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Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis

World Journal of Gastroenterology 2012年第37期18卷 5211-5218页

作者： Hauke S Heinzow Philipp Lenz Michael Khler Frank Reinecke hansjrg ullerich Wolfram Domschke Dirk Domagk Tobias Meister Department of Medicine B University of Muenster Institute of Radiology University of Muenster Department of Medicine Ⅱ Helios Albert-Schweitzer-Hospital

AIM： To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt （TIPS） implantation in cirrhotic patients. METHODS： Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implanta- tion （bare metal） for either refractory ascites （RA）（n = 27） or variceal bleeding （VB）（n = 54）. Endpoints for the study were： technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clini- cal records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score （MELD score）, underlying disease] were retrieved. The Kaplan- Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox pro- portional hazards regression model. Results were ex- pressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the4,2 test as appropriate. RESULTS： No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient （PPG） reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg （VB） vs 22.1± 5.5 mmHg （RA） be- fore TIPS to 11.8 ±4.0 vs 11.7 ± 4.2 after TIPS im- plantation （P = 0.001 within each group）. There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group （24 vs 6, P = 0.052）. The median survival for the ascites group was 29 mo compared to 〉 60 mo for the bleed- ing group （P = 0.009）. The number of radiological con- trols for stent patency was 6.3 for bleeders and 3.8 for ascites patients （P = 0.029）. Kaplan-Meier calculation indicated that stent occlusion at first control （P = 0.027）, ascites prior to TIPS implantation （P = 0.009）, CHILD stage （P = 0.013）, M

关键词： Transjugular intrahepatic portosystemicstent shunt Liver cirrhosis Ascites Gastrointestinalhemorrhage Treatment outcome

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A typical presentation of a rare cause of obscure gastrointestinal bleeding

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World Journal of Gastrointestinal Endoscopy 2011年第2期3卷 40-45页

作者： Stefan Reuter Dominik Bettenworth Sren Torge Mees Jrg Neumann Torsten Beyna Wolfram Domschke Johannes Wessling hansjrg ullerich Department of Internal Medicine D University Hospital Münster Albert-Schweitzer Str. 33 Münster 48149 Germany Department of Internal Medicine B University Hospital Münster Albert-Schweitzer Str. 33 Münster 48149 Germany Department of General and Visceral Surgery University Hospital Münster Albert-Schweitzer Str. 33 Münster 48149 Germany Gerhard Domagk Institute of Pathology University Hospital Münster Albert-Schweitzer Str. 33 Münster 48149 Germany Department of Radiology University Hospital Münster Albert-Schweitzer Str. 33 Münster 48149 Germany

A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral doubleballoon enteroscopy (DBE) did not detect any bleeding sour ce, suggesting obscure GI bleeding. However, in video capsule endoscopy a jejunal ulceration without blee ding signs was suspected and this was endoscopically conf irmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general *** weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a followup of eight months. We herein describe the comp lex presentation and course of this patient with GIST and also review the current approach to treatm ent.

关键词： Gastrointestinal stromal tumor Gastrointestinal neoplasms Gastrointestinal hemorrhage Computed tomography

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Digital single-operator video cholangioscopy improves endoscopic management in patients with primary sclerosing cholangitis-a retrospective observational study

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World Journal of Gastroenterology 2022年第20期28卷 2201-2213页

作者： Arne Bokemeyer Frank Lenze Viorelia Stoica Timur Selcuk Sensoy Iyad Kabar Hartmut Schmidt hansjoerg ullerich Department of Medicine B(Gastroenterology HepatologyEndocrinologyClinical Infectiology)University Hospital MuensterMuenster 48149Germany Department of Gastroenterology Hepatology and Transplant MedicineUniversity Hospital EssenEssen 45147Germany

