Pub Date : 2023-08-01Epub Date: 2023-07-14DOI: 10.1159/000531682
Alida Finze, Mirko Otto, Georg Kähler
Introduction: Obesity and obesity-related disease such as diabetes mellitus type 2 are a permanently rising concern worldwide. Current effective therapeutic options mostly include medication and surgery, but there is a lack of effective treatment options between medication and surgery. Previously, devices such as EndoBarrier® have been placed on the market. However, high complication rates, especially liver abscesses, were seen in patients after implantation of the device. Nevertheless, duodenal lining seems to be an effective therapy for type 2 diabetes in obese patients and can lead to weight loss.
Methods: A new removable transduodenal bypass was developed and tested on a porcine model. In this course, the device evolved in its mechanism and handling. The device is designed to avoid typical complications seen in previous duodenal liners.
Results: After further development of the device, implantation and use were feasible and safe in the porcine model. Autopsies showed that the device stayed in place and remained intact.
Discussion: The new removable transduodenal bypass aims to be a removable therapeutic option for diabetes mellitus type 2 and obesity, replacing previous duodenal lining devices. Use and handling of the device, however, are yet to be tested in the human model in the future.
{"title":"Removable Transduodenal Bypass: Development of a New Endoscopic Concept.","authors":"Alida Finze, Mirko Otto, Georg Kähler","doi":"10.1159/000531682","DOIUrl":"10.1159/000531682","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity and obesity-related disease such as diabetes mellitus type 2 are a permanently rising concern worldwide. Current effective therapeutic options mostly include medication and surgery, but there is a lack of effective treatment options between medication and surgery. Previously, devices such as EndoBarrier<sup>®</sup> have been placed on the market. However, high complication rates, especially liver abscesses, were seen in patients after implantation of the device. Nevertheless, duodenal lining seems to be an effective therapy for type 2 diabetes in obese patients and can lead to weight loss.</p><p><strong>Methods: </strong>A new removable transduodenal bypass was developed and tested on a porcine model. In this course, the device evolved in its mechanism and handling. The device is designed to avoid typical complications seen in previous duodenal liners.</p><p><strong>Results: </strong>After further development of the device, implantation and use were feasible and safe in the porcine model. Autopsies showed that the device stayed in place and remained intact.</p><p><strong>Discussion: </strong>The new removable transduodenal bypass aims to be a removable therapeutic option for diabetes mellitus type 2 and obesity, replacing previous duodenal lining devices. Use and handling of the device, however, are yet to be tested in the human model in the future.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"87-92"},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45567309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01Epub Date: 2023-06-12DOI: 10.1159/000530362
Philipp H von Kroge, Anna Duprée
Background: Fluorescent imaging using indocyanine green (FI-ICG) has become quite popular in the past century, giving the surgeon various pre- and intraoperative approaches in visceral surgery. Nevertheless, several aspects and pitfalls of using the technology need to be addressed.
Summary: This article focused on the applications of FI-ICG in esophageal and colorectal surgery as this is where the clinical relevance is most important. Important benchmark studies were summarized to explain the background. In addition, dosage, the timing of application, and future perspectives - especially quantification methods - were the article's content.
Key message: There are currently encouraging data on the use of FI-ICG, particularly concerning perfusion assessment to reduce anastomotic leakage, although its use is mainly subjective. The optimal dosage remains unclear; for perfusion evaluation, it should be around 0.1 mg/kg body weight. Moreover, the quantification of FI-ICG opens new possibilities, so that reference values may be available in the future. However, in addition to perfusion measurement, the detection of additional hepatic lesions such as liver metastases or lesions of peritoneal carcinomatosis is also possible. A standardization of FI-ICG and further studies are needed to fully utilize FI-ICG.
