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Okhrimchuk D, Hurtevent P, Gonze MA, Simon-Cornu M, Roulier M, Carasco L, Orjollet D, Nicolas M, Probst A. Long-term behaviour of Cs-137, Cs-133 and K in beech trees of French forests. J Environ Radioact 2024; 277:107450. [PMID: 38762981 DOI: 10.1016/j.jenvrad.2024.107450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/04/2024] [Accepted: 05/12/2024] [Indexed: 05/21/2024]
Abstract
In the long-term after atmospheric deposit onto a forest ecosystem, Cs-137 becomes incorporated into the biogeochemical cycle of stable elements and progressively reaches a quasi-equilibrium state. This study aimed at determining to what extent Cs-137 activity distribution in tree vegetation could be predicted from that of stable caesium (Cs-133) and potassium (K), which are known to be stable chemical analogues and competitors for Cs-137 intake in tree organs. Field campaigns that focused on beech trees (Fagus sylvatica L.) were conducted in 2021 in three French forest stands with contrasted characteristics regarding either the contribution of global vs. Chornobyl fallouts, soil or climatic conditions. Decades after Cs-137 fallouts, it was found that more than 80% of the total radioactive inventory in the system remained confined in the top 20 cm mineral layers, while organic layers and beech vegetation (including roots) contributed each to less than 1.5%. The enhanced downward migration of Cs-137 in cambisol than podzol forest sites was presumably due to migration of clay particles and bioturbation. The distribution of Cs-137 and Cs-133 inventories in beech trees was very similar among sites but differed from that of K due a higher accumulation of Cs isotopes in roots (40-50% vs. < 25% for K). The aggregated transfer factor (Tag) of Cs-137 calculated for aerial beech organs were all lower than those reported in literature more than 20 years ago, this suggesting a decrease of bioavailability in soil due to ageing processes. Regarding their variability, Tags were generally lower by a factor 5 at the cambisol site, which was fairly well explained by a much higher value of RIP (radiocesium immobilisation potential). Cs-137 concentrations in trees organs normalized by the soil exchangeable fractions were linearly correlated to those of Cs-133 and the best fit was found for the linear regression model without intercept indicating that no more contribution of the foliar uptake could be observed on long term. Provided that the vertical distribution of caesium concentrations and fine root density are properly measured or estimated, Cs-133 was shown to be a much better proxy than K to estimate the root transfer of Cs-137.
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Affiliation(s)
- D Okhrimchuk
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - P Hurtevent
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France.
| | - M-A Gonze
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - M Simon-Cornu
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - M Roulier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - L Carasco
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - D Orjollet
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LEREN, PSE-ENV/SPDR/LT2S, PSE-ENV/STAAR/LRTA, F-13115 Saint-Paul-lez-Durance, France
| | - M Nicolas
- ONF/Département Recherche-Développement-Innovation, F-77330, Fontainebleau, France
| | - A Probst
- CRBE (Centre de Recherche sur la Biodiversité et l'Environnement), Université de Toulouse, CNRS, IRD, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UT3), F-31062, Toulouse, France
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2
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Meinikheim M, Mendel R, Palm C, Probst A, Muzalyova A, Scheppach MW, Nagl S, Schnoy E, Römmele C, Schulz DAH, Schlottmann J, Prinz F, Rauber D, Rückert T, Matsumura T, Fernández-Esparrach G, Parsa N, Byrne MF, Messmann H, Ebigbo A. Influence of artificial intelligence on the diagnostic performance of endoscopists in the assessment of Barrett's esophagus: a tandem randomized and video trial. Endoscopy 2024. [PMID: 38547927 DOI: 10.1055/a-2296-5696] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/04/2024]
Abstract
BACKGROUND This study evaluated the effect of an artificial intelligence (AI)-based clinical decision support system on the performance and diagnostic confidence of endoscopists in their assessment of Barrett's esophagus (BE). METHODS 96 standardized endoscopy videos were assessed by 22 endoscopists with varying degrees of BE experience from 12 centers. Assessment was randomized into two video sets: group A (review first without AI and second with AI) and group B (review first with AI and second without AI). Endoscopists were required to evaluate each video for the presence of Barrett's esophagus-related neoplasia (BERN) and then decide on a spot for a targeted biopsy. After the second assessment, they were allowed to change their clinical decision and confidence level. RESULTS AI had a stand-alone sensitivity, specificity, and accuracy of 92.2%, 68.9%, and 81.3%, respectively. Without AI, BE experts had an overall sensitivity, specificity, and accuracy of 83.3%, 58.1%, and 71.5%, respectively. With AI, BE nonexperts showed a significant improvement in sensitivity and specificity when videos were assessed a second time with AI (sensitivity 69.8% [95%CI 65.2%-74.2%] to 78.0% [95%CI 74.0%-82.0%]; specificity 67.3% [95%CI 62.5%-72.2%] to 72.7% [95%CI 68.2%-77.3%]). In addition, the diagnostic confidence of BE nonexperts improved significantly with AI. CONCLUSION BE nonexperts benefitted significantly from additional AI. BE experts and nonexperts remained significantly below the stand-alone performance of AI, suggesting that there may be other factors influencing endoscopists' decisions to follow or discard AI advice.
