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| 1 | Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology显示文摘AIM:To report the largest patient cohort study investigating the diagnostic yield of intraductal ultrasound (IDUS) in indeterminate strictures of the common bile duct.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by IDUS.Sensitivity,specificity and accuracy rates of IDUS were calculated relating to the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.Analysis of the endosonographic report allowed drawing conclusions with respect to the T and N staging in 147 patients.IDUS staging was compared to the postoperative histopathological staging data allowing calculation of sensitivity,specificity and accuracy rates for T and N stages.The endoscopic retrograde cholangio-pancreatography and IDUS procedures were performed under fluoroscopic guidance using a side-viewing duodenoscope (Olympus TJF 160,Olympus,Ltd.,Tokyo,Japan).All procedures were performed under conscious sedation (propofol combined with pethidine) according to the German guidelines.For IDUS,a 6 F or 8 F ultrasound miniprobe was employed with a radial scanner of 15-20 MHz at the tip of the probe (Aloka Co.,Tokyo,Japan).RESULTS:A total of 397 patients (210 males,187 females,mean age 61.43 ± 13 years) with indeterminate bile duct strictures were included.Two hundred and sixty-four patients were referred to the department of surgery for operative exploration,thus surgical histopathological correlation was available for those patients.Out of 264 patients,174 had malignant disease proven by surgery,in 90 patients benign disease was found.In these patients decision for surgical exploration was made due to suspicion for malignant disease in multimodal diagnostics (computed tomography scan,endoscopic ultrasound or magnetic resonance imaging).Twenty benign bile duct strictures were misclassified by IDUS as malignant while 14 patients with malignant strictures were initially misdiagnosed by IDUS as benign resulting in sensitivity,specificity and accuracy ratesof 93.2%,89.5% and 91.4%,respectively.In the subgroup analysis of malignancy prediction,IDUS showed best performance in cholangiocellular carcinoma as underlying disease (sensitivity rate,97.6%) followed by pancreatic carcinoma (93.8%),gallbladder cancer (88.9%) and ampullary cancer (80.8%).A total of 133 patients were not surgically explored.32 patients had palliative therapy due to extended tumor disease in IDUS and other imaging modalities.Ninety-five patients had benign diagnosis by IDUS,forceps biopsy and radiographic imaging and were followed by a surveillance protocol with a follow-up of at least 12 mo;the mean follow-up was 39.7 mo.Tumor localization within the common bile duct did not have a significant influence on prediction of malignancy by IDUS.The accuracy rate for discriminating early T stage tumors (T1) was 84% while for T2 and T3 malignancies the accuracy rates were 73% and 71%,respectively.Relating to N0 and N1 staging,IDUS procedure achieved accuracy rates of 69% for N0 and N1,respectively.Limitations:Pretest likelihood of 52% may not rule out bias and overinterpretation due to the clinical scenario or other prior performed imaging tests.CONCLUSION:IDUS shows good results for accurate diagnostics of bile duct strictures of uncertain etiology thus allowing for adequate further clinical management. | Tobias Meister Hauke S Heinzow Carina Woestmeyer Philipp Lenz Josef Menzel Torsten Kucharzik Wolfram Domschke Dirk Domagk | 2013 | World Journal of Gastroenterology2013，19，6： | 19 |
| 2 | Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis显示文摘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 implantation (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. Clinical 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 proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney Utest and the χ 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) before TIPS to 11.8 ± 4.0 vs 11.7 ± 4.2 after TIPS implantation (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 bleeding group (P = 0.009). The number of radiological controls 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), MELD score (P = 0.001) and those