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Cahyadi O, Dhir V, Leeds J, de-Madaria E, Tehami N. The DESTIN trial: to step up or not? Lancet Gastroenterol Hepatol 2024; 9:289. [PMID: 38460533 DOI: 10.1016/s2468-1253(24)00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology, St. Josef-Hospital, Ruhr-University Bochum, Bochum D-44791, Germany.
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
| | - John Leeds
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK; Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Enrique de-Madaria
- Department of Gastroenterology, Dr Balmis General University Hospital and Department of Clinical Medicine, Miguel Herna´ndez University, Alicante, Spain; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Nadeem Tehami
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Cahyadi O, Siau K. Retained biopsy specimens: Are they a major issue in endoscopy? Endosc Int Open 2023; 11:E719-E720. [PMID: 37564333 PMCID: PMC10411110 DOI: 10.1055/a-2114-3681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Germany
| | - Keith Siau
- Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom of Great Britain and Northern Ireland
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Gerber TS, Goeppert B, Hausen A, Witzel HR, Bartsch F, Schindeldecker M, Gröger LK, Ridder DA, Cahyadi O, Esposito I, Gaida MM, Schirmacher P, Galle PR, Lang H, Roth W, Straub BK. N-Cadherin Distinguishes Intrahepatic Cholangiocarcinoma from Liver Metastases of Ductal Adenocarcinoma of the Pancreas. Cancers (Basel) 2022; 14:cancers14133091. [PMID: 35804866 PMCID: PMC9264797 DOI: 10.3390/cancers14133091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/12/2022] Open
Abstract
Carcinomas of the pancreatobiliary system confer an especially unfavorable prognosis. The differential diagnosis of intrahepatic cholangiocarcinoma (iCCA) and its subtypes versus liver metastasis of ductal adenocarcinoma of the pancreas (PDAC) is clinically important to allow the best possible therapy. We could previously show that E-cadherin and N-cadherin, transmembrane glycoproteins of adherens junctions, are characteristic features of hepatocytes and cholangiocytes. We therefore analyzed E-cadherin and N-cadherin in the embryonally related epithelia of the bile duct and pancreas, as well as in 312 iCCAs, 513 carcinomas of the extrahepatic bile ducts, 228 gallbladder carcinomas, 131 PDACs, and precursor lesions, with immunohistochemistry combined with image analysis, fluorescence microscopy, and immunoblots. In the physiological liver, N-cadherin colocalizes with E-cadherin in small intrahepatic bile ducts, whereas larger bile ducts and pancreatic ducts are positive for E-cadherin but contain decreasing amounts of N-cadherin. N-cadherin was highly expressed in most iCCAs, whereas in PDACs, N-cadherin was negative or only faintly expressed. E- and N-cadherin expression in tumors of the pancreaticobiliary tract recapitulate their expression in their normal tissue counterparts. N-cadherin is a helpful marker for the differential diagnosis between iCCA and PDAC, with a specificity of 96% and a sensitivity of 67% for small duct iCCAs and 50% for large duct iCCAs.
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Affiliation(s)
- Tiemo S. Gerber
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Benjamin Goeppert
- Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, 71640 Ludwigsburg, Germany; (B.G.); (P.S.)
| | - Anne Hausen
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Hagen R. Witzel
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (F.B.); (L.-K.G.); (H.L.)
| | - Mario Schindeldecker
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
- Tissue Biobank, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Lisa-Katharina Gröger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (F.B.); (L.-K.G.); (H.L.)
| | - Dirk A. Ridder
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Oscar Cahyadi
- Institute of Pathology, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Irene Esposito
- Institute of Pathology, University Clinic Düsseldorf, 40225 Düsseldorf, Germany;
| | - Matthias M. Gaida
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Peter Schirmacher
- Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, 71640 Ludwigsburg, Germany; (B.G.); (P.S.)
| | - Peter R. Galle
- Department of Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (F.B.); (L.-K.G.); (H.L.)
| | - Wilfried Roth
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
| | - Beate K. Straub
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (T.S.G.); (A.H.); (H.R.W.); (M.S.); (D.A.R.); (M.M.G.); (W.R.)