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Affiliation(s)
- Michael Meinikheim
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Anna Muzalyova
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Markus W Scheppach
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Dominik A H Schulz
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Schlottmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Friederike Prinz
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - David Rauber
- Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tobias Rückert
- Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tomoaki Matsumura
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, United States
- Satisfai Health, Vancouver, Canada
| | - Michael F Byrne
- Satisfai Health, Vancouver, Canada
- Gastroenterology, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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3
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Saito Y, Sakamoto T, Dekker E, Pioche M, Probst A, Ponchon T, Messmann H, Dinis-Ribeiro M, Matsuda T, Ikematsu H, Saito S, Wada Y, Oka S, Sano Y, Fujishiro M, Murakami Y, Ishikawa H, Inoue H, Tanaka S, Tajiri H. First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial. Dig Endosc 2024; 36:591-599. [PMID: 37702082 DOI: 10.1111/den.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/10/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Narrow-band imaging (NBI) contributes to real-time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. METHODS This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non-JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white-light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. RESULTS In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high-grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. CONCLUSION The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity.
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Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- University of Tsukuba, Ibaraki, Japan
| | - Evelien Dekker
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andreas Probst
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Helmut Messmann
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Toho University, Tokyo, Japan
| | | | | | | | - Shiro Oka
- Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | - Shinji Tanaka
- Hiroshima University, Hiroshima, Japan
- JA Onomichi General Hospital, Hiroshima, Japan
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Schlottmann J, Miller S, Scheurig-Münkler C, Merkl C, Weber T, Eser S, Fuchs A, Messmann H, Probst A. [Acute abdomen-Rare cause in an 80-year-old female patient under immunosuppressive treatment]. Inn Med (Heidelb) 2024; 65:503-507. [PMID: 37831085 PMCID: PMC11058932 DOI: 10.1007/s00108-023-01593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/14/2023]
Abstract
An 80-year-old woman presented to the emergency department due to abdominal pain. She had a history of opportunistic pneumonia under the effects of immunosuppression after the diagnosis of autoimmune hepatitis. The imaging showed an omental cake formation and the suspicion of peritoneal carcinomatosis. The patient developed an acute abdomen during the hospital stay, followed by exploratory laparotomy. In the presence of extensive intra-abdominal abscess formation both surgically acquired material and blood culture revealed disseminated nocardiosis. The course was fatal due to fulminant septic shock.
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Affiliation(s)
- J Schlottmann
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - S Miller
- Institut für Pathologie und molekulare Diagnostik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - C Scheurig-Münkler
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - C Merkl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T Weber
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - S Eser
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Fuchs
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - H Messmann
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Probst
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
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5
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Ferlitsch M, Hassan C, Bisschops R, Bhandari P, Dinis-Ribeiro M, Risio M, Paspatis GA, Moss A, Libânio D, Lorenzo-Zúñiga V, Voiosu AM, Rutter MD, Pellisé M, Moons LMG, Probst A, Awadie H, Amato A, Takeuchi Y, Repici A, Rahmi G, Koecklin HU, Albéniz E, Rockenbauer LM, Waldmann E, Messmann H, Triantafyllou K, Jover R, Gralnek IM, Dekker E, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy 2024. [PMID: 38670139 DOI: 10.1055/a-2304-3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/28/2024]
Abstract
1: ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2: ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3: ESGE recommends CSP, to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of small polyps (6-9 mm).Strong recommendation, high quality of evidence. 4: ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10-19 mm in size.Strong recommendation, high quality of evidence. 5: ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6: ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7: Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8: ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9: ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10: ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11: ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.
