196 results on '"Stefan Seewald"'
Search Results
2. Perianastomotic Irrigation With Passive Drainage Dramatically Decreases POPF Rate After High-risk Pancreaticoduodenectomy
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Olga Adamenko, Dr., Carlo Ferrari, Dr., Annamaria Porreca, PhD, Stefan Seewald, Prof. Dr. med., Stefan Groth, Dr. med., Jean-Pierre Gutzwiller, PD Dr. med., Hasan Kulaksiz, Prof. Dr. med., and Jan Schmidt, Prof. Dr. med. Dres. h.c. MME
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Surgery ,RD1-811 - Abstract
Objective:. To assess whether prophylactic irrigation and passive drainage of pancreatico-jejunal anastomosis could reduce leak and mortality rates after high-risk pancreaticoduodenectomies. Background:. Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreaticoduodenectomy. Several risk factors have been proposed likewise potential mitigation strategies. Regarding the latter, surgical drain policy remains a “hot topic.” We propose an innovative approach to mitigate POPF and POPF-related mortality following high-risk pancreaticoduodenectomies. Methods:. One hundred fifty-seven patients undergoing pancreaticoduodenectomy between January 2012 and November 2021 were included in the study. Subjects with main pancreatic duct ≤ 3 mm and soft parenchyma were classified as high-risk for POPF development. Since August 2015, high-risk patients received prophylactic irrigation and drainage of the perianastomotic area. These patients were compared with risk-matched historical controls. Results:. We identified 73 high-risk patients. Of these, the 47 subjects receiving prophylactic perianastomotic irrigation showed significantly lower POPF rates (12.7% vs 69.2%, P < 0.001). Multivariate regression analysis confirmed the significant association between irrigation drainages and POPF (odds ratio 0.014, P = 0.01). Although not significant, mortality was lower in the irrigation group (4.2% vs 13.0%, P = 0.340). However, none of the fatalities in the irrigation-drainage group were POPF-related. No significant difference in length of hospital stay was observed between the 2 groups (18.0 vs 21.0 days, P = 0.091). Conclusions:. Irrigation and drainage of the perianastomotic area represents a powerful approach to reduce POPF and, potentially, mortality after high-risk pancreaticoduodenectomies.
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- 2022
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3. Durability of per-oral endoscopic myotomy beyond 6 years
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Jad P. AbiMansour, Yervant Ichkhanian, Hitomi Minami, Pietro Familiari, Rosario Landi, Guido Costamagna, Stefan Seewald, Zachary M. Callahan, Michael B. Ujiki, Mathieu Pioche, Thierry Ponchon, Sabine Roman, Joo Young Cho, In Kyung Yoo, Megan Sippey, Jeffrey M. Marks, Nikolas Eleftheriadis, Vivek Khumbari, Olaya I. Brewer Gutierrez, and Mouen A. Khashab
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia. Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated. Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years (P
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- 2021
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4. Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience
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Kaveh Hajifathalian, Yervant Ichkhanian, Qais Dawod, Alexander Meining, Arthur Schmidt, Nicholas Glaser, Kia Vosoughi, David L. Diehl, Ian S. Grimm, Theodore James, Adam W. Templeton, Jason B. Samarasena, Nabil El Hage Chehade, John G. Lee, Kenneth J. Chang, Meir Mizrahi, Mohammed Barawi, Shayan Irani, Shai Friedland, Paul Korc, Abdul Aziz Aadam, Mohammad Al-Haddad, Thomas E. Kowalski, George Smallfield, Gregory G. Ginsberg, Norio Fukami, Michael Lajin, Nikhil A. Kumta, Shou-jiang Tang, Yehia Naga, Stuart K. Amateau, Franklin Kasmin, Martin Goetz, Stefan Seewald, Vivek Kumbhari, Saowanee Ngamruengphong, Srihari Mahdev, Saurabh Mukewar, Kartik Sampath, David L. Carr-Locke, Mouen A. Khashab, and Reem Z. Sharaiha
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68–138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.
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- 2020
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5. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study
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Olaya I. Brewer Gutierrez, Robert A. Moran, Pietro Familiari, Mohamad H. Dbouk, Guido Costamagna, Yervant Ichkhanian, Stefan Seewald, Amol Bapaye, Joo Young Cho, Maximilien Barret, Nikolas Eleftheriadis, Mathieu Pioche, Bu' Hussain Hayee, Marcel Tantau, Michael Ujiki, Rosario Landi, Martina Invernizzi, In Kyung Yoo, Sabine Roman, Amyn Haji, H. Mason Hedberg, Nasim Parsa, Francois Mion, Lea Fayad, Vivek Kumbhari, Anant Agarwalla, Saowanee Ngamruengphong, Omid Sanaei, Thierry Ponchon, and Mouen A. Khashab
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.
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- 2020
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6. Towards a robust and compact deep learning system for primary detection of early Barrett’s neoplasia: Initial image‐based results of training on a multi‐center retrospectively collected data set
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Kiki N. Fockens, Jelmer B. Jukema, Tim Boers, Martijn R. Jong, Joost A. van der Putten, Roos E. Pouw, Bas L. A. M. Weusten, Lorenza Alvarez Herrero, Martin H. M. G. Houben, Wouter B. Nagengast, Jessie Westerhof, Alaa Alkhalaf, Rosalie Mallant, Krish Ragunath, Stefan Seewald, Peter Elbe, Maximilien Barret, Jacobo Ortiz Fernández‐Sordo, Oliver Pech, Torsten Beyna, Fons van der Sommen, Peter H. de With, A. Jeroen de Groof, Jacques J. Bergman, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism
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Oncology ,Gastroenterology - Abstract
Introduction: Endoscopic detection of early neoplasia in Barrett's esophagus is difficult. Computer Aided Detection (CADe) systems may assist in neoplasia detection. The aim of this study was to report the first steps in the development of a CADe system for Barrett's neoplasia and to evaluate its performance when compared with endoscopists. Methods: This CADe system was developed by a consortium, consisting of the Amsterdam University Medical Center, Eindhoven University of Technology, and 15 international hospitals. After pretraining, the system was trained and validated using 1.713 neoplastic (564 patients) and 2.707 non-dysplastic Barrett's esophagus (NDBE; 665 patients) images. Neoplastic lesions were delineated by 14 experts. The performance of the CADe system was tested on three independent test sets. Test set 1 (50 neoplastic and 150 NDBE images) contained subtle neoplastic lesions representing challenging cases and was benchmarked by 52 general endoscopists. Test set 2 (50 neoplastic and 50 NDBE images) contained a heterogeneous case-mix of neoplastic lesions, representing distribution in clinical practice. Test set 3 (50 neoplastic and 150 NDBE images) contained prospectively collected imagery. The main outcome was correct classification of the images in terms of sensitivity. Results: The sensitivity of the CADe system on test set 1 was 84%. For general endoscopists, sensitivity was 63%, corresponding to a neoplasia miss-rate of one-third of neoplastic lesions and a potential relative increase in neoplasia detection of 33% for CADe-assisted detection. The sensitivity of the CADe system on test sets 2 and 3 was 100% and 88%, respectively. The specificity of the CADe system varied for the three test sets between 64% and 66%. Conclusion: This study describes the first steps towards the establishment of an unprecedented data infrastructure for using machine learning to improve the endoscopic detection of Barrett's neoplasia. The CADe system detected neoplasia reliably and outperformed a large group of endoscopists in terms of sensitivity.
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- 2023
7. Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrettʼs esophagus: a multicenter randomized study
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Philippe Leclercq, Sanne N. van Munster, Rehan Haidry, Helmut Messmann, Andreas Probst, Krish Ragunath, Pradeep Bhandari, Alessandro Repici, Miguel Munoz-Navas, Stefan Seewald, Arnaud Lemmers, Glòria Fernández-Esparrach, Oliver Pech, Erik J. Schoon, Revital Kariv, Horst Neuhaus, Bas L. A. M. Weusten, Peter D. Siersema, Loredana Correale, Sybren L. Meijer, Gert de Hertogh, Jacques J.G.H.M. Bergman, Cesare Hassan, Raf Bisschops, Interne Geneeskunde, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
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Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,All institutes and research themes of the Radboud University Medical Center ,Surveillance ,Gastroenterology - Abstract
Background Current surveillance for Barrett’s esophagus (BE), consisting of four-quadrant random forceps biopsies (FBs), has an inherent risk of sampling error. Wide-area transepithelial sampling (WATS) may increase detection of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). In this multicenter randomized trial, we aimed to evaluate WATS as a substitute for FB. Methods Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice versa. All WATS samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Diagnostics laboratory. Similarly, all FBs were examined by two expert pathologists. The primary end point was concordance/discordance for detection of HGD/EAC between the two techniques. Results 172 patients were included, of whom 21 had HGD/EAC detected by both modalities, 18 had HGD/EAC detected by WATS but missed by FB, and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (P = 0.36). Using WATS as an adjunct to FB significantly increased the detection of HGD/EAC vs. FB alone (absolute increase 10 % [95 %CI 6 % to 16 %]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95 %CI 5.9 to 7.1), 4.9 (95 %CI 4.1 to 5.4), and 11.2 (95 %CI 10.5 to 14.0), respectively. Conclusions Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for the detection of HGD/EAC as single modality.