{"title":"Fluorescent Imaging in Visceral Surgery: Current Opportunities and Future Perspectives.","authors":"Philipp H von Kroge, Anna Duprée","doi":"10.1159/000530362","DOIUrl":"10.1159/000530362","url":null,"abstract":"<p><strong>Background: </strong>Fluorescent imaging using indocyanine green (FI-ICG) has become quite popular in the past century, giving the surgeon various pre- and intraoperative approaches in visceral surgery. Nevertheless, several aspects and pitfalls of using the technology need to be addressed.</p><p><strong>Summary: </strong>This article focused on the applications of FI-ICG in esophageal and colorectal surgery as this is where the clinical relevance is most important. Important benchmark studies were summarized to explain the background. In addition, dosage, the timing of application, and future perspectives - especially quantification methods - were the article's content.</p><p><strong>Key message: </strong>There are currently encouraging data on the use of FI-ICG, particularly concerning perfusion assessment to reduce anastomotic leakage, although its use is mainly subjective. The optimal dosage remains unclear; for perfusion evaluation, it should be around 0.1 mg/kg body weight. Moreover, the quantification of FI-ICG opens new possibilities, so that reference values may be available in the future. However, in addition to perfusion measurement, the detection of additional hepatic lesions such as liver metastases or lesions of peritoneal carcinomatosis is also possible. A standardization of FI-ICG and further studies are needed to fully utilize FI-ICG.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"39-45"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01Epub Date: 2023-06-12DOI: 10.1159/000530983
Robert Pietschner, Timo Rath, Markus F Neurath, Raja Atreya
Background: Ulcerative colitis is one of the main entities of inflammatory bowel diseases. The clinical course of this immune-mediated disorder is marked by unpredictable exacerbations and asymptomatic remission, causing lifelong morbidity. Optimized anti-inflammatory treatment is a prerequisite to not only restore the quality of life of the affected patients but also halt progressive bowel damage and reduce the risk for colitis-associated neoplasia. Advances in understanding the underlying immunopathogenesis of ulcerative colitis have led to the advent of targeted therapies that selectively inhibit crucial molecular structures or signaling pathways that perpetuate the inflammatory reaction.
Summary: We will delineate the mode of action and summarize efficacy and safety data of current and emerging targeted therapies in ulcerative colitis, which encompasses representatives of the drug classes of antibodies, small molecules, and oligonucleotides. These substances have already been approved for induction and maintenance treatment or are being tested in late-stage clinical trials in moderately-to-severely active ulcerative colitis patients. These advanced therapies have enabled us to define and achieve novel therapeutic outcomes, such as clinical and endoscopic remission, histological remission, mucosal healing, and recently, also barrier healing as an emerging outcome measure.
Key messages: Established and emerging targeted therapies and monitoring modalities broaden our therapeutic armamentarium and have enabled us to define novel therapeutic outcomes that have the potential to modify the individual disease course of patients with ulcerative colitis.
{"title":"Current and Emerging Targeted Therapies for Ulcerative Colitis.","authors":"Robert Pietschner, Timo Rath, Markus F Neurath, Raja Atreya","doi":"10.1159/000530983","DOIUrl":"10.1159/000530983","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis is one of the main entities of inflammatory bowel diseases. The clinical course of this immune-mediated disorder is marked by unpredictable exacerbations and asymptomatic remission, causing lifelong morbidity. Optimized anti-inflammatory treatment is a prerequisite to not only restore the quality of life of the affected patients but also halt progressive bowel damage and reduce the risk for colitis-associated neoplasia. Advances in understanding the underlying immunopathogenesis of ulcerative colitis have led to the advent of targeted therapies that selectively inhibit crucial molecular structures or signaling pathways that perpetuate the inflammatory reaction.</p><p><strong>Summary: </strong>We will delineate the mode of action and summarize efficacy and safety data of current and emerging targeted therapies in ulcerative colitis, which encompasses representatives of the drug classes of antibodies, small molecules, and oligonucleotides. These substances have already been approved for induction and maintenance treatment or are being tested in late-stage clinical trials in moderately-to-severely active ulcerative colitis patients. These advanced therapies have enabled us to define and achieve novel therapeutic outcomes, such as clinical and endoscopic remission, histological remission, mucosal healing, and recently, also barrier healing as an emerging outcome measure.</p><p><strong>Key messages: </strong>Established and emerging targeted therapies and monitoring modalities broaden our therapeutic armamentarium and have enabled us to define novel therapeutic outcomes that have the potential to modify the individual disease course of patients with ulcerative colitis.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"46-53"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01Epub Date: 2023-06-12DOI: 10.1159/000530031
Johannes Reiner, Katharina Reichenbach, Imad Kamaleddine, Daniel Mokosch, Felix Streckenbach, Beate Brinkmann, Annette Pertschy, Maria Witte, Clemens Schafmayer, Marc-André Weber, Georg Lamprecht
We report the case of a 74-year-old female with abdominal pain, tarry stools, and tachycardia. Previous history included diabetes mellitus with micro- and macroangiopathy. Imaging revealed portal gas, left sided colitis, and emphysematous gastritis, besides severe atherosclerosis with subtotal celiac trunk occlusion and moderate stenosis of the inferior mesenteric artery. Upper endoscopy revealed findings consistent with focal necrotizing gastritis at the greater curvature and acute esophageal necrosis. Blood cultures immediately grew Clostridium perfringens. The patient was treated with broad spectrum antibiotics and was discharged after 21 days in the hospital. This case demonstrates the rare coincident occurrence of nontransmural ischemia of the left colon, the esophagus, and the stomach as a result of low-flow circulatory compromise, which then precipitated C. perfringens associated emphysematous gastritis and blood stream infection.