patients not having undergone liver transplantation (P = 0.024) were significant predictors of survival. In the Cox regression model, stent occlusion (P = 0.022), RA (P = 0.043), CHILD stage (P = 0.015) and MELD score (P = 0.004) turned out to be independent prognostic factors of survival. The anticoagulation management (P = 0.097), the porto-systemic pressure gradient (P= 0.460) and rebleeding episodes (P = 0.765) had no significant effect on the overall survival. CONCLUSION:RA, stent occlusion, initial CHILD stage and MELD score are independent predictors of survival in patients with TIPS, speaking for a close follow-up in these circumstances. | Hauke S Heinzow Philipp Lenz Michael Khler Frank Reinecke Hansjrg Ullerich Wolfram Domschke Dirk Domagk Tobias Meister | 2012 | World Journal of Gastroenterology2012，18，37： | 17 |
| 3 | Comparative analysis of ERCP,IDUS,EUS and CT in predicting malignant bile duct strictures显示文摘AIM:To compare endoscopic retrograde cholangio-pancreatography(ERCP),intraductal ultrasound(IDUS),endosonography(EUS),endoscopic transpapillary forceps biopsies(ETP)and computed tomography(CT)with respect to diagnosing malignant bile duct strictures.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS,ETP,EUS,and CT.The sensitivity,specificity,and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.For each of the diagnostic measures,the sensitivity,specificity,and accuracy rates were calculated.In all cases,the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo.A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and theχ2test as appropriate.A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test.Differences were considered statistically significant if P<0.05.RESULTS:A total of 234 patients(127 males,107 females,median age 64,range 20-90 years)with indeterminate bile duct strictures were included.A total of 161patients underwent operative exploration;thus,a surgical histopathological correlation was available for those patients.A total of 113 patients had malignant disease proven by surgery;in 48 patients,benign disease was surgically found.In these patients,the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics(ERCP,CT,or EUS).Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a followup of at least 12 mo;the median follow-up was 34 mo.Twenty-three patients had extended malignant disease,and thus were considered palliative.A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91%(ERCP/IDUS),59%(ETP),92%(IDUS+ETP),74%(EUS),and 73%(CT),respectively.In the subgroup analysis,the accuracy rates(%,ERCP+IDUS/ETP/IDUS+ETP;EUS;CT)for each tumor entity were as follows:cholangiocellular carcinoma:92%/74%/92%/70%/79%;pancreatic carcinoma:90%/68%/90%/81%/76%;and ampullary carcinoma:88%/90%/90%/76%/76%.The detection rate of malignancy by ERCP/IDUS was superior to ETP(91%vs 59%,P<0.0001),EUS(91%vs74%,P<0.0001)and CT(91%vs 73%,P<0.0001);EUS was comparable to CT(74%vs 73%,P=0.649).When analyzing accuracy rates with regard to localization of the bile duct stenosis,the accuracy rate of EUS for proximal vs distal stenosis was significantly higher for distal stenosis(79%vs 57%,P<0.0001).CONCLUSION:ERCP/IDUS is superior to EUS and CT in providing accurate diagnoses of bile duct strictures of uncertain etiology.Multimodal diagnostics is recommended. | Hauke S Heinzow Sara Kammerer Carina Rammes Johannes Wessling Dirk Domagk Tobias Meister | 2014 | World Journal of Gastroenterology2014，20，30： | 14 |
| 4 | Colon capsule endoscopy versus standard colonoscopy in assessing disease activity of ulcerative colitis: a prospective trial显示文摘 | T. Meister H. S. Heinzow D. Domagk A. Dortgolz F. Lenze M. Ross W. Domschke A. Lügering | 2013 | Techniques in Coloproctology2013，，6： | 4 |