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- 2022
8. Dysplastic Recurrence After Successful Treatment for Early Barrett's Neoplasia
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Sanne N. van Munster, Esther Nieuwenhuis, Raf Bisschops, Hilde Willekens, Bas L.A. M. Weusten, Lorenza Alvarez Herrero, Auke Bogte, Alaa Alkhalaf, Ed B.E. Schenk, Erik J. Schoon, Wouter Curvers, Arjun D. Koch, Pieter Jan F. de Jonge, Tjon J. Tang, Wouter B. Nagengast, Jessie Westerhof, Martin H.M.G. Houben, Stefan Seewald, Martinus J.C. Eijkemans, Jacques J.G.H.M. Bergman, Roos E. Pouw, Gastroenterology & Hepatology, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Interne Geneeskunde, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, Graduate School, and CCA - Cancer Treatment and Quality of Life
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Male ,Radiofrequency Ablation ,Hyperplasia ,Esophageal Neoplasms ,Hepatology ,Incidence ,Gastroenterology ,Endoscopic Eradication Therapy ,Barrett's Esophagus ,Barrett Esophagus ,SDG 3 - Good Health and Well-being ,Catheter Ablation ,Gastroesophageal Reflux ,ESOPHAGUS ,Humans ,Esophagoscopy ,Esophageal Adenocarcinoma - Abstract
BACKGROUND & AIMS: The combination of endoscopic resection and radiofrequency ablation is the treatment of choice for eradication of Barrett's esophagus (BE) with dysplasia and/or early cancer. Currently, there are no evidence-based recommendations on how to survey patients after successful treatment, and most patients undergo frequent follow-up endoscopies. We aimed to develop and externally validate a prediction model for visible dysplastic recurrence, which can be used to personalize surveillance after treatment. METHODS: We collected data from the Dutch Barrett Expert Center Registry, a nationwide registry that captures outcomes from all patients with BE undergoing endoscopic treatment in the Netherlands in a centralized care setting. We used predictors related to demographics, severity of reflux, histologic status at baseline, and treatment characteristics. We built a Fine and Gray survival model with least absolute shrinkage and selection operator penalization to predict the incidence of visible dysplastic recurrence after initial successful treatment. The model was validated externally in patients with BE treated in Switzerland and Belgium. RESULTS: A total of 1154 patients with complete BE eradication were included for model building. During a mean endoscopic follow-up of 4 years, 38 patients developed recurrent disease (1.0%/person-year). The following characteristics were independently associated with recurrence (strongest to weakest predictor): a new visible lesion during treatment phase, higher number of endoscopic resection treatments, male sex, increasing BE length, high-grade dysplasia or cancer at baseline, and younger age. External validation showed a C-statistic of 0.91 (95% confidence interval, 0.86-0.94) with good calibration. CONCLUSIONS: This is the first externally validated model to predict visible dysplastic recurrence after successful endoscopic eradication treatment of BE with dysplasia or early cancer. On external validation, our model has good discrimination and calibration. This model can help clinicians and patients to determine a personalized follow-up strategy. ispartof: GASTROENTEROLOGY vol:163 issue:1 pages:285-294 ispartof: location:United States status: published
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- 2022
9. Predictors of Long-term Outcomes of Endoscopic Submucosal Dissection of Early Gastric Neoplasia in the West: A Multicentre Study
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Pradeep Bhandari, Mohamed Abdelrahim, Asma Alkandari, Piera Alessia Galtieri, Marco Spadaccini, Stefan Groth, Nastazja Pilonis, Sharmila Subramaniam, Kesavan Kandiah, Ejaz Hossain, Sophie Arndtz, Paul Bassett, Katie Siggens, Hein Htet, Roberta Maselli, Michal F. Kaminski, Stefan Seewald, and Alessandro Repici
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Gastroenterology - Abstract
Introduction In this study, we review long-term outcomes of gastric endoscopic submucosal dissection [ESD] in western setting in light of the latest Japanese indication criteria, and examine predictors of outcomes and complications. Methods Data was collected on consecutive patients referred for gastric ESD in four participating centres from 2009 to 2021. Retrospective analysis of data with logistic regression and survival analysis was performed. Results A total of 415 patients were included. Mean age was 71.7 years, 56.4% were males. Absolute indication criteria [2018 guidelines] were fulfilled in 75.3% of patients. Median follow-up was 52 months. Post-resection histology was adenocarcinoma, HGD and LGD in 49.9%, 22.7% and 17.1% respectively. Perforation, early bleeding and delayed bleeding occurred in 2.4%, 4.3% and 3.4% respectively. En-bloc, R0 and recurrence on first endoscopic follow-up were 94.7%, 83.4% and 2.7% respectively. Relative indication [2018 Guidelines] for ESD was associated with R1 outcome [P-value 0.002]. Distal location [P-value 0.002] and increased procedure time [P-value 0.04] were significantly associated with bleeding risk, whereas scarring [P-value 0.009] and increased procedure duration [P-value 0.003] were associated with perforation. Recurrence-free survival at 2 years and 5 years was 94% and 83% respectively. Conclusion This is the largest multicenter western cohort suggesting gastric ESD is safe and effective in the western setting. A quarter of our patients fell outside of the new absolute indications for ESD, suggesting that western practice involves more advanced lesions. We identified the predictors of adverse outcomes in western practice. This should inform future practice and research.
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- 2023
10. Endoscopic Submucosal Dissection (ESD) Offers a Safer and More Cost-effective Alternative to Transanal Endoscopic Microsurgery (TEM)
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Marina, Kim, Romy, Bareket, Nikolas P, Eleftheriadis, Prashant, Kedia, Stefan, Seewald, Stefan, Groth, Jose, Nieto, Nikhil A, Kumta, Ameya A, Deshmukh, Jordan, Katz, Supriya, Suresh, Felipe, Zamarripa, Ma Guadalupe, Martínez, Jennifer, Liu-Burdowski, Monica, Gaidhane, Avik, Sarkar, Haroon M, Shahid, Amy, Tyberg, and Michel, Kahaleh
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Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that treat early rectal cancer (ERC). Both are effective treatments, yet there are very few studies comparing them. The aim of our study was to identify ideal candidates for each procedure.Between January 2016 and November 2019, 204 ERC patients were managed with either ESD (n=101) or TEM (n=103) at 7 international centers. Data analyzed included clinical success, tumor characteristics, procedure info, and recurrence rates.Median tumor size was 40 mm±23.9 in the ESD group and 56 mm±27.9 in the TEM group, significantly larger in the latter (P0.00001). Average procedure time was 131.5±67.9 minutes in ESD group and 104.9±28.4 minutes in TEM group (P=0.000347). Average hospital stay was 3.3±2.6 days in the ESD group and 4.7±0.7 days in the TEM group (P0.00001). Adverse event rate was 6.8% in the ESD group and 24% in the TEM group. There were no significant difference in the rate of en bloc resection, technical success, tumor location, necessity of additional procedures, and tumor recurrence rates.Compared with TEM, ESD is a safer procedure with shorter hospital stay and should be offered for patients who have ERC.
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- 2022
11. Endoscopic Vacuum Therapy for Esophageal Perforation
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Lisanne M. D. Pattynama, Joanna Luttikhold, Stefan Seewald, Stefan Groth, Bernhard K. Morell, Christian A. Gutschow, Satoshi Ida, Magnus Nilsson, Wietse J. Eshuis, Roos E. Pouw, Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, and CCA - Imaging and biomarkers
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Gastroenterology - Abstract
Background Endoscopic vacuum therapy (EVT) is a novel treatment for esophageal perforations. This study aimed to describe initial experience with EVT of esophageal perforations due to iatrogenic cause, Boerhaave syndrome, or other perforations not related to prior upper gastrointestinal surgery. Methods Data from patients treated with EVT for esophageal perforation at five hospitals in three European countries, between January 2018 and October 2021, were retrospectively collected. The primary end point was successful defect closure by EVT, with or without the use of other endoscopic treatment modalities. Secondary end points included mortality and adverse events. Results 27 patients were included (median age 71 years). The success rate was 89 % (24/27, 95 %CI 77–100). EVT failed in three patients: two deceased during EVT (septic embolic stroke, pulmonary embolism) and one underwent esophagectomy due to a persisting defect. Two adverse events occurred: one iatrogenic defect expansion during sponge exchange and one hemorrhage during sponge removal. Median treatment duration was 12 days (interquartile range [IQR] 6–16) with 1 sponge exchange (IQR 1–3). Conclusion EVT is a promising organ-preserving treatment for esophageal perforations, with a success rate of 89 %. More experience with the technique and indications will likely improve success rates.
