Zeitschrift fur Gastroenterologie最新文献

Esophageal squamous cell carcinoma (ESCC) is a malignant tumor originating from the squamous epithelium. In contrast, esophageal submucosal tumors are common benign lesions arising from mesenchymal tissues. To date, an entirely intramural growth of ESCC is very rare. This study described a case of an esophageal submucosal tumor resected by endoscopic submucosal dissection (ESD) that was finally diagnosed as ESCC.A 51-year-old woman presented with progressive dysphagia and was provisionally diagnosed with esophageal leiomyoma by further diagnostic modalities. The patient did not have any obvious suspicious malignant features and underwent ESD. However, the histopathology of the resected specimen was reported as poorly differentiated infiltrating squamous cell carcinoma with normal overlying squamous epithelium. Consequently, the patient received additional chemoradiotherapy, and no recurrence was observed during the 2-year follow-up.A comprehensive literature search related to ESCC with entirely intramural growth was performed in PubMed and Embase from their inception up to November 2023, and 12 articles including 13 cases were finally included in the literature review. Subsequently, we extracted information about these cases.It is concluded that ESCC may masquerade as a submucosal tumor with a complete submucosal growth pattern and is easily misdiagnosed because endoscopic biopsy and iodine staining are always negative. Therefore, if a patient with a submucosal tumor has dysphagia or weight loss in the short term, clinicians should be alert to the possibility of ESCC with a complete submucosal growth pattern. Endoscopic ultrasonography (EUS), chest computed tomography (CT), or positron emission tomography-computed tomography (PET-CT) may help assist in the diagnosis, and EUS-guided fine-needle aspiration (EUS-FNA) could be used to confirm the diagnosis.

Crohn's disease (CD), also known as cicatrizing enteritis, is an inflammatory bowel disease that occurs in the distal ileum and right colon of unknown cause and is also called inflammatory bowel disease (IBD) with ulcerative colitis (UC). In recent years, intestinal biota have been confirmed to play a significant role in various gastrointestinal diseases. Studies have found that intestinal microbiota disorders are closely associated with the onset and progression of Crohn's disease. Bacteroidetes, the second largest microbiota in the intestine, are crucial for equilibrium in the microbiota and intestinal environment. Certain Bacteroides can induce the development of Crohn's disease and aggravate intestinal inflammation directly or through their metabolites. Conversely, certain Bacteroides can reduce intestinal inflammation and symptoms of Crohn's disease. This article reviews the effect of several intestinal Bacteroides in the onset and progression of Crohn's disease and their impact on its treatment.

Prion diseases pose a challenge for flexible reusable endoscopes. Especially for the new variant of Creutzfeld Jakob disease (vCJD) there is currently no suitable processing procedure. In these patients only disposable endoscopes are hygienically safe. The case report shows a PEG placement in a 42-year-old patient with suspected vCJD using a disposable bronchoscope.

In 2016, the World Health Organization (WHO) decided on an initiative to identify 90% of the world's existing hepatitis B and C virus infections by 2030, treat 80% and reduce the mortality by 65%. In 2016, the federal government endorsed these goals. From Oct 1, 2021, the G-BA included a one-time screening for hepatitis B and C in the health examination (GU) for people aged 35 and over who have statutory health insurance. The previous participation rates in the GU were evaluated and the effectiveness of the program is documented using the reporting data on hepatitis B and C of Robert Koch Institute (RKI).Notifications from Central Institute of Statutory Health Insurance (ZI) and Scientific Institute of the local health insurance companies (WIdO) were compiled with regard to the GU, the reporting data from the RKI were collected and analyzed using SURVSTAT@RKI 2.0 as well as billing data from the Association of Statutory Health Insurance Physicians (KBV).Between 2007 and 2021, around 83% of all insured persons took part in a GU at least once. From the fourth quarter of 2021, the number of newly diagnosed cases of hepatitis B and C increased. In 2022, the increase for hepatitis B was 91.9% and for hepatitis C 68%. This trend continued in 2023, with new diagnoses of hepatitis B increasing by 160% (to 22,795 cases) and hepatitis C increasing by 121% (to 10,508 cases) compared to 2021. The analysis of the KBV billing data showed that the increase in new diagnoses shows a strong correlation between the number of new diagnoses within the GU and the total number of diagnoses.The decision of the Federal Joint Committee (G-BA) to include hepatitis B and C screening in the GU seems to be a success in detecting previously undetected cases of the disease. Based on the billing data from the KBV, a high level of agreement could be demonstrated between the number of new diagnoses within the GU and the increase in the total number of diagnoses. The goals of the WHO may be achievable.