{"title":"<i>C. perfringens</i> Blood Stream Infection due to Nontransmural Ischemia of the Esophagus, Stomach, and Left Colon: Case Report.","authors":"Johannes Reiner, Katharina Reichenbach, Imad Kamaleddine, Daniel Mokosch, Felix Streckenbach, Beate Brinkmann, Annette Pertschy, Maria Witte, Clemens Schafmayer, Marc-André Weber, Georg Lamprecht","doi":"10.1159/000530031","DOIUrl":"10.1159/000530031","url":null,"abstract":"<p><p>We report the case of a 74-year-old female with abdominal pain, tarry stools, and tachycardia. Previous history included diabetes mellitus with micro- and macroangiopathy. Imaging revealed portal gas, left sided colitis, and emphysematous gastritis, besides severe atherosclerosis with subtotal celiac trunk occlusion and moderate stenosis of the inferior mesenteric artery. Upper endoscopy revealed findings consistent with focal necrotizing gastritis at the greater curvature and acute esophageal necrosis. Blood cultures immediately grew <i>Clostridium perfringens</i>. The patient was treated with broad spectrum antibiotics and was discharged after 21 days in the hospital. This case demonstrates the rare coincident occurrence of nontransmural ischemia of the left colon, the esophagus, and the stomach as a result of low-flow circulatory compromise, which then precipitated <i>C. perfringens</i> associated emphysematous gastritis and blood stream infection.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"54-57"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9966029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Front & Back Matter","authors":"U. Denzer, T. Hackert","doi":"10.1159/000531605","DOIUrl":"https://doi.org/10.1159/000531605","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46957976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darmkrebsmonat März, Matthias P. Ebert, Vorstandsmitglied der Dgvs
In der Normalbevölkerung steigt das Darmkrebsrisiko ab dem 50. Lebensjahr. Daher erhalten gesetzlich Versicherte in diesem Alter regelmäßig Einladungen zur Darmkrebsvorsorge. Für Menschen, bei denen bereits Darmkrebsfälle in der Familie bekannt sind, wären regelmäßige Vorsorgeuntersuchungen bereits ab dem 30. Lebensjahr sinnvoll und kosteneffektiv. Das zeigen die Ergebnisse der im vergangenen Jahr veröffentlichten FARKOR-Studie. Im Rahmen der Studie wurden Menschen mit familiärer Darmkrebs-Vorbelastung zu einem Darmkrebs-Screening eingeladen. Das Ergebnis: Jede achte Untersuchung brachte Darmkrebs-Vorstufen zutage. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) begrüßt daher die Empfehlung des Gemeinsamen Bundesausschusses (G-BA), das familiäre Darmkrebsscreening in die Krebsfrüherkennungsrichtlinie aufzunehmen und fordert eine Umsetzung noch in diesem Jahr. Das Kürzel FARKOR steht für das Projekt „Vorsorge bei familiärem Risiko für das kolorektale Karzinom“ – eine Studie, die auf Initiative der Felix Burda Stiftung als bayrisches Modellprojekt durch den Innovationsausschuss des G-BA seit 2017 gefördert wurde und deren Auswertung nun vorliegt. „Die Studie belegt klar den Nutzen einer früheren Darmkrebsvorsorge bei Menschen mit familiärer Vorbelastung“, sagt Professor Dr. med. Frank Kolligs, Chefarzt der Inneren Medizin und Gastroenterologie am Helios Klinikum Berlin-Buch, der die Task Force Darmkrebs der DGVS leitet. Als familiär DGVS fordert zum Darmkrebsmonat März
{"title":"Society Bulletins","authors":"Darmkrebsmonat März, Matthias P. Ebert, Vorstandsmitglied der Dgvs","doi":"10.1159/000531095","DOIUrl":"https://doi.org/10.1159/000531095","url":null,"abstract":"In der Normalbevölkerung steigt das Darmkrebsrisiko ab dem 50. Lebensjahr. Daher erhalten gesetzlich Versicherte in diesem Alter regelmäßig Einladungen zur Darmkrebsvorsorge. Für Menschen, bei denen bereits Darmkrebsfälle in der Familie bekannt sind, wären regelmäßige Vorsorgeuntersuchungen bereits ab dem 30. Lebensjahr sinnvoll und kosteneffektiv. Das zeigen die Ergebnisse der im vergangenen Jahr veröffentlichten FARKOR-Studie. Im Rahmen der Studie wurden Menschen mit familiärer Darmkrebs-Vorbelastung zu einem Darmkrebs-Screening eingeladen. Das Ergebnis: Jede achte Untersuchung brachte Darmkrebs-Vorstufen zutage. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) begrüßt daher die Empfehlung des Gemeinsamen Bundesausschusses (G-BA), das familiäre Darmkrebsscreening in die Krebsfrüherkennungsrichtlinie aufzunehmen und fordert eine Umsetzung noch in diesem Jahr. Das Kürzel FARKOR steht für das Projekt „Vorsorge bei familiärem Risiko für das kolorektale Karzinom“ – eine Studie, die auf Initiative der Felix Burda Stiftung als bayrisches Modellprojekt durch den Innovationsausschuss des G-BA seit 2017 gefördert wurde und deren Auswertung nun vorliegt. „Die Studie belegt klar den Nutzen einer früheren Darmkrebsvorsorge bei Menschen mit familiärer Vorbelastung“, sagt Professor Dr. med. Frank Kolligs, Chefarzt der Inneren Medizin und Gastroenterologie am Helios Klinikum Berlin-Buch, der die Task Force Darmkrebs der DGVS leitet. Als familiär DGVS fordert zum Darmkrebsmonat März","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"62 - 70"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41870458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Das Leitlinienprogramm Onkologie hat seine S3-Leitlinie zum Hepatozellulären Karzinom (HCC) und zu biliären Karzinomen aktualisiert. Die überarbeitete Fassung enthält unter anderem neue Empfehlungen zur Zweitlinientherapie bei biliären Karzinomen und zu seltenen Erkrankungen als Risikofaktoren für HCC. Die S3Leitlinie entstand unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und unter Mitwirkung von 36 Fachgesellschaften und Organisationen. Ziel ist es, evidenzbasierte Behandlungsmöglichkeiten aufzuzeigen und die Therapie von Patient*innen mit hepatobiliären Tumoren zu verbessern.
{"title":"Society Bulletins","authors":"biliären Karzinomen","doi":"10.1159/000530032","DOIUrl":"https://doi.org/10.1159/000530032","url":null,"abstract":"Das Leitlinienprogramm Onkologie hat seine S3-Leitlinie zum Hepatozellulären Karzinom (HCC) und zu biliären Karzinomen aktualisiert. Die überarbeitete Fassung enthält unter anderem neue Empfehlungen zur Zweitlinientherapie bei biliären Karzinomen und zu seltenen Erkrankungen als Risikofaktoren für HCC. Die S3Leitlinie entstand unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und unter Mitwirkung von 36 Fachgesellschaften und Organisationen. Ziel ist es, evidenzbasierte Behandlungsmöglichkeiten aufzuzeigen und die Therapie von Patient*innen mit hepatobiliären Tumoren zu verbessern.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"30 - 38"},"PeriodicalIF":1.9,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46783337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01Epub Date: 2023-02-23DOI: 10.1159/000529725
Imad Kamaleddine, Magdalena Popova, Ahmad Alwali, Clemens Schafmayer
An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.
{"title":"Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature.","authors":"Imad Kamaleddine, Magdalena Popova, Ahmad Alwali, Clemens Schafmayer","doi":"10.1159/000529725","DOIUrl":"10.1159/000529725","url":null,"abstract":"<p><p>An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"18-24"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9399576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01Epub Date: 2022-11-30DOI: 10.1159/000526633
Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz
Background: Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a "high-risk" situation, there is a risk for lymph node metastasis of up to 23%.
Summary: The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.
Key messages: Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a "high-risk" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a "low-risk" constellation (G1/G2; L0, size <3 cm) and an R0 resection.
{"title":"Diagnostic and Therapeutic Management of Early Colorectal Cancer.","authors":"Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz","doi":"10.1159/000526633","DOIUrl":"10.1159/000526633","url":null,"abstract":"<p><strong>Background: </strong>Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a \"high-risk\" situation, there is a risk for lymph node metastasis of up to 23%.</p><p><strong>Summary: </strong>The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.</p><p><strong>Key messages: </strong>Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a \"high-risk\" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a \"low-risk\" constellation (G1/G2; L0, size <3 cm) and an R0 resection.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"10-16"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10230821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9571889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01Epub Date: 2023-03-28DOI: 10.1159/000530030
Karoline Horisberger, Carolina Mann, Hauke Lang
Background: Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).
Summary: LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.
Key message: Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.
{"title":"Current Surgical Concepts in Lynch Syndrome and Familial Adenomatous Polyposis.","authors":"Karoline Horisberger, Carolina Mann, Hauke Lang","doi":"10.1159/000530030","DOIUrl":"10.1159/000530030","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).</p><p><strong>Summary: </strong>LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.</p><p><strong>Key message: </strong>Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10051043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9297024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}