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- 2023
12. Durability of per-oral endoscopic myotomy beyond 6 years
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Zachary M. Callahan, Sabine Roman, In Kyung Yoo, Yervant Ichkhanian, Nikolas Eleftheriadis, Rosario Landi, Pietro Familiari, Olaya I. Brewer Gutierrez, Stefan Seewald, Joo Young Cho, Vivek Khumbari, Megan Sippey, Mouen A. Khashab, Michael B. Ujiki, Thierry Ponchon, Jeffrey M. Marks, Hitomi Minami, Guido Costamagna, Mathieu Pioche, and Jad P. AbiMansour
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Myotomy ,medicine.medical_specialty ,Original article ,business.industry ,Settore MED/18 - CHIRURGIA GENERALE ,Incidence (epidemiology) ,medicine.medical_treatment ,Per-oral endoscopic myotomy ,Reflux ,Achalasia ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Tertiary care ,Surgery ,N/A ,Cohort ,medicine ,Pharmacology (medical) ,In patient ,business - Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia. Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated. Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years (P Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastroesophageal reflux post-procedure which persist at long-term follow-up.
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- 2021
13. 393. ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ESOPHAGEAL PERFORATION: A MULTI-CENTER RETROSPECTIVE COHORT STUDY
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Joanna Luttikhold, Lisanne MD Pattynama, Stefan Seewald, Stefan Groth, Bernhard Morell, Satoshi Ida, Magnus Nilsson, Wietse J Eshuis, and Roos E Pouw
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Gastroenterology ,General Medicine - Abstract
Esophageal perforations are associated with high morbidity. Recently, endoscopic vacuum therapy (EVT) has been introduced as a novel treatment option for esophageal perforations. This technique has so far mainly been described for anastomotic leakage after upper gastrointestinal surgery. The aim of this study was to describe the initial experiences with EVT for treatment of esophageal perforations caused by Boerhaave syndrome or with an iatrogenic cause. For this retrospective, multicenter cohort study, all patients primarily treated with EVT for an esophageal perforation at four hospitals in the Netherlands, Switzerland and Sweden between January 2018 and October 2021, were included. Data on patient characteristics, EVT and outcomes were analyzed. The primary endpoint was success rate of EVT, defined as closure of the defect, as assessed by endoscopy or CT-scan. 27 patients were included (Table 1). EVT succeeded in 24/27 patients (89%, 95%CI[71,98]) with 16/19 using EVT alone (84%, 95%CI[60,97]). In 8 patients an additional treatment modality was used. In 3 patients EVT failed: 2 (Boerhaave and unknown cause) deceased due to a pulmonary embolism and septic embolic stroke, and 1 (Boerhaave) underwent an additional esophagectomy. All had a ‘large’ perforation-size. Median hospital stay was 18 days, with median 12 days EVT-duration and 1 sponge-exchange. Additional drainage was performed in 8 patients. EVT-associated complications occurred in 3 patients: 1 iatrogenic defect-expansion from the overtube and 2 hemorrhages, which spontaneously stopped. EVT is a promising, possibly organ-preserving treatment for Boerhaave syndrome or iatrogenic esophageal perforation, with a success rate of 84–89%. More experience with the technique and indications for use will likely improve success rates in the future.
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- 2022
14. A robust and compact deep learning system for primary detection of early Barrett's neoplasia outperforms general endoscopists
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Kiki Fockens, Jelmer Jukema, Martijn Jong, Tim G. Boers, Joost Van Der Putten, Roos E. Pouw, Bas L. Weusten, Martin H. Houben, Wouter B. Nagengast, Jessie Westerhof, L. Alvarez Herrero, A. Alkhalaf, Krish Ragunath, Maximilien Barret, Jacobo Ortiz-Fernandez-Sordo, Oliver Pech, Torsten Beyna, Stefan Seewald, Fons Van Der Sommen, P.H.N. De With, Jeroen De Groof, Jacques Bergman, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
15. O1 Efficacy and safety of endoscopic submucosal dissection of early gastric neoplasia in the West: a multicentre prospective european study
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Mohamed Abdelrahim, Asma A Alkandari, Piera Alessia Galtieri, Marco Spadaccini, Stefan Groth, Nastazja D Pilonis, Sharmila Subhramaniam, Kesavan Kandiah, Ejaz Hossain, Martina Invernizzi, Michal F Kaminski, Stefan Seewald, Roberta Maselli, Alessandro Repici, and Pradeep Bhandari
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- 2022
16. The 'Cold Revolution' - cold snare resection of sessile colorectal polyps
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Stefan, Seewald and Tiing Leong, Ang
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Intestinal Polyposis ,Colonic Polyps ,Humans ,Intestinal Polyps ,Colonoscopy ,Colorectal Neoplasms - Published
- 2022
17. Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review
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Olga Adamenko, Carlo Ferrari, Stefan Seewald, and Jan Schmidt
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Case-Control Studies ,Anastomosis, Surgical ,Humans ,Surgery ,Anastomotic Leak ,Digestive System Surgical Procedures ,Negative-Pressure Wound Therapy ,Retrospective Studies - Abstract
In the last decade, endoluminal vacuum therapy (eVAC) has emerged as an effective treatment for anastomotic leak (AL); however, little is known regarding its prophylactic use. In this systematic review we evaluated overall outcomes in patients undergoing major gastrointestinal surgery and treated with prophylactic eVAC. A systematic review of English articles on four electronic databases was performed according to the PRISMA statement up until January 2022. References of selected articles were manually screened to identify relevant missing papers. Primary endpoints were AL and mortality rates estimates. Secondary endpoints included analysis of eVAC-associated morbidity, treatment duration, long-term complications, and general indications for the eVAC management in the perioperative period. A total of 11 studies (5 case reports, 5 retrospective case series and a retrospective, case-control study) were included in the analysis. AL ranged from 0 to 25%. No major eVAC-associated complications were observed, except for sponge dislocation or obstruction. Overall mortality ranged between 0 and 12.5%; however, these fatalities were neither related to the use of eVAC, nor to AL-associated complications. The most frequent long-term complication was anastomotic stenosis responsive to endoscopic dilatation in most cases. The operating negative pressure ranged from -25 to -125 mmHg among different papers. In all studies but two, prophylactic eVAC was applied to anastomoses at high risk of dehiscence based on the subjective evaluation of the leading surgeon. In conclusion, prophylactic eVAC is safe and it could lead to potential benefit for prevention of AL, especially in high-risk anastomoses.