- Correspondence:
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Abd El Aziz M, Cahyadi O, Meier JJ, Schmidt WE, Nauck MA. Incretin-based glucose-lowering medications and the risk of acute pancreatitis and malignancies: a meta-analysis based on cardiovascular outcomes trials. Diabetes Obes Metab 2020; 22:699-704. [PMID: 31750601 DOI: 10.1111/dom.13924] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022]
Abstract
Some epidemiological data have suggested an elevated risk of acute pancreatitis and pancreatic cancer after exposure to glucagon-like peptide (GLP)-1 receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors. Recently, such outcomes have been assessed and adjudicated as adverse events of special interest in cardiovascular outcomes studies. We performed a meta-analysis of cases of acute pancreatitis and pancreatic cancer as well as any malignant neoplasm reported in cardiovascular outcomes trials (CVOTs) with GLP-1 receptor agonists and DPP-4 inhibitors. The numbers of cases observed with active drug or placebo (both on a background of standard care) were related to patient-years of observation. Rate ratios and their confidence intervals were calculated for the individual agents as well as for the classes of GLP-1 receptor agonists and DPP-4 inhibitors. Neither data on individual CVOTs of GLP-1 receptor agonists nor their meta-analysis [rate ratio: 1.05 (0.78-1.41)] indicated a significantly elevated risk of acute pancreatitis. All individual DPP-4 inhibitors displayed a non-significant trend towards an increased risk of acute pancreatitis, which was significant in the meta-analysis [1.75 (1.14-2.70); P = 0.01]. Neither GLP-1 receptor agonists nor DPP-4 inhibitors were associated with a significantly elevated or reduced risk of pancreatic cancer or for the totality of all malignant neoplasms. Based on a large database of randomized, placebo-controlled, prospective cardiovascular outcomes studies with GLP-1 receptor agonists and DPP-4 inhibitors, no signal for pancreatic cancer or any malignant neoplasms were detected. However, a 75% risk increase for the development of an acute pancreatitis was seen in the meta-analysis of DPP-4 inhibitor CVOTs.
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Affiliation(s)
- Mirna Abd El Aziz
- Diabetes Division, Department of Medicine I, St. Josef-Hospital (Ruhr-University Bochum), Gudrunstraße 56, D-44791, Bochum, Germany
| | - Oscar Cahyadi
- Diabetes Division, Department of Medicine I, St. Josef-Hospital (Ruhr-University Bochum), Gudrunstraße 56, D-44791, Bochum, Germany
| | - Juris J Meier
- Diabetes Division, Department of Medicine I, St. Josef-Hospital (Ruhr-University Bochum), Gudrunstraße 56, D-44791, Bochum, Germany
| | - Wolfgang E Schmidt
- Diabetes Division, Department of Medicine I, St. Josef-Hospital (Ruhr-University Bochum), Gudrunstraße 56, D-44791, Bochum, Germany
| | - Michael A Nauck
- Diabetes Division, Department of Medicine I, St. Josef-Hospital (Ruhr-University Bochum), Gudrunstraße 56, D-44791, Bochum, Germany
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Cahyadi O, Bauder M, Meier B, Caca K, Schmidt A. Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding - a single center experience. Endosc Int Open 2017; 5:E1159-E1164. [PMID: 29124127 PMCID: PMC5677459 DOI: 10.1055/s-0043-118794] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. PATIENTS AND METHODS Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods. RESULTS Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. CONCLUSIONS TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an "add-on" therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.
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Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Markus Bauder
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
- Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Cahyadi O, Caca K, Schmidt A. Over-the-scope clip is an effective therapy for postbanding ulcer bleeding after initially successful transjugular intrahepatic portosystemic shunt therapy. Endoscopy 2017; 49:E258-E259. [PMID: 28759921 DOI: 10.1055/s-0043-115890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Arthur Schmidt
- Center of Interdisciplinary Gastrointestinal Endoscopy, University Medical Center Freiburg, Germany
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Cahyadi O, Damm M, Merk T, Hetzel M. Pulmonale Langerhanszell-Histiozytose als seltene Ursache des chronischen Hustens. Pneumologie 2016. [DOI: 10.1055/s-0036-1572166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND AND AIMS Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device. METHODS Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD). RESULTS Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed. CONCLUSIONS EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections.
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Oscar Cahyadi
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Schmidt A, Riecken B, Damm M, Cahyadi O, Bauder M, Caca K. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46:762-6. [PMID: 24770968 DOI: 10.1055/s-0034-1365493] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Over-the-scope clips (OTSCs; Ovesco Endoscopy, Tübingen, Germany) are extensively used for treatment of gastrointestinal perforations, leakages, fistulas, and bleeding. In this report, a new method of removing OTSCs using a prototype bipolar cutting device is described. PATIENTS AND METHODS A total of 11 patients underwent endoscopic removal of an OTSC. The OTSC was cut at two opposing sites by a prototype device (DC ClipCutter; Ovesco Endoscopy). The remaining clip fragments were extracted using a standard forceps. RESULTS Mean procedure time was 47 minutes (range 35 - 75 minutes). Cutting of the OTSC at two opposing sites was successful in all cases (100 %). Complete retrieval of all clip fragments was possible in 10 patients (91 %). The overall success rate for cutting and complete removal of the clip was 91 %. No major complications were observed. CONCLUSIONS Removal of OTSCs with the prototype device was feasible and effective. The device may be valuable for OTSC removal in emergency as well as elective indications.
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Michael Damm
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Oscar Cahyadi
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Markus Bauder
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Cahyadi O, Schmidt A, Caca K. Transgastric endoscopic biliary drainage in an old patient with complete ligation of the common bile duct at cholecystectomy. Dig Endosc 2014; 26:605-6. [PMID: 24754312 DOI: 10.1111/den.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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