| 5 | Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis显示文摘AIM:To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis.METHODS: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(ClinicalTrials.gov:NCT01109550).Bile,buccal,and stool samples were collected.When indicated,endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal infections.RESULTS: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(P<0.05).Patients with immunosuppression(P=0.058)and recent long-term antibiotic therapy(>7 d)(P=0.089)tend to be at risk for biliary candidiasis.One patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed histologically.Of Candida subspecies detected,36.7%were azole-resistant,such as C glabrata.Eight patients received anti-mycotic therapy,based on our algorithm.Of these,3 had cancer with biliary tract involvement,2had secondary sclerosing cholangitis,1 had retroperitoneal fibrosis,and 5 had septicemia.In all patients contamination was ruled out by smears of the endoscope channel.CONCLUSION:Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary disorders.Our suggested algorithm facilitates the further clinical management. | Philipp Lenz Franziska Eckelskemper Thomas Erichsen Tim Lankisch Alexander Dechêne Gabriele Lubritz Frank Lenze Torsten Beyna Hansjorg Ullerich Andre Schmedt Dirk Domagk | 2014 | World Journal of Gastroenterology2014，20，34： | 2 |
| 6 | Double- vs. single-balloon vs. spiral enteroscopy显示文摘 | Philipp Lenz Dirk Domagk | 2012 | Best Practice & Research Clinical Gastroenterology2012，，3： | 2 |
| 7 | S3 Guideline: Sedation for gastrointestinal endoscopy 2008显示文摘 | A. Riphaus T. Wehrmann B. Weber J. Arnold U. Beilenhoff H. Bitter S. von Delius D. Domagk A. Ehlers S. Faiss D. Hartmann W. Heinrichs M.-L. Hermans C. Hofmann S. In der Smitten M. Jung G. K?hler M. Kraus J. Martin A. Meining J. Radke T. R?sch H. Seifert A | 2009 | Endoscopy2009，，09： | 1 |
| 8 | Diagnosis of and Therapy for Hepatocellular Carcinoma显示文摘 | T. Greten N. Malek S. Schmidt J. Arends P. Bartenstein W. Bechstein T. Bernatik M. Bitzer A. Chavan M. Dollinger D. Domagk O. Drognitz M. Düx S. Farkas G. Folprecht P. Galle M. Gei?ler G. Gerken D. Habermehl T. Helmberger K. Herfarth R. Hoffmann M. Holtma | 2013 | Z Gastroenterol2013，，11： | 1 |
| 9 | Colorectal polyps: detection with multi-slice CT colonography显示文摘 | Wessling J Fischbach R Domagk D | 2001 | Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr2001，173，12： | 1 |
| 10 | Endoscopic retrograde cholangiopancreatography,intraductal utrasonography,and magnet-ic resonance cholangiopancreatography in bile duct strictures:a prospective comparision of imaging diagnostic with histopathological correlation显示文摘 | Domagk D Wessling J Reimer V | 2004 | Am J Gastroenterol2004，99，16： | 1 |
| 11 | Single-versus doub- le-balloon enteroscopy: the evidence base: Comment on Endoscopy essentials, Small-bowel endoseopy显示文摘 | Lenz P Domagk D Mensink P | 2012 | Endos- copy2012，44，8： | 1 |
| 12 | Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial显示文摘 | D. Domagk P. Mensink H. Aktas P. Lenz T. Meister A. Luegering H. Ullerich L. Aabakken A. Heinecke W. Domschke E. Kuipers M. Bretthauer | 2011 | Endoscopy2011，，06： | 1 |
| 13 | Endoscopic Retrograde Cholangiopancreatography,Intraductal Ultrasonography,and Magnetic Resonance Cholangiopancreatography in Bile Duct Strictures:a Prospective Comparison of Imaging Diagnostics with Histopathological Correlation显示文摘 | Domagk D Wessling J Reimer P | 2004 | Am J Gastroenterol2004，99，9： | 1 |
| 14 | Malignant bowel obstruction显示文摘 | Zorn M Domagk D Auerbauch T | | 0，，02： | 1 |
| 15 | Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostic with histopathological correlation显示文摘 | Domagk D Wessling J Reimer P | 2004 | Am J Gastroenterol2004，99，9： | 1 |
| 16 | Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and mag- netic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation显示文摘 | Domagk D Wessling J Reimer P | 2004 | Am J Gastroenterol2004，99，9： | 1 |
| 17 | Diagnostic and radio-logical management of cystic pancreatic lesions: important fea-tures for radiologists 显示文摘 | Buerke B Domagk D Heindel W | 2012 | Clin Radiol2012，67，8： | 1 |
| 18 | Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure 显示文摘 | Kuster GG Domagk D | 1996 | Surg Endosc1996，10，4： | 1 |
| 19 | Double- vs. single-balloon vs. spiral enteroscopy显示文摘 | Philipp Lenz Dirk Domagk | 2012 | Best Practice & Research Clinical Gastroenterology2012，，3： | 1 |
| 20 | Gastric duplication cyst: A rare endosonographic finding in an adult显示文摘 | Verena Hlouschek Dirk Domagk Joerg Naehrig Joerg Ruediger Siewert W. Domschke | 2005 | Scandinavian Journal of Gastroenterology2005，，9： | 1 |
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