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- 2022
18. Wide Area Transepithelial Sample Esophageal Biopsy Combined with Computer Assisted 3-Dimensional Tissue Analysis (Wats3d) for the Detection of Flat High Grade Dysplasia and Adenocarcinoma in Barrett: A Multi-Center, Prospective, Randomized, Tandem Study
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Sanne van Munster, Ph. Leclercq, Rehan Haidry, H. Messmann, A Probst, K Ragunath, P. Bhandari, A. Repici, M. Munoz-Navas, Stefan Seewald, A. Lemmers, G. Fernández-Esparrach, O. Pech, Erik Schoon, R. Kariv, H. Neuhaus, B. Weusten, P.D. Siersema, L. Correale, S.L. Meijer, G. De Hertogh, Jacques Bergman, Hassan Cesare, and Raf Bisschops
- Published
- 2022
19. Risk factors for serious adverse events associated with multiband mucosectomy in Barrett's esophagus: an international multicenter analysis of 3827 endoscopic resection procedures
- Author
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Martin Everson, Stefan Seewald, Massimiliano di Pietro, Gregory G. Ginsberg, Rehan Haidry, Farzan F. Bahin, Michael B. Wallace, Nahid Mostafavi, Jacques J. Bergman, Kamar Belghazi, Raf Bisschops, Lady Katherine Mejia Perez, Pujan Kandel, Krish Ragunath, Norman E. Marcon, Gene K. Ma, Erik J. Schoon, Jacobo Ortiz-Fernández-Sordo, Christopher W. Teshima, Roos E. Pouw, Arjun D. Koch, Kenneth K. Wang, Bas L. Weusten, Michael J. Bourke, Reza V. Milano, Gastroenterology and hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Gastroenterology & Hepatology
- Subjects
Male ,medicine.medical_specialty ,Canada ,multiband mucosectomy ,Esophageal Neoplasms ,Perforation (oil well) ,03 medical and health sciences ,Barrett Esophagus ,0302 clinical medicine ,endoscopic resection ,Interquartile range ,Risk Factors ,medicine ,Humans ,Barrett’s esophagus ,perforation ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Risk factor ,Adverse effect ,Aged ,Retrospective Studies ,business.industry ,Gastroenterology ,Australia ,Odds ratio ,medicine.disease ,bleeding ,Confidence interval ,Surgery ,Europe ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Barrett's esophagus ,030211 gastroenterology & hepatology ,Female ,Esophagoscopy ,business - Abstract
BACKGROUND AND AIMS: Multiband mucosectomy (MBM) is a widely used technique for the treatment of Barrett's esophagus (BE). However, large multicenter studies enabling a generalizable estimation of the risk of serious adverse events, such as perforation and postprocedural bleeding, are lacking. The aim of this study was to estimate the rate of, and risk factors for, serious adverse events associated with MBM. METHODS: In this retrospective analysis, consecutive patients who underwent MBM for treatment of BE in 14 tertiary referral centers in Europe, the United States, Canada, and Australia were included. Primary outcomes were perforation and postprocedural bleeding rate. Potential risk factors were identified by logistic regression. RESULTS: Between 2001 and 2016, a total of 3827 MBM procedures were performed in 2447 patients (84% male, mean age 66 years, median BE length C2M4). Perforation occurred in 17 procedures (0.4%; 95% confidence interval [CI], 0.3-0.7), of which 15 could be treated endoscopically or conservatively. Female gender was an independent risk factor for perforation (odds ratio [OR], 2.77; 95% CI, 1.02-7.57; P = .05). Postprocedural bleeding occurred after 35 procedures (0.9%; 95% CI, 0.6-1.3). The number of resections (OR, 1.15; 95% CI, 1.06-1.25; P < .001) was significantly associated with postprocedural bleeding. CONCLUSION: The results of this study show that MBM for BE is safe with a low risk of serious adverse events. In addition, most of the adverse events could be managed endoscopically or conservatively. The number of resections was an independent risk factor for postprocedural bleeding. ispartof: GASTROINTESTINAL ENDOSCOPY vol:92 issue:2 pages:259-+ ispartof: location:United States status: published
- Published
- 2020
20. ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ESOPHAGEAL PERFORATION: A MULTI- CENTER RETROSPECTIVE COHORT STUDY
- Author
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Joanna Luttikhold, Lisanne M. Pattynama, Stefan Seewald, Stefan Groth, Bernhard Morell, Wietse J. Eshuis, and Roos E. Pouw
- Subjects
Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
21. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) guideline
- Author
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Pierre Henri Deprez, Lumir Kunovsky, Enrique Pérez-Cuadrado-Robles, Alan C. Moss, Manu Nayar, Marianna Arvanitakis, Stefan Seewald, Bertrand Napoleon, Gianpiero Manes, Urban Arnelo, Olivier R. Busch, Marin Strijker, Marc Barthet, Jeanin E. van Hooft, Geoffroy Vanbiervliet, Torsten Beyna, Kumanan Nalankilli, Alberto Larghi, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, and UCL - (SLuc) Service de gastro-entérologie
- Subjects
medicine.medical_specialty ,Endoscope ,medicine.medical_treatment ,Perforation (oil well) ,Colonoscopy ,Colonic Polyps ,Endoscopic mucosal resection ,Guidelines as Topic ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,Duodenal Neoplasms ,Medicine ,Humans ,Duodenal Neoplasm ,medicine.diagnostic_test ,business.industry ,General surgery ,Gastroenterology ,Polypectomy ,3. Good health ,Endoscopy ,Major duodenal papilla ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business - Abstract
Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.
- Published
- 2021
22. Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience
- Author
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Manabu Onimaru, Hitomi Minami, Hironari Shiwaku, Shinwa Tanaka, Norio Fukami, Robert H. Hawes, Yasutoshi Kobayashi, Guido Costamagna, Haruhiro Inoue, Philip Wai Yan Chiu, Esperanza Grace Santi, Stefan Seewald, Yuto Shimamura, Horst Neuhaus, Stavros N. Stavropoulos, Hisao Tajiri, and Kevin L Grimes
- Subjects
Natural Orifice Endoscopic Surgery ,Myotomy ,medicine.medical_specialty ,Consensus ,Delphi Technique ,medicine.medical_treatment ,Modified delphi ,Achalasia ,Review Article ,Disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Endoscopy, Digestive System ,Tokyo ,Curative effect ,business.industry ,Standard treatment ,General surgery ,Gastroenterology ,Reflux ,GERD ,medicine.disease ,humanities ,digestive system diseases ,Esophageal Achalasia ,030220 oncology & carcinogenesis ,Gastroesophageal Reflux ,030211 gastroenterology & hepatology ,business - Abstract
It has been 10 years since peroral endoscopic myotomy (POEM) was reported for the first time, and POEM has currently become the standard treatment for achalasia and related disorders globally because it is less invasive and has a higher curative effect than conventional therapeutic methods. However, there are limited studies comparing the long-term outcomes of POEM with those of conventional therapeutic methods, particularly in the occurrence of gastroesophageal reflux disease (GERD) after therapy. With this background, we held a consensus meeting to discuss the pathophysiology and management of GERD after POEM based on published papers and experiences of each expert and to discuss the prevention of GERD and dealing with anti-acid drug refractory GERD. This meeting was held on April 27, 2018 in Tokyo to establish statements and finalize the recommendations using the modified Delphi method. This manuscript presents eight statements regarding GERD after POEM.
- Published
- 2019
23. Endoskopische Prävention von Darmkrebs – Detektion, Therapie und Kontrollintervalle
- Author
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Stefan Groth and Stefan Seewald
- Subjects
medicine.medical_specialty ,Adenoma ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Colonoscopy ,Endoscopic mucosal resection ,General Medicine ,Endoscopic submucosal dissection ,Gold standard (test) ,medicine.disease ,Intestinal mucosa ,Bowel preparation ,Medicine ,Radiology ,business - Abstract
Endoscopic prevention of colorectal cancer - detection, therapy and control intervals Abstract. Colonoscopy is the gold standard for the diagnosis of adenomas and early cancers in the colon. The procedure should be done according to defined standards and quality guidelines. The most important quality parameters are adenoma detection rate, withdrawal time and bowel preparation. Much of the technical developments of the recent years, such as attachment hoods, wide-angle optics and special filters aim to improve the detection rate. Techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and full-thickness resection help to safely and curatively remove adenomas and early cancers. The surveillance intervals depend on the findings and the familiar history and are determined by the gastroenterological societies.
- Published
- 2018
24. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
- Author
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Marc Barthet, Jeanin E. van Hooft, Bertrand Napoleon, Marianna Arvanitakis, Marin Strijker, Urban Arnelo, Enrique Pérez-Cuadrado-Robles, Gianpiero Manes, Pierre Henri Deprez, Alan C. Moss, Stefan Seewald, Arthur S. Aelvoet, Manu Nayar, Torsten Beyna, Olivier R. Busch, Geoffroy Vanbiervliet, Alberto Larghi, Lumir Kunovsky, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, and UCL - (SLuc) Service de gastro-entérologie
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Ampulla of Vater ,Adenoma ,Common Bile Duct Neoplasms ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,Duodenal Neoplasms ,medicine ,Humans ,Duodenoscopy ,Pancreatic duct ,Magnetic resonance cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Ampullectomy ,General surgery ,Gastroenterology ,Pancreatic Ducts ,Guideline ,medicine.disease ,3. Good health ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business - Abstract
Main Recommendations1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence.2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence.3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence.4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence.5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence.6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence.7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence.8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.
- Published
- 2021
25. Dysplastic Recurrence after Successful Treatment For Early Barrett's Neoplasia: Development and Validation of a Penalized Prediction Model
- Author
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Sanne van Munster, Esther Nieuwenhuis, Raf Bisschops, Hilde Willekens, Bas Weusten, Lorenza Alvarez Herrero, Auke Bogte, Alaa Alkhalaf, Ed Schenk, Erik Schoon, Wouter Curvers, Arjun Koch, Pieter-Jan de Jonge, Thjon Tang, Wouter Nagengast, Jessie Westerhof, Martin Houben, Stefan Seewald, Rene Eijkemans, Jacques Bergman, and Roos Pouw
- Published
- 2021
26. P227 A European comparison of barrett’s versus squamous oesophageal resections: is stricture risk related to pathology?