BACKGROUND Patients with primary sclerosing cholangitis(PSC)are at a high risk of developing cholestatic liver disease and biliary cancer,and endoscopy is crucial for the complex management of these *** To clarify the utility of recently introduced digital single-operator video cholangioscopy(SOVC)for the endoscopic management of PSC *** In this observational study,all patients with a history of PSC and in whom digital SOVC(using the SpyGlass DS System)was performed between 2015 and 2019 were included and retrospectively *** were performed at a tertiary referral centre in *** total,46 SOVCs performed in 38 patients with a history of PSC were *** primary endpoint was the evaluation of dominant biliary strictures using digital SOVC,and the secondary endpoints were the performance of selective guidewire passage across biliary strictures and the diagnosis and treatment of biliary stone disease in PSC *** The 22 of 38 patients had a dominant biliary stricture(57.9%).In 4 of these 22 patients,a cholangiocellular carcinoma was diagnosed within the stricture(18.2%).Diagnostic evaluation of dominant biliary strictures using optical signs showed a sensitivity of 75%and a specificity of 94.4%to detect malignant strictures,whereas SOVC-guided biopsies to gain tissue for histopathological analysis showed a sensitivity of 50%and a specificity of 100%.In 13%of examinations,SOVC was helpful for guidewire passage across biliary strictures that could not be passed by conventional methods(technical success rate 100%).Biliary stone disease was observed in 17.4%of examinations;of these,in 37.5%of examinations,biliary stones could only be visualized by SOVC and not by standard *** stone treatment was successful in all cases(100%);25%required SOVC-assisted electrohydraulic ***,such as postinterventional cholangitis and pancreatitis,occurred in 13%of examinations;however,no procedur

关键词： Cholangitis Sclerosing Biliary tract diseases Biliary strictures Endoscopy Gastrointestinal Cholangioscopy Digital single-operator video cholangioscopy

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Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis

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World Journal of Gastroenterology 2014年第34期20卷 12260-12268页

作者： Philipp Lenz Franziska Eckelskemper Thomas Erichsen Tim Lankisch Alexander Dechêne Gabriele Lubritz Frank Lenze Torsten Beyna hansjorg ullerich Andre Schmedt Dirk Domagk Department of Medicine B University of MuensterD-48149 MuensterGermany Department of Gastroenterology Hepatology and EndocrinologyHannover Medical School30625 HannoverGermany Department of Gastroenterology and Hepatology University Hospital Essen45147 EssenGermany Institute of Medical Microbiology University Hospital MuensterD-48149 MuensterGermany

AIM:To develop an algorithm to improve the diagnosis and treatment of patients with biliary ***:We performed a prospective study of 127patients who underwent endoscopic retrograde cholangiopancreatography,for various biliary disorders,at 3 tertiary referral centers in Germany from July 2011through July 2012(***:NCT01109550).Bile,buccal,and stool samples were *** indicated,endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal ***:Candida species were detected in 38 of the 127 bile samples(29.9%).By multivariate analysis patients’age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis(P7 d)(P=0.089)tend to be at risk for biliary *** patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed *** Candida subspecies detected,36.7%were azole-resistant,such as C *** patients received anti-mycotic therapy,based on our *** these,3 had cancer with biliary tract involvement,2had secondary sclerosing cholangitis,1 had retroperitoneal fibrosis,and 5 had *** all patients contamination was ruled out by smears of the endoscope ***:Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary *** suggested algorithm facilitates the further clinical management.

关键词： Cholangitis Biliary candidiasis Invasive fungal infection Biliary obstruction

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Ileal gallstone obstruction:Single-balloon enteroscopic removal

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World Journal of Gastrointestinal Endoscopy 2010年第9期2卷 321-324页

作者： Hauke Sebastian Heinzow Tobias Meister Johannes Wessling Wolfram Domschke hansjoerg ullerich Department of Medicine B University of Muenster Department of Radiology University of Muenster

Gallstone-induced ileus is a rare complication of *** localization of gallstones impacted in the small bowel,especially in the ileum,prevents access by conventional endoscopy in most cases,the mainstay of treatment remains *** invention of double-and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed ***,for the first time,we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.

关键词： Gallstone ileus Small bowel obstruction Single-balloon enteroscopy Cholelithiasis

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