymphoproliferative disorder. The median Boston Bowel Preparation Scale was 1+2+3 = 6 (9), including four cases with fecaliths trapped in the appendiceal orifice. Conclusion: In this prospective study (pre-)malignant GI lesions were common in lung transplanted CF patients, irrespective of the presence of GI symptoms. These data further support the necessity of GI endoscopic screening in these patients. Prior to colonoscopy 2-days of bowel-cleansing is suggested.
Hematological Oncology, 2017
Digestive Endoscopy, 2017
Objectives Symptomatic cervical heterotopic gastric mucosa also addressed as cervical inlet patch... more Objectives Symptomatic cervical heterotopic gastric mucosa also addressed as cervical inlet patch (CIP) may present in varying shapes and causes symptoms of laryngopharyngeal reflux (LPR) like globus sensations, hoarseness and chronic cough. Unfortunately, argon plasma coagulation, standard treatment of small symptomatic CIP, is limited in large CIP mainly due to concerns of stricture formation. Therefore, we aimed to investigate radiofrequency ablation (RFA), a novel minimalinvasive ablation method, in the treatment of CIP focusing on large symptomatic patches. Methods Consecutive patients with macroscopic and histologic evidence of large (≥ 20mm diameter) heterotopic gastric mucosa were included in this prospective trial. Primary outcome was the complete macroscopic and histologic eradication rate of CIP. Secondary outcome measures were symptom improvement, quality of life, severity of LPR and adverse events.
Journal of pediatric gastroenterology and nutrition, Jan 12, 2016
This Guideline refers to infants, children and adolescents aged 0-18 years. The areas covered inc... more This Guideline refers to infants, children and adolescents aged 0-18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileo-colonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangio-pancreatography and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) has been dealt with in other Guidelines [1-3] and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
Zeitschrift für Gastroenterologie, 2016
Background: Helicobacter pylori (H. pylori) causes a diversity of gastric diseases. Rapid urease ... more Background: Helicobacter pylori (H. pylori) causes a diversity of gastric diseases. Rapid urease tests (RUT) are well established for the point-of-care, invasive diagnosis of H. pylori infection. The study aimed to evaluate the diagnostic performance of a new liquid RUT, the preOx-HUT, within a prospective cohort of treatment-naïve patients. Methods: The multicenter prospective clinical trial was conducted at nine Austrian centers for gastrointestinal endoscopy. Patients referred for a diagnostic upper gastrointestinal endoscopy underwent gastric biopsy sampling for routine histological evaluation, and in parallel, the preOx-HUT. Histology served as reference standard to evaluate the diagnostic performance of the preOx-HUT. Results: From January 2015 to January 2016, a total of 183 consecutive patients (54 males and 129 females, median age 50 years) were included. Endoscopy revealed pathological findings in 149/183 cases (81%), which were mostly gastritis (59%) and gastro-esophageal reflux disease (27%). H. pylori infection was detected by histology in 41/183 (22%) cases. In relation to histology, the preOx-HUT had a sensitivity of 85%, a specificity of 94%, a positive predictive value of 80% and a negative predictive value of 96%. Performance of preOx-HUT was not affected significantly by concomitant PPI-use as present in 15% of cases (P = 0.73). Conclusions: This was the first study evaluating the preOx-HUT in a prospective, multicenter clinical setting. We found a high diagnostic accuracy for the point-of-care, invasive diagnostic test of H. pylori infection. Hence, this test may be a valuable diagnostic adjunct to the clinical presentation of patients with suspected H. pylori infection.