- Author
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Stefan Seewald, Asma Alkandari, Sharmila Subramaniam, Pradeep Bhandari, Sophie Arndtz, Piera Alessia Galtieri, Mohamed Abdelrahim, Alessandro Repici, Ejaz Hossain, Roberta Maselli, and Gaia Pellegatta
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,business - Published
- 2021
27. Endoscopic prediction of submucosal invasion in Barrett's cancer with the use of artificial intelligence: a pilot study
- Author
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Prateek Sharma, David Rauber, Pierre Henri Deprez, Christoph Palm, Tobias Rückert, Helmut Messmann, Akiko Takahashi, Tsuneo Oyama, Stefan Seewald, Ingo Steinbrück, João Paulo Papa, Luis Antonio De Souza, Johannes Manzeneder, Laurin Schuster, Siegbert Faiss, Robert Mendel, Andreas Probst, Alanna Ebigbo, Michael F. Byrne, Friederike Prinz, Matthias Mende, Univ Klinikum Augsburg, Ostbayer TH Regensburg OTH Regensburg, OTH Regensburg, Sana Klinikum Lichtenberg, Asklepios Klin Barmbek, Regensburg Univ, Universidade Estadual Paulista (Unesp), Catholic Univ Louvain, Saku Cent Hosp Adv Care Ctr, Klin Hirslanden, Vet Affairs Med Ctr, Univ Kansas, Univ British Columbia, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, and UCL - (SLuc) Service de gastro-entérologie
- Subjects
Esophageal Neoplasms ,business.industry ,Deep learning ,Significant difference ,Gastroenterology ,Cancer ,Video sequence ,Pilot Projects ,Adenocarcinoma ,medicine.disease ,Tertiary care ,03 medical and health sciences ,Barrett Esophagus ,0302 clinical medicine ,Artificial Intelligence ,030220 oncology & carcinogenesis ,medicine ,Humans ,030211 gastroenterology & hepatology ,Artificial intelligence ,Esophagoscopy ,F1 score ,business ,Retrospective Studies - Abstract
Made available in DSpace on 2021-06-26T02:53:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-11-16 Bavarian Academic Forum (BayWISS) Background The accurate differentiation between T1a and T1b Barrett's-related cancer has both therapeutic and prognostic implications but is challenging even for experienced physicians. We trained an artificial intelligence (AI) system on the basis of deep artificial neural networks (deep learning) to differentiate between T1a and T1b Barrett's cancer on white-light images. Methods Endoscopic images from three tertiary care centers in Germany were collected retrospectively. A deep learning system was trained and tested using the principles of cross validation. A total of 230 white-light endoscopic images (108 T1a and 122 T1b) were evaluated using the AI system. For comparison, the images were also classified by experts specialized in endoscopic diagnosis and treatment of Barrett's cancer. Results The sensitivity, specificity, F1 score, and accuracy of the AI system in the differentiation between T1a and T1b cancer lesions was 0.77, 0.64, 0.74, and 0.71, respectively. There was no statistically significant difference between the performance of the AI system and that of experts, who showed sensitivity, specificity, F1, and accuracy of 0.63, 0.78, 0.67, and 0.70, respectively. Conclusion This pilot study demonstrates the first multicenter application of an AI-based system in the prediction of submucosal invasion in endoscopic images of Barrett's cancer. AI scored equally to international experts in the field, but more work is necessary to improve the system and apply it to video sequences and real-life settings. Nevertheless, the correct prediction of submucosal invasion in Barrett's cancer remains challenging for both experts and AI. Univ Klinikum Augsburg, Med Klin 3, Stenglinstr 2, D-86156 Augsburg, Germany Ostbayer TH Regensburg OTH Regensburg, Regensburg Med Image Comp ReMIC, Regensburg, Germany OTH Regensburg, Regensburg Ctr Hlth Sci & Technol RCHST, Regensburg, Germany Sana Klinikum Lichtenberg, Gastroenterol, Berlin, Germany Asklepios Klin Barmbek, Dept Gastroenterol Hepatol & Intervent Endoscopy, Hamburg, Germany OTH Regensburg, Regensburg Ctr Biomed Engn RCBE, Regensburg, Germany Regensburg Univ, Regensburg, Germany Sao Paulo State Univ, Dept Comp, Sao Paulo, Brazil Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium Saku Cent Hosp Adv Care Ctr, Nagano, Japan Klin Hirslanden, GastroZentrum, Zurich, Switzerland Vet Affairs Med Ctr, Dept Gastroenterol & Hepatol, Kansas City, MO USA Univ Kansas, Sch Med, Kansas City, MO USA Univ British Columbia, Vancouver Gen Hosp, Div Gastroenterol, Vancouver, BC, Canada Sao Paulo State Univ, Dept Comp, Sao Paulo, Brazil
- Published
- 2020
28. POST ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) STRICTURES - IS RISK RELATED TO PATHOLOGY? A EUROPEAN COMPARISON OF BARRETT’S VERSUS SQUAMOUS NEOPLASIA
- Author
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Sharmila Subramaniam, Gaia Pellegatta, Roberta Maselli, Sophie Arndtz, Asma Alkandari, Mohamed Abdelrahim, Ejaz Hossain, A. Repici, Stefan Seewald, Pradeep Bhandari, and Piera Alessia Galtieri
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Radiology ,Endoscopic submucosal dissection ,business - Published
- 2020
29. LONG-TERM OUTCOME OF SALVAGE ENDOSCOPIC RESECTION AFTER DEFINITIVE CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER: A WESTERN EXPERIENCE
- Author
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Rha Verhoeven, Jonathan Hoare, Pierre Henri Deprez, Stefan Seewald, Ali Al-Kaabi, Pradeep Bhandari, Erik J. Schoon, Marc Giovannini, Frieder Berr, Barbara Braden, R S van der Post, Peter D. Siersema, and Arnaud Lemmers
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Cancer ,Endoscopic resection ,Definitive chemoradiotherapy ,medicine.disease ,business ,Outcome (game theory) ,Surgery ,Term (time) - Published
- 2020
30. Boerhaave's Syndrome and Esophageal Perforations
- Author
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Paul M. Schneider, Stefan Seewald, Marc Schiesser, Stefan Gutknecht, and Peter Bauerfeind
- Published
- 2020
31. Management of Early-Stage Adenocarcinoma of the Esophagus
- Author
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Roos E. Pouw, Stefan Seewald, Jacques J. Bergman, Tiing Leong Ang, and Fridolin Bannwart
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,Esophageal Neoplasms ,Physiology ,Radiofrequency ablation ,Endoscopic mucosal resection ,Adenocarcinoma ,law.invention ,03 medical and health sciences ,Barrett Esophagus ,0302 clinical medicine ,law ,Internal medicine ,Medicine ,Humans ,Stage (cooking) ,Esophagus ,Clinical Trials as Topic ,business.industry ,Gastroenterology ,Disease Management ,Hepatology ,medicine.disease ,medicine.anatomical_structure ,Dysplasia ,030220 oncology & carcinogenesis ,Barrett's esophagus ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Barrett's esophagus with high-grade dysplasia and early-stage adenocarcinoma is amenable to curative treatment by endoscopic resection. Histopathological correlation has established that mucosal cancer has minimal risk of nodal metastases and that long-term complete remission can be achieved. Although surgery is the gold-standard treatment once there is submucosal involvement, even T1sm1 (submucosal invasion ≤ 500 μm) cases without additional risk factors for nodal metastases might also be cured with endoscopic resection. Endoscopic resection is foremost an initial diagnostic procedure, and once histopathological assessment confirms that curative criteria are met, it will be considered curative. Endoscopic resection may be achieved by endoscopic mucosal resection, which, although easy to perform with relatively low risk, is limited by an inability to achieve en bloc resection for lesions of size more than 1.5 cm. Conversely, the technique of endoscopic submucosal dissection is more technically demanding with higher risk of complications but is able to achieve en bloc resection for lesions larger than 1.5 cm. Endoscopic submucosal dissection would be particularly important in specific situations such as suspected submucosal invasion and lesion size more than 1.5 cm. In other situations, since endoscopic resection would always be combined with radiofrequency ablation to ablate the remaining Barrett's epithelium, piecemeal endoscopic mucosal resection would suffice since any remnant superficial invisible dysplasia would be ablated.
- Published
- 2018
32. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines
- Author
-
Tomas Hucl, Jacques Devière, Jean-Marc Dumonceau, Marianna Arvanitakis, Tibor Gyökeres, István Hritz, Marc G. Besselink, Ioannis S. Papanikolaou, Stefan Seewald, Krijn P. van Lienden, Geoffroy Vanbiervliet, Marc Barthet, Jörg G. Albert, Jeanin E. van Hooft, Rogier P. Voermans, Jan-Werner Poley, Marianna Milashka, Alexandre Oliveira Ferreira, Hjalmar C. van Santvoort, Myriam Delhaye, Maria Antonietta Bali, Abdenor Badaoui, Gastroenterology & Hepatology, Surgery, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, and Gastroenterology and Hepatology
- Subjects
medicine.medical_specialty ,Percutaneous ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Adverse effect ,Societies, Medical ,Pancreatic duct ,medicine.diagnostic_test ,Pancreatitis, Acute Necrotizing ,business.industry ,Gastroenterology ,Magnetic resonance imaging ,Guideline ,medicine.disease ,Endoscopy ,Europe ,medicine.anatomical_structure ,Fine-needle aspiration ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
MAIN RECOMMENDATION 1 ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2 ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3 ESGE recommends initial goal-directed intravenous fluid therapy with Ringer’s lactate (e. g. 5 – 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4 ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5 ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6 ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7 ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8 ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence.