We present the case of a 70-year-old patient of Caucasian origin under palliative chemotherapy for metastasized colorectal cancer, who presented with signs of complete small bowel obstruction six months after placement of a diverting ileostomy. Following previous tumor perforation, he was not considered a candidate for further surgical intervention.Thus, endoscopic ultrasound-guided enterocolostomy (i.e., ileosigmoidostomy) with a lumen-apposing metal stent was successfully performed in a coloenteric approach to restore the passage.Oral nutrition could be resumed the next day, and the patient could be discharged in substantially improved condition after three days.

AL-Amyloidosis is a rare systemic disease that can occur in patients with monoclonal gammopathy or multiple myeloma. As multiple organs may be affected by deposition of amyloid fibrils, the clinical presentation varies considerably, and the diagnostic process may be challenging.We report on a 59-year-old female who suffered from gastroesophageal reflux symptoms, nausea, epigastric pain, and meteorism over several years. Repeated upper GI endoscopies including biopsies and CT scans were unremarkable except for unspecific enlargement of mesenterial lymph nodes.A few weeks after a surgical hiatal hernia repair with fundoplication, the patient developed massive distension of the stomach and the proximal duodenum resulting in gastric perforation. Histopathological staining of gastric biopsies and mesenterial lymph nodes using hematoxylin and eosin was unremarkable. Because of endoscopic findings (submucosal hematomas, and ulcerations) and the unexplained severe motility disorder, histopathological staining was performed using Congo red. Extensive amyloid deposits were seen. Further workup confirmed AL amyloidosis caused by monoclonal gammopathy. Specific oncological treatment was started.The rare differential diagnosis of amyloidosis should be taken into account in patients with unexplained motility disorders, unspecific gastrointestinal symptoms, and abdominal lymphadenopathy. In the presented case, delayed diagnosis of AL amyloidosis in the gastrointestinal tract led to severe gastroparesis resulting in gastric perforation. Specific histopathologic staining can confirm the diagnosis.

In Germany, there are no uniform hospital standards for the transparent calculation of medical staffing requirements in hospitals. This is particularly true for outpatient services.The ALGK conducted a member survey via the link https://de.surveymonkey.com/r/H7TTJYZ from March 21 to May 1, 2024. 400 members with a valid email address were contacted. The 119 extraordinary members who had ended their professional activity were not included. 17 questions were asked in the survey.The response rate was 24%. 37% represented basic and standard, 47% specialized and 16% maximum care providers. Municipal hospitals were represented by 42%, denominational providers by 34% and private providers by 24%. 7% of the hospitals had fewer than 200 beds, 28% 200 to 400 beds, 37% 400 to 600 beds, 15% 600 to 800 beds and 13% more than 800 beds. Up to 1.500 patients were treated annually in 15%, up to 2.500 patients in 15%, each up to 3.000 or 4.000 patient in 22%s, up to 5,000 patientsin 16% and more than 5.000 patients per year in 12%. The average casemix was 2373 ± 999 and the casemix index 0.70 ± 0.11. On average, 17.6 ± 7.6 doctor's posts were available and one consultant treated 14 ± 2.7 patients per day. A transparent personnel calculation was not available in 56% of the departments or clinics, in 82% there was no internal cost allocation or cost recovery calculation, in 54% there was no internal cost allocation. In 54%, there was no feedback on outpatient services from the administration, in 93% there was no transparent calculation of physician positions based on outpatient services, in 97% the training and further training of young colleagues was not taken into account in the calculation of positions, in 75% there was no communicated and recognizable strategic plan by the hospital operator for the senior gastroenterologists with regard to outpatient services. 49% of those surveyed feared that their hospital operator would not be able to cope with the restructuring in the healthcare sector with outpatient services, centralization, minimum volume compliance and would even jeopardize its existence.Transparent job calculation and communication about inpatient and outpatient gastroenterology services and the strategic objectives of the healthcare structural reform are very patchy in German hospitals. This leads to a high degree of uncertainty and existential fears.