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Affiliation(s)
- Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Department of Gastroenterology, Evangelical Hospital, Vienna, Austria
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
| | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Mauro Risio
- Department of Pathology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
| | - Gregorios A Paspatis
- Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Vincente Lorenzo-Zúñiga
- Endoscopy Unit, La Fe University and Polytechnic Hospital / IISLaFe, Valencia, Spain
- Department of Medicine, Catholic University of Valencia, Valencia, Spain
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Department of Gastroenterology, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leon M G Moons
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Halim Awadie
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy
| | - Yoji Takeuchi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Gabriel Rahmi
- Hepatogastroenterology and Endoscopy Department, Hôpital européen Georges Pompidou, Paris, France
- Laboratoire de Recherches Biochirurgicales, APHP-Centre Université de Paris, Paris, France
| | - Hugo U Koecklin
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Teknon Medical Center, Barcelona, Spain
| | - Eduardo Albéniz
- Gastroenterology Department, Hospital Universitario de Navarra (HUN); Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lisa-Maria Rockenbauer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Waldmann
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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6
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Rodríguez de Santiago E, van Tilburg L, Deprez PH, Pioche M, Pouw RE, Bourke MJ, Seewald S, Weusten BLAM, Jacques J, Leblanc S, Barreiro P, Lemmers A, Parra-Blanco A, Küttner-Magalhães R, Libânio D, Messmann H, Albéniz E, Kaminski MF, Mohammed N, Ramos-Zabala F, Herreros-de-Tejada A, Huchima Koecklin H, Wallenhorst T, Santos-Antunes J, Cunha Neves JA, Koch AD, Ayari M, Garces-Duran R, Ponchon T, Rivory J, Bergman JJGHM, Verheij EPD, Gupta S, Groth S, Lepilliez V, Franco AR, Belkhir S, White J, Ebigbo A, Probst A, Legros R, Pilonis ND, de Frutos D, Muñoz González R, Dinis-Ribeiro M. Western outcomes of circumferential endoscopic submucosal dissection for early esophageal squamous cell carcinoma. Gastrointest Endosc 2024; 99:511-524.e6. [PMID: 37879543 DOI: 10.1016/j.gie.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/12/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS Circumferential endoscopic submucosal dissection (cESD) in the esophagus has been reported to be feasible in small Eastern case series. We assessed the outcomes of cESD in the treatment of early esophageal squamous cell carcinoma (ESCC) in Western countries. METHODS We conducted an international study at 25 referral centers in Europe and Australia using prospective databases. We included all patients with ESCC treated with cESD before November 2022. Our main outcomes were curative resection according to European guidelines and adverse events. RESULTS A total of 171 cESDs were performed on 165 patients. En bloc and R0 resections rates were 98.2% (95% confidence interval [CI], 95.0-99.4) and 69.6% (95% CI, 62.3-76.0), respectively. Curative resection was achieved in 49.1% (95% CI, 41.7-56.6) of the lesions. The most common reason for noncurative resection was deep submucosal invasion (21.6%). The risk of stricture requiring 6 or more dilations or additional techniques (incisional therapy/stent) was high (71%), despite the use of prophylactic measures in 93% of the procedures. The rates of intraprocedural perforation, delayed bleeding, and adverse cardiorespiratory events were 4.1%, 0.6%, and 4.7%, respectively. Two patients died (1.2%) of a cESD-related adverse event. Overall and disease-free survival rates at 2 years were 91% and 79%. CONCLUSIONS In Western referral centers, cESD for ESCC is curative in approximately half of the lesions. It can be considered a feasible treatment in selected patients. Our results suggest the need to improve patient selection and to develop more effective therapies to prevent esophageal strictures.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, CIBEREHD, Universidad de Alcalá, Madrid, Spain.
| | - Laurelle van Tilburg
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stefan Seewald
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jeremie Jacques
- Service d'Hépato-Gastro-Entérologie CHU Dupuytren, Limoges, France
| | - Sara Leblanc
- Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Pedro Barreiro
- Gastroenterology Department of Centro Hospitalar Lisboa Ocidental, Advanced Endoscopy Center of Hospital Lusíadas, Lisboa, Portugal
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | | | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal; MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Helmut Messmann
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra Navarrabiomed, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Michal F Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Noor Mohammed
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom
| | - Felipe Ramos-Zabala
- Gastroenterology Department, Hospital Universitario HM Montepríncipe, Grupo HM Hospitales, Boadilla del Monte, Madrid, Spain
| | - Alberto Herreros-de-Tejada
- Puerta de Hierro University Hospital Majadahonda IDIPHISA Instituto de Investigacion Segovia Arana, Majadahonda, Spain
| | | | | | - João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - João A Cunha Neves
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, CIBEREHD, Universidad de Alcalá, Madrid, Spain; Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Myriam Ayari
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Rodrigo Garces-Duran
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Eva P D Verheij
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stefan Groth
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | | | - Ana Rita Franco
- Gastroenterology Department of Centro Hospitalar Lisboa Ocidental, Advanced Endoscopy Center of Hospital Lusíadas, Lisboa, Portugal
| | - Sanaa Belkhir
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan White
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Alanna Ebigbo
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Romain Legros
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nastazja Dagny Pilonis
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Diego de Frutos
- Puerta de Hierro University Hospital Majadahonda IDIPHISA Instituto de Investigacion Segovia Arana, Majadahonda, Spain
| | | | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal; MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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7
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Grosser B, Heyer CM, Austgen J, Sipos E, Reitsam NG, Hauser A, VanSchoiack A, Kroeppler D, Vlasenko D, Probst A, Novotny A, Weichert W, Keller G, Schlesner M, Märkl B. Stroma AReactive Invasion Front Areas (SARIFA) proves prognostic relevance in gastric carcinoma and is based on a tumor-adipocyte interaction indicating an altered immune response. Gastric Cancer 2024; 27:72-85. [PMID: 37874427 PMCID: PMC10761465 DOI: 10.1007/s10120-023-01436-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Recently, we presented Stroma AReactive Invasion Front Areas (SARIFA) as a new histomorphologic negative prognostic biomarker in gastric cancer. It is defined as direct contact between tumor cells and fat cells. The aim of this study was to further elucidate the underlying genomic, transcriptional, and immunological mechanisms of the SARIFA phenomenon. METHODS To address these questions, SARIFA was classified on H&E-stained tissue sections of three cohorts: an external cohort (n = 489, prognostic validation), the TCGA-STAD cohort (n = 194, genomic and transcriptomic analysis), and a local cohort (n = 60, digital spatial profiling (whole transcriptome) and double RNA in situ hybridization/immunostaining of cytokines). RESULTS SARIFA status proved to be an independent negative prognostic factor for overall survival in an external cohort of gastric carcinomas. In TCGA-STAD cohort, SARIFA is not driven by distinct genomic alterations, whereas the gene expression analyses showed an upregulation of FABP4 in SARIFA-positive tumors. In addition, the transcriptional regulations of white adipocyte differentiation, triglyceride metabolism, and catabolism were upregulated in pathway analyses. In the DSP analysis of SARIFA-positive tumors, FABP4 and the transcriptional regulation of white adipocyte differentiation were upregulated in macrophages. Additionally, a significantly lower expression of the cytokines IL6 and TNFα was observed at the invasion front. CONCLUSIONS SARIFA proves to be a strong negative prognostic biomarker in advanced gastric cancer, implicating an interaction of tumor cells with tumor-promoting adipocytes with crucial changes in tumor cell metabolism. SARIFA is not driven by tumor genetics but is very likely driven by an altered immune response as a causative mechanism.
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Affiliation(s)
- Bianca Grosser
- Pathology, Medical Faculty Augsburg, Institute of Pathology and Molecular Diagnostics, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Christian M Heyer
- Biomedical Informatics, Data Mining and Data Analytics, Faculty of Applied Computer Science and Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Johannes Austgen
- Pathology, Medical Faculty Augsburg, Institute of Pathology and Molecular Diagnostics, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Eva Sipos
- Pathology, Medical Faculty Augsburg, Institute of Pathology and Molecular Diagnostics, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Nic G Reitsam
- Pathology