- Published
- 2018
33. Complex early Barrett’s neoplasia at 3 Western centers: European Barrett’s Endoscopic Submucosal Dissection Trial (E-BEST)
- Author
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Kesavan Kandiah, Stefan Seewald, Fergus Chedgy, Gaius Longcroft-Wheaton, Alessandro Repici, Sharmila Subramaniam, Roberta Maselli, and Pradeep Bhandari
- Subjects
Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Esophageal Neoplasms ,Lymphovascular invasion ,medicine.medical_treatment ,Perforation (oil well) ,Adenocarcinoma ,Postoperative Hemorrhage ,Barrett Esophagus ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Interquartile range ,medicine ,Clinical endpoint ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Gastroenterology ,Margins of Excision ,Retrospective cohort study ,Endoscopic submucosal dissection ,United Kingdom ,Surgery ,Radiation therapy ,Italy ,030220 oncology & carcinogenesis ,Esophageal Stenosis ,Female ,030211 gastroenterology & hepatology ,Esophagoscopy ,Gastrointestinal Hemorrhage ,business ,Precancerous Conditions ,Switzerland - Abstract
Background and Aims Endoscopic submucosal dissection (ESD) is an effective technique to resect early Barrett's neoplasia and has advantages over conventional EMR in that it enables en-bloc resection and accurate histopathologic analysis of cancer resection margins. However, its long learning curve and higher adverse event rate have tempered its uptake in the West. We aimed to analyze the safety and efficacy of ESD when used to resect complex Barrett's neoplasia. The primary endpoint was the en-bloc and R0 resection rate. Methods This was a retrospective analysis of 143 ESDs for Barrett's neoplasia performed in 3 tertiary referral centers from 2008 to 2016. Results The mean lesion size was 31.1 mm (range, 5-90) and median follow-up time 21.6 months (interquartile range, 11.0-32.6). In total, 24.5% of lesions (35/143) were scarred after previous endoscopic resection, surgery, or radiotherapy. The en-bloc resection rate was 90.8% and R0 resection rate 79% in this series. The overall adverse event rate was 3.5% (1.4% bleeding, 0% perforation, and 2.1% stricture formation). The expanded curative resection rate was 65.8%, reflecting the R0 resection rate and proportion of cases with more advanced disease. Submucosal cancer was identified as a significant factor affecting the R0 resection rate. Conclusion We demonstrated the feasibility and safety of ESD in the West for resection of complex Barrett's neoplasia including large, nodular, or scarred lesions. This is a safe and effective technique with a low adverse event rate when performed by an experienced operator. The en-bloc resection rate reached a plateau once 30 procedures had been performed.
- Published
- 2017
34. Tu1484 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION OF EARLY GASTRIC NEOPLASIA IN THE WEST: RESULTS FROM FOUR TERTIARY REFERRAL EUROPEAN CENTRES
- Author
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Kesavan Kandiah, Nastazja Dagny Pilonis, Asma Alkandari, Stefan Seewald, Roberta Maselli, Sophie Arndtz, Stefan Groth, Mohamed Abdelrahim, Ejaz Hossain, Michal F. Kaminski, Martina Invernizzi, Piera Alessia Galtieri, Pradeep Bhandari, and Alessandro Repici
- Subjects
medicine.medical_specialty ,Referral ,business.industry ,General surgery ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic submucosal dissection ,business - Published
- 2020
35. 253 THE USE OF ENDOSCOPIC VACUUM THERAPY (EVT) OR COMBINATION THERAPY WITH ENDOSCOPIC STENTING AS COMPARED TO ENDOSCOPIC STENTING (ES) ALONE FOR LEAKAGES AFTER FOREGUT SURGERY
- Author
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Stefan Groth, Hon Chi Yip, Anthony Yuen Bun Teoh, Philip Wai Yan Chiu, Shannon M. Chan, Paul M. Schneider, Ho wai Ip, Tom Chi Man Chow, Enders K.W. Ng, and Stefan Seewald
- Subjects
medicine.medical_specialty ,Combination therapy ,business.industry ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic stenting ,Foregut ,business ,Surgery - Published
- 2020
36. Therapeutic endoscopic ultrasound: rationally progressing
- Author
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Stefan Seewald and Tiing Leong Ang
- Subjects
Endoscopic ultrasound ,Cholangiopancreatography, Endoscopic Retrograde ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Digestive System Diseases ,Gastroenterology ,MEDLINE ,Endosonography ,Text mining ,Medicine ,Drainage ,Humans ,Stents ,Radiology ,Ultrasonography ,business ,Ultrasonography, Interventional - Published
- 2019
37. [Endoscopic prevention of colorectal cancer - detection, therapy and control intervals]
- Author
-
Stefan, Groth and Stefan, Seewald
- Subjects
Adenoma ,Humans ,Colonoscopy ,Intestinal Mucosa ,Colorectal Neoplasms - Abstract
Endoscopic prevention of colorectal cancer - detection, therapy and control intervals
- Published
- 2019
38. OTU-21 Endoscopic submucosal dissection of early gastric neoplasia: experience from three european tertiary centres
- Author
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Sophie Arndtz, Pradeep Bhandari, Roberta Masseli, Stefan Seewald, K Kandiah, Alessandro Repici, Martina Invernizzi, Mohamed Abdelrahim, Asma Alkandari, Ejaz Hossain, and Lazaros Varytimiadis
- Subjects
medicine.medical_specialty ,High prevalence ,business.industry ,Endoscopic submucosal dissection ,Surgery ,Resection ,Lesion ,Medicine ,Endoscopic resection ,Electronic database ,medicine.symptom ,business ,Adverse effect ,Proximal stomach - Abstract
Introduction Endoscopic submucosal dissection (ESD) is a technique first developed in Japan to enable en-bloc endoscopic resection of early gastric neoplasia. The high prevalence of gastric neoplasia allowed for greater opportunity to train and refine the technique in the Far East. The same is not applicable to the West where the prevalence of gastric neoplasia is low. In this study, we aim to review the efficacy and safety of ESD for early gastric neoplasia from three large European referral centres. Methods Data was prospectively collected on an electronic database. We analysed this database and patient’s electronic record. Parameters related to ESD outcome were collected. Results A total of 175 gastric neoplasia were resected between 2009 and 2017 (152 ESD, 23 hybrid ESD), 51.4% were in proximal stomach. Mean size was 29 mm. Only 13 (7.42%) were sub-epithelial lesions. Table 1 shows outcomes and procedure-related complications. The overall en-bloc resection, R0 (deep), and R0 (deep and lateral) rates were 92.5%, 83.4%, and 61.0%, respectively. Proximal location of the lesion was a predictor for R1 outcome (p value 0.011). Size of the lesion was not significantly related to the R0 rate. The overall adverse event rate was 11.3%. There was no 30-day procedure related mortality. Recurrence at 3 months occurred in 7 patients (4%). Conclusion This is the largest western gastric ESD series, demonstrating the feasibility and safety of this technique in a European setting. Despite the low R0 rate, our recurrence rate is low and comparable to Japanese data. Reasons behind good clinical outcome (very low recurrence) despite an average technical outcome (R0) remains uncertain. This raises a possibility that in the west, R-1 should not automatically be considered as an indication for surgery.
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- 2019
39. The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: Controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma
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Franco Roviello, Paul M. Schneider, Fátima Carneiro, Christoph Röcken, William H. Allum, Florian Lordick, Marcel Verheij, Guillaume Piessen, Antoine Adenis, Manfred P. Lutz, Heike I. Grabsch, Elizabeth C Smyth, Michel Ducreux, Stefan Seewald, Pierre Laurent-Puig, John Zalcberg, Anna Dorothea Wagner, Markus Möhler, Angela Riddell, Eric Van Cutsem, Florian Otto, Daniela Aust, Stefan Mönig, Radka Obermannova, Monash University [Melbourne], Institut Gustave Roussy (IGR), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Royal Marsden NHS Foundation Trust, Cambridge University Hospitals - NHS (CUH), University of Cambridge [UK] (CAM), Institut für Pathologie [Berlin], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto = University of Porto, Faculdade de Medicina da Universidade do Porto (FMUP), Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Université Paris Descartes - Paris 5 (UPD5), University Hospital Leipzig, University Medical Center [Mainz], Hôpitaux Universitaires de Genève (HUG), Masaryk Memorial Cancer Institute (MMCI), Université de Lille, The Royal Marsden, Christian-Albrechts University of Kiel, Università degli Studi di Siena = University of Siena (UNISI), University Hospital Gasthuisberg [Leuven], Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Brustzentrum Kantonsspital St. Gallen, Universidade do Porto, Masaryk Memorial Cancer Institute (RECAMO), University Hospital Gasthuisberg, Charité - Universitätsmedizin Berlin / Charite - University Medicine Berlin, Universidade do Porto [Porto], Faculdade de Medicina da Universidade do Porto [Porto] (FMUP), Maastricht University Medical Center (MUMC), and Università degli Studi di Siena (UNISI)
- Subjects
0301 basic medicine ,Endoscopic ultrasound ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,Adenocarcinoma of the gastro-oesophageal junction ,Expert consensus ,Gastric cancer ,Multimodal treatment ,SURGERY ,[SDV]Life Sciences [q-bio] ,Adenocarcinoma ,DECISION-MAKING ,DIAGNOSIS ,CHEMORADIOTHERAPY ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Gastrointestinal cancer ,the gastro-oesophageal junction ,medicine.diagnostic_test ,PERIOPERATIVE CHEMOTHERAPY ,GASTROESOPHAGEAL ADENOCARCINOMA ,Perioperative ,medicine.disease ,Combined Modality Therapy ,Neoadjuvant Therapy ,3. Good health ,Oxaliplatin ,PATHOLOGY ,Regimen ,030104 developmental biology ,Oncology ,Docetaxel ,Fluorouracil ,030220 oncology & carcinogenesis ,SURVIVAL ,Esophagogastric Junction ,CLINICAL-PRACTICE GUIDELINES ,Radiology ,Adenocarcinoma of ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,medicine.drug - Abstract
Contains fulltext : 207090.pdf (Publisher’s version ) (Closed access) Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multimodal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting.