A 45-year-old male presented with jaundice, abdominal discomfort, and weight loss. Abdominal ultrasound revealed intrahepatic cholestasis and cholelithiasis indicative of Caroli-syndrome. Subsequent magnetic resonance imaging demonstrated a corresponding 5 × 4 cm polycyclic, calcified mass and a distant 12 mm subhilar stenosis of the common bile duct resembling cholangiocarcinoma. Calcifications seemed unusual and brought up differential diagnosis of echinococcosis. Serology revealed an echinococcus antibody-titer of 33 U (cut-off > 11.5 U). However, the clinical presentation with jaundice, weight loss, and a distant subhilar stenosis of the common bile duct without association to the intrahepatic process led to underestimation of the positive antibody-titer. Thus, the patient underwent right hemihepatectomy for potential cholangiocarcinoma. Dense infiltrative small cysts interspersed the resected right lobe of the liver. Histopathology revealed a granulomatous inflammation surrounding typical cuticulas, confirming hepatobiliary alveolar echinococcosis. Alveolar echinococcosis is considered as one of the neglected diseases by the World Health Organization, although incidence is rising worldwide and specifically in Germany. Our case illustrates hurdles in diagnosing alveolar echinococcosis and underlines the importance to be aware of classical and rare clinical manifestations.

Real-world data on the management of patients with primary biliary cholangitis (PBC) are so far scarce in Germany. Therefore, we aimed to establish a nationwide registry and describe the clinical characteristics and therapy of PBC patients.Three different cohorts defined as ursodeoxycholic acid (UDCA) responders, as inadequate responders according to Paris II criteria, and as newly diagnosed patients were prospectively recruited.This manuscript includes the baseline data of the project.In total, 33/77 (43%) contacted centres (58% of university hospitals, 38% of non-university hospitals, and 24% of private practices) recruited 515 patients including 204 UDCA responders, 221 inadequate responders to UDCA, and 90 newly diagnosed patients.All patients were treated with UDCA; however, a UDCA dosage below the recommended dosage of 13 mg/kg/d was observed in 38.5% of individuals after 12 months of treatment. UDCA dosages were lower in nonacademic compared to academic centres.Only 75/219 (38.5%) of inadequate responders to UDCA received a second-line therapy with obeticholic acid (OCA) and/or bezafibrate (BZF). OCA (13% vs. 4.5%) and BZF (14% vs. 6.5%) were significantly more often prescribed by academic vs. nonacademic centres.Pruritus (27% vs. 15.5%), fatigue (23% vs. 4.5%), and sicca syndrome (14% vs. 1%) were significantly more often reported by academic centres.The German PBC registry could be established, which indicates suboptimal therapy in a relevant proportion of patients and shows significant differences between academic and nonacademic centres. Results are fundamental to improving clinical management at different levels of care.

Granular cell tumors, uncommon soft tissue growths, predominantly manifest in the subcutaneous and tongue areas, while those in the gastrointestinal tract are scarce and develop slowly. Patients typically show no distinct clinical symptoms and are hard to differentiate from gastrointestinal mesenchymal tumors, smooth muscle tumors, neural sheath tumors, and rhabdomyosarcomas using endoscopy. This paper details a case of a granular cell tumor in the stomach addressed through endoscopic submucosal dissection, focusing on its endoscopic attributes and clinicopathological traits.