Klinikum Ludwigsburg

Ludwigsburg, Germany

Klinikum Ludwigsburg

Ludwigsburg, Germany
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Meier B.,Klinikum Ludwigsburg | Caca K.,Klinikum Ludwigsburg
Visceral Medicine | Year: 2016

Background: Most patients with cholangiocarcinoma (CCA) have unresectable disease. Endoscopic bile duct drainage is one of the major objectives of palliation of obstructive jaundice. Methods/Results: Stent implantation using endoscopic retrograde cholangiography is considered to be the standard technique. Unilateral versus bilateral stenting is associated with different advantages and disadvantages; however, a standard approach is still not defined. As there are various kinds of stents, there is an ongoing discussion on which stent to use in which situation. Palliation of obstructive jaundice can be augmented through the use of photodynamic therapy (PDT). Studies have shown a prolonged survival for the combinations of PDT and different stent applications as well as combinations of PDT and additional systemic chemotherapy. Conclusion: More well-designed studies are needed to better evaluate and standardize endoscopic treatment of unresectable CCA. © 2016 S. Karger GmbH, Freiburg.

Meier B.,Klinikum Ludwigsburg | Caca K.,Klinikum Ludwigsburg | Schmidt A.,Klinikum Ludwigsburg
Surgical Endoscopy and Other Interventional Techniques | Year: 2017

Background: Clip-assisted endoscopic full-thickness resection (EFTR) with an over-the-scope device has been recently described to be feasible and effective for the resection of non-lifting adenomas in the lower gastrointestinal tract. However, tumor size is the major limitation of that technique. We describe a hybrid technique using endoscopic mucosal resection (EMR) in ten patients with large non-lifting colorectal adenomas to reduce tumor size and facilitate clip-assisted EFTR. Methods: Data of ten consecutive patients (median age 72.5 years, SD 8.86) who underwent combined EMR and EFTR in the colon were analyzed retrospectively. The main outcome measures were technical success, histological confirmation of full-thickness resection, and adverse events. Results: All lesions (median size 35.5 mm, SD 5.99) could be resected successfully. No immediate or delayed adverse events were observed. Histology confirmed full-thickness resection in all cases. Three-month follow-up showed no residual or recurrent adenomas. Conclusions: Hybrid EMR–EFTR in the colon seems to be an effective approach for large non-lifting lesions with positive lateral lifting signs. Prospective studies are needed to further evaluate efficacy, safety, rate of recurrence, and long-term outcome of this technique. © 2017 Springer Science+Business Media New York

Schmidt A.,Klinikum Ludwigsburg | Damm M.,Klinikum Ludwigsburg | Bauder M.,Klinikum Ludwigsburg | Caca K.,Klinikum Ludwigsburg
Endoscopy | Year: 2015

Background and study aims: Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract may be a valuable therapeutic and diagnostic approach for a variety of indications. Although feasibility of EFTR has been demonstrated, there is a lack of safe and effective endoscopic devices for routine use. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR. Patients and methods: Between July 2012 and July 2014, 25 patients underwent EFTR at two tertiary referral centers. All resections were performed using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Data were collected retrospectively. Results: Indications for EFTR were: recurrent or incompletely resected adenoma with nonlifting sign (n=11), untreated adenoma and nonlifting sign (n=2), adenoma involving the appendix (n=5), flat adenoma in a patient with coagulopathy (n=1), diagnostic re-resection after incomplete resection of a T1 carcinoma (n=2), adenoma involving a diverticulum (n=1), submucosal tumor (n=2), and diagnostic resection in a patient with suspected Hirschsprung's disease (n=1). In one patient, the lesion could not be reached because of a sigmoid stenosis. In the other patients, resection of the lesion was macroscopically complete and en bloc in 20/24 patients (83.3%). The mean diameter of the resection specimen was 24mm (range 12-40mm). The R0 resection rate was 75.0% (18/24), and full-thickness resection was histologically confirmed in 87.5%. No perforations or major bleeding were observed during or after resection. Two patients developed postpolypectomy syndrome, which was managed with antibiotic therapy. Conclusions: Full-thickness resection in the lower gastrointestinal tract with the novel FTRD was feasible and effective. Prospective studies are needed to further evaluate the device and technique. © 2015 Georg Thieme Verlag KG Stuttgart.New York.

Ommer A.,End und Dickdarmpraxis Essen | Herold A.,End und Dickdarmzentrum | Berg E.,Prosper Hospital | Furst A.,Caritas Krankenhaus St.Josef | And 2 more authors.
International Journal of Colorectal Disease | Year: 2012

Background The incidence of anal abscess is relatively high, and the condition is most common in young men. Methods A systematic review of the literature was undertaken. Results This abscess usually originates in the proctodeal glands of the intersphincteric space. A distinction is made between subanodermal, intersphincteric, ischioanal, and supralevator abscesses. The patient history and clinical examination are diagnostically sufficient to establish the indication for surgery. Further examinations (endosonography, MRI) should be considered in recurrent abscesses or supralevator abscesses. The timing of the surgical intervention is primarily determined by the patient's symptoms, and acute abscess is generally an indication for emergency treatment. Anal abscesses are treated surgically. The type of access (transrectal or perianal) depends on the abscess location. The goal of surgery is thorough drainage of the focus of infection while preserving the sphincter muscles. The wound should be rinsed regularly (using tap water). The use of local antiseptics is associated with a risk of cytotoxicity. Antibiotic treatment is only necessary in exceptional cases. Intraoperative fistula exploration should be conducted with extreme care if at all; no requirement to detect fistula should be imposed. The risk of abscess recurrence or secondary fistula formation is low overall, but they can result from insufficient drainage. Primary fistulotomy should only be performed in case of superficial fistulas and by experienced surgeons. In case of unclear findings or high fistulas, repair should take place in a second procedure. Conclusion In this clinical S3 guideline, instructions for diagnosis and treatment of anal abscess are described for the first time in Germany. © Springer-Verlag 2011.

Schmidt A.,Klinikum Ludwigsburg | Bauder M.,Klinikum Ludwigsburg | Riecken B.,Klinikum Ludwigsburg | von Renteln D.,Center Hospitalier Of Luniversite Of Montreal Chum | And 2 more authors.
Endoscopy | Year: 2015

BACKGROUND AND STUDY AIMS: Endoscopic full-thickness resection of gastric subepithelial tumors with a full-thickness suturing device has been described as feasible in two small case series. The aim of this study was to evaluate the efficacy, safety, and clinical outcome of this resection technique.PATIENTS AND METHODS: After 31 patients underwent endoscopic full-thickness resection, the data were analyzed retrospectively. Before snare resection, 1 to 3 full-thickness sutures were placed underneath each tumor with a device originally designed for endoscopic anti-reflux therapy.RESULTS: All tumors were resected successfully. Bleeding occurred in 12 patients (38.7 %); endoscopic hemostasis could be achieved in all cases. Perforation occurred in 3 patients (9.6 %), and all perforations could be managed endoscopically. Complete resection was histologically confirmed in 28 of 31 patients (90.3 %). Mean follow-up was 213 days (range, 1 - 1737), and no tumor recurrences were observed.CONCLUSION: Endoscopic full-thickness resection of gastric subepithelial tumors with the suturing technique described above is feasible and effective. After the resection of gastrointestinal stromal tumors (GISTs), we did not observe any recurrences during follow-up, indicating that endoscopic full-thickness resection may be an alternative to surgical resection for selected patients. © Georg Thieme Verlag KG Stuttgart · New York.

Wolpert C.,Klinikum Ludwigsburg | Lubinski A.,Medical University of Lódz | Bissinger A.,Medical University of Lódz | Merkely B.,Semmelweis University | And 2 more authors.
Europace | Year: 2011

Although clinical trial results and the implementation of current guidelines appear to have encouraged progress in the treatment of arrhythmias, great discrepancies still exist between European Society of Cardiology (ESC) member countries. Guidelines are not adhered to for a variety of reasons. This cannot be explained only by economic factors, although these obviously play a substantial role. Other factors responsible for adequate guideline implementation appear to be the lack of trained personnel, the lack of infrastructure, or different health insurance systems. In this complex scenario, the data based on European registries are useful for creating standards and harmonizing the treatment of arrhythmias. Moreover, a summary of registry data, such as presented in the European Heart Rhythm Association (EHRA) White Book, can provide the opportunity to share and exchange information among ESC member countries on specific needs for improvements, reimbursement policy, and training issues. © The Author 2011.

Schmidt A.,Klinikum Ludwigsburg | Meier B.,Klinikum Ludwigsburg | Caca K.,Klinikum Ludwigsburg
World Journal of Gastroenterology | Year: 2015

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices. © The Author(s) 2015.

The author reports his experience with his own case of Miller-Fisher syndrome (MFS) and discusses the spectrum of GQ 1b-positive oculomotor nerve diseases, including MFS, Bickerstaffs brainstem encephalitis, Guillain-Barré syndrome, ophthalmoplegia without ataxia and isolated oculomotor palsies. © Georg Thieme Verlag KG Stuttgart · New York.

Schmidt A.,Klinikum Ludwigsburg | Meier B.,Klinikum Ludwigsburg | Cahyadi O.,Klinikum Ludwigsburg | Caca K.,Klinikum Ludwigsburg
Gastrointestinal Endoscopy | Year: 2015

Background and Aims Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device. Methods Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD). Results Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed. Conclusions EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections. © 2015 American Society for Gastrointestinal Endoscopy.

Schmidt A.,Klinikum Ludwigsburg | Riecken B.,Klinikum Ludwigsburg | Damm M.,Klinikum Ludwigsburg | Cahyadi O.,Klinikum Ludwigsburg | And 2 more authors.
Endoscopy | Year: 2014

Background and study aims: Over-the-scope clips (OTSCs; Ovesco Endoscopy, Tübingen, Germany) are extensively used for treatment of gastrointestinal perforations, leakages, fistulas, and bleeding. In this report, a new method of removing OTSCs using a prototype bipolar cutting device is described. Patients and methods: A total of 11 patients underwent endoscopic removal of an OTSC. The OTSC was cut at two opposing sites by a prototype device (DC ClipCutter; Ovesco Endoscopy). The remaining clip fragments were extracted using a standard forceps. Results: Mean procedure time was 47 minutes (range 35 - 75 minutes). Cutting of the OTSC at two opposing sites was successful in all cases (100%). Complete retrieval of all clip fragments was possible in 10 patients (91%). The overall success rate for cutting and complete removal of the clip was 91%. No major complications were observed. Conclusions: Removal of OTSCs with the prototype device was feasible and effective. The device may be valuable for OTSC removal in emergency as well as elective indications.© Georg Thieme Verlag KG Stuttgart • New York.

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