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- 2019
40. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study
- Author
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Mouen A. Khashab, Michael B. Ujiki, Amol Bapaye, Rosario Landi, Robert A. Moran, Stefan Seewald, Pietro Familiari, Anant Agarwalla, Sabine Roman, Nikolas Eleftheriadis, Martina Invernizzi, H. Mason Hedberg, Amyn Haji, Vivek Kumbhari, Bu Hayee, Saowanee Ngamruengphong, Thierry Ponchon, Lea Fayad, Yervant Ichkhanian, Mathieu Pioche, In Kyung Yoo, Mohamad Dbouk, François Mion, Joo Young Cho, Marcel Tantau, Nasim Parsa, Olaya I. Brewer Gutierrez, Omid Sanaei, Maximilien Barret, and Guido Costamagna
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Myotomy ,Heller myotomy ,medicine.medical_specialty ,Original article ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Reflux ,Achalasia ,medicine.disease ,Endoscopy ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,lcsh:Diseases of the digestive system. Gastroenterology ,Reflux esophagitis ,lcsh:RC799-869 ,Adverse effect ,business ,Cohort study - Abstract
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.
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- 2019
41. PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA: A EUROPEAN MULTICENTER SURVEY ABOUT CLINICAL PRACTICE
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Edouard Chabrun, Vincent Lepilliez, Timothée Wallenhorst, Sarah Leblanc, G Rahmi, Stefan Seewald, E Fedorov, Julien Branche, G Vanbiervliet, Véronique Vitton, J Privat, Marc Barthet, Mathieu Pioche, A Smirnov, Pradeep Bhandari, E Albeniz, JM Gonzalez, Jérémie Jacques, Antoine Charachon, C Guarner Aguilar, Jacques Devière, and J Rivory
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Clinical Practice ,Myotomy ,medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,Multicenter survey ,medicine ,Achalasia ,medicine.disease ,business - Published
- 2019
42. ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC TUMOURS: EXPERIENCE FROM THREE LARGE EUROPEAN TERTIARY CENTRES
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Stefan Seewald, Pradeep Bhandari, A. Repici, Ejaz Hossain, M Invernizzi, R Masseli, Mohamed Abdelrahim, Asma Alkandari, K Kandiah, and Sophie Arndtz
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medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Endoscopic submucosal dissection ,business - Published
- 2019
43. Multicenter Evaluation of Clinical Efficacy and Safety of Per-Oral Endoscopic Myotomy in Children
- Author
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Lybil B. Mendoza Alvarez, Yuto Shimamura, Eduardo Albéniz, Jérôme Rivory, Adrien Choné, Maximilien Barret, Pankaj N. Desai, Hinorari Shiwaku, Alain Lachaux, François Mion, Nikos Eleftheriadis, Nicolas Benech, Gabriel Arevalo, Stefan Seewald, Mathew Abraham, Mouen A. Khashab, Jeffrey M. Marks, Kanefumi Yamashita, Peter V. Draganov, Mathieu Pioche, Marcel Tantau, Sabine Roman, Burkhard H.A. von Rahden, Rémi Dubois, Stanislas Chaussade, Pietro Familiari, Haruhiro Inoue, Fabien Subtil, Thierry Ponchon, IIS, The University of Tokyo (UTokyo), Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Stanford University, Institut des Nanosciences de Paris (INSP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Département de pédiatrie [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Application des ultrasons à la thérapie (LabTAU), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut des Sciences de la Terre (ISTerre), Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR)-Institut national des sciences de l'Univers (INSU - CNRS)-Institut de recherche pour le développement [IRD] : UR219-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM), The University of Tokyo, Stanford University [Stanford], Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-PRES Université de Grenoble-Institut de recherche pour le développement [IRD] : UR219-Institut national des sciences de l'Univers (INSU - CNRS)-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR)-Université Joseph Fourier - Grenoble 1 (UJF)
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Male ,Natural Orifice Endoscopic Surgery ,Myotomy ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Fistula ,medicine.medical_treatment ,Settore MED/18 - CHIRURGIA GENERALE ,[SDV]Life Sciences [q-bio] ,Achalasia ,multicenter ,per-oral endoscopic myotomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Japan ,030225 pediatrics ,medicine ,Humans ,endoscopy ,Adverse effect ,Retrospective Studies ,business.industry ,Gastroenterology ,Reflux ,Retrospective cohort study ,medicine.disease ,Dilatation ,United States ,3. Good health ,Esophageal Achalasia ,Europe ,achalasia ,international ,Pediatrics, Perinatology and Child Health ,GERD ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Subcutaneous emphysema - Abstract
International audience; OBJECTIVES: Per-Oral Endoscopic Myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children. METHODS: International multicenter retrospective study conducted in 14 tertiary centers that included consecutive children who underwent POEM between January 2012 and August 2018. Outcomes such as clinical response were assessed when available. Adverse events and factors associated with clinical failure were also investigated. RESULTS: A total of 117 patients (mean +/- SD age: 14.2 +/- 3.7 years) underwent POEM for achalasia (type I n=36, II n=66, III n=8). Among these, 30 (26%) were pre-treated (botulinum injection and/or pneumatic dilatation). Mean +/- SD baseline Eckardt score was 7.5 +/- 2.0. Clinical success was achieved in 90.6% of cases (95%CI [83.8%;95.2%]) in the intention-to-treat analysis. The mean +/- SD Eckardt score post-POEM was 0.9 +/- 1.2 (p\textless0.001). The mean duration of follow-up time 545 days (range: 100-1612). A total of 7 adverse events occurred (4 mucosotomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were seen in 17 patients (15%); missing data for 10 patients (9%). There was a trend towards more frequent clinical failure in achalasia associated with genetic disorders (40% versus 8%, p=0.069). CONCLUSION: POEM in pediatric patients appears to be effective and safe, although there was a trend towards more frequent clinical failure achalasia associated with genetic disorders. Further studies are needed to assess the long-term outcomes, especially the consequences of GERD.
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- 2019
44. Salvage endoscopic resection after definitive chemoradiotherapy for esophageal cancer: a Western experience
- Author
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Erik J. Schoon, Pradeep Bhandari, Marc Giovannini, Rachel S. van der Post, Rob H.A. Verhoeven, Stefan Seewald, Barbara Braden, Arnaud Lemmers, Frieder Berr, Ali Al-Kaabi, Pierre Henri Deprez, Peter D. Siersema, Jonathan Hoare, Stefan Groth, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Service de gastro-entérologie, Internal medicine, APH - Methodology, and APH - Quality of Care
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,Esophageal Neoplasms ,Perforation (oil well) ,Endoscopic mucosal resection ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Interquartile range ,medicine ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Gastro-entérologie ,Humans ,Radiology, Nuclear Medicine and imaging ,Endoscopic resection ,Adverse effect ,Imagerie médicale, radiologie, tomographie ,Retrospective Studies ,business.industry ,Gastroenterology ,Definitive chemoradiotherapy ,Chemoradiotherapy ,Esophageal cancer ,medicine.disease ,Surgery ,Europe ,Treatment Outcome ,Neoplasm Recurrence, Local ,business - Abstract
Background and Aims: Definitive chemoradiotherapy (CRT) is increasingly used as a nonsurgical treatment for esophageal cancer. In Japanese studies, salvage endoscopic resection (ER) has emerged as a promising strategy for local failure after definitive CRT. We aimed to evaluate the safety and efficacy of salvage ER in a Western setting. Methods: Gastroenterologists from Europe and the United States were invited to submit their experience with salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) after definitive CRT. Participating gastroenterologists completed an anonymized database, including patient demographics, clinicopathologic variables, and follow-up on survival and recurrence. Results: Gastroenterologists from 10 endoscopic units in 6 European countries submitted information on 25 patients. A total of 35 salvage ER procedures were performed, of which 69% were ESD and 31% EMR. Most patients had squamous cell carcinoma (64%) of the middle or lower esophagus (68%) staged as cT2-3 (68%) and cN+ (52%) before definitive CRT. The median time from end of definitive CRT to ER was 22 months (interquartile range, 6-47). The en-bloc resection rate was 92% for ESD and 46% for EMR. During a median of 24 months (interquartile range, 12-59) of follow-up after salvage ER, 52% developed a recurrence (11 locoregional, 2 distant). The 5-year recurrence-free survival, overall survival, and disease-specific survival were 36%, 52%, and 79%, respectively. No major intra- or postprocedural adverse events, such as bleeding or perforation, were reported. Conclusions: In carefully selected esophageal cancer patients, salvage ER is technically feasible after definitive CRT. Further prospective research is recommended to validate the safety and effectivity of salvage ER for the management of local failure., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2021
45. Comprehensive epidemiological and genotype–phenotype analyses in a large European sample with idiopathic achalasia
- Author
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Robert Hüneburg, Ines Gockel, Markus M. Nöthen, Arcangelo Ricchiuto, Jessica Becker, Johannes Schumacher, Stefan Seewald, Rolf Fimmers, Michael Knapp, Burkhard H.A. von Rahden, Alexander J. Eckardt, Lothar Veits, Michael Vieth, Mira M. Wouters, Annette Schafft, Nicole Kreuser, Timo Hess, Henning R. Gockel, Uwe Scheuermann, Tobias Waltgenbach, Philipp Lingohr, Henning G. Schulz, Hanno Matthaei, Gavin Lehmann, Stefan Niebisch, Hauke Lang, Marino Venerito, Michaela Müller, Guy E. Boeckxstaens, Frank Lenze, and Eva J. Schaich
- Subjects
Adult ,Male ,0301 basic medicine ,Herpesvirus 3, Human ,Heterozygote ,medicine.medical_specialty ,Genotype ,Prevalence ,Achalasia ,Comorbidity ,Disease ,Herpes Zoster ,Gastroenterology ,White People ,Autoimmune Diseases ,03 medical and health sciences ,Chickenpox ,Pregnancy ,Internal medicine ,Psoriasis ,Epidemiology ,Hypersensitivity ,medicine ,HLA-DQ beta-Chains ,Humans ,Family ,Alleles ,Hepatology ,business.industry ,Case-control study ,Middle Aged ,medicine.disease ,Esophageal Achalasia ,Europe ,Pregnancy Complications ,Phenotype ,Sjogren's Syndrome ,030104 developmental biology ,Virus Diseases ,Case-Control Studies ,Etiology ,Female ,business - Abstract
BACKGROUND AND AIM Although an eight-residue insertion in HLA-DQβ1 has been recently identified as a genetic risk factor for idiopathic achalasia, other risk factors are still unknown. In the present study, we carried out an epidemiological survey and a genotype-phenotype (G×P) analysis to gain further insights into the etiology of achalasia. METHODS We obtained medical data from 696 achalasia patients and 410 controls, as well as their first-degree relatives (2543 of patients and 1497 of controls). For the G×P analysis, we stratified the patients into HLA-DQβ1 insertion carriers and noncarriers. RESULTS Our data show that patients are more often affected by viral infections before achalasia onset (P
- Published
- 2016
46. Fully covered self-expandable metal stents: The 'be all and end all' for pancreatic fluid collections?
- Author
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Stefan Seewald and Tiing Leong Ang
- Subjects
medicine.medical_specialty ,Pancreatic Fluid ,business.industry ,Walled off necrosis ,Pancreatic juice ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Self Expandable Metal Stents ,Surgery - Published
- 2015
47. Quality Indicators for the Management of Barrett’s Esophagus, Dysplasia, and Esophageal Adenocarcinoma: International Consensus Recommendations from the American Gastroenterological Association Symposium
- Author
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Douglas A. Corley, David A. Katzka, Nicholas J. Shaheen, Rhonda F. Souza, Hashem B. El-Serag, Navtej S. Buttar, Alessandro Repici, Kenneth K. Wang, Gary W. Falk, Prateek Sharma, David H. Ilson, Pankaj J. Pasricha, John M. Inadomi, Jaffer A. Ajani, David C. Metz, Frank McKeon, Jeffrey H. Peters, John R. Goldblum, Rebecca C. Fitzgerald, Stuart J. Spechler, Prashanth Vennalaganti, E. J. Kuipers, Stefan Seewald, Neil Gupta, Richard M. Peek, John P. Lynch, Amitabh Chak, Frank Gress, Oliver Pech, and Gastroenterology & Hepatology
- Subjects
medicine.medical_specialty ,Consensus ,Esophageal Neoplasms ,Consensus Development Conferences as Topic ,media_common.quotation_subject ,Endoscopic mucosal resection ,Adenocarcinoma ,Article ,Barrett Esophagus ,Esophagus ,Documentation ,medicine ,Humans ,Quality (business) ,Disease management (health) ,media_common ,Government ,Hepatology ,business.industry ,Gastroenterology ,Disease Management ,medicine.disease ,United States ,digestive system diseases ,Surgery ,medicine.anatomical_structure ,Dysplasia ,Family medicine ,Barrett's esophagus ,Disease Progression ,Esophagoscopy ,business - Abstract
The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters by which we measure quality, which will likely affect reimbursements. Barrett’s esophagus remains a particularly important disease entity for which we should maintain up-to-date guidelines, given its commonality, potentially lethal outcomes, and controversies regarding screening and surveillance. To achieve this goal, a relatively large group of international experts was assembled and, using the modified Delphi method, evaluated the validity of multiple candidate quality indicators for the diagnosis and management of Barrett’s esophagus. Several candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett’s esophagus.
- Published
- 2015
48. 243 WIDE AREA TRANSEPITHELIAL SAMPLE ESOPHAGEAL BIOPSY COMBINED WITH COMPUTER ASSISTED 3-DIMENSIONAL TISSUE ANALYSIS (WATS3D) FOR DETECTION OF HIGH GRADE DYSPLASIA AND ADENOCARCINOMA IN BARRETT: EUROPEAN MULTI-CENTER, PROSPECTIVE, RANDOMIZED, TANDEM STUDY
- Author
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Frank B. Fromowitz, Bas L. Weusten, Cesare Hassan, EJ Schoon, Jacques J. Bergman, Alessandro Repici, Gert De Hertogh, Arnaud Lemmers, Revital Kariv, Horst Neuhaus, Helmut Messmann, Peter D. Siersema, Krish Ragunath, Raf Bisschops, Stefan Seewald, Pradeep Bhandari, Rehan Haidry, Loredana Correale, Antoni Castells, Miguel Muñoz Navas, and Oliver Pech
- Subjects
medicine.medical_specialty ,Wide area ,High grade dysplasia ,business.industry ,Gastroenterology ,medicine ,Adenocarcinoma ,Radiology, Nuclear Medicine and imaging ,Esophageal biopsy ,Radiology ,business ,medicine.disease ,Sample (graphics) - Published
- 2020
49. Sa1300 POST ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) STRICTURES – IS RISK RELATED TO PATHOLOGY? A EUROPEAN COMPARISON OF BARRETT’S VERSUS SQUAMOUS NEOPLASIA
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Roberta Maselli, Sophie Arndtz, Alessandro Repici, Stefan Seewald, Sharmila Subramaniam, Gaia Pellegatta, Mohamed Abdelrahim, Asma Alkandari, Pradeep Bhandari, Ejaz Hossain, and Piera Alessia Galtieri
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Endoscopic submucosal dissection ,Radiology ,business - Published
- 2020
50. 104 WIDE AREA TRANSEPITHELIAL SAMPLE ESOPHAGEAL BIOPSY COMBINED WITH COMPUTER ASSISTED 3-DIMENSIONAL TISSUE ANALYSIS (WATS3D) FOR DETECTION OF HIGH GRADE DYSPLASIA AND ADENOCARCINOMA IN BARRETT: EUROPEAN MULTI-CENTER, PROSPECTIVE, RANDOMIZED, TANDEM STUDY
- Author
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Raf Bisschops, Stefan Seewald, Revital Kariv, Horst Neuhaus, Gert De Hertogh, Pradeep Bhandari, Peter D. Siersema, Alessandro Repici, Arnaud Lemmers, Helmut Messmann, Oliver Pech, Cesare Hassan, Frank B. Fromowitz, Miguel Muñoz Navas, Loredana Correale, Jacques J. Bergman, Krish Ragunath, Bas L. Weusten, Rehan Haidry, Antoni Castells, and EJ Schoon
- Subjects
medicine.medical_specialty ,Wide area ,High grade dysplasia ,business.industry ,Gastroenterology ,medicine ,Adenocarcinoma ,Radiology, Nuclear Medicine and imaging ,Esophageal biopsy ,Radiology ,business ,medicine.disease ,Sample (graphics) - Published
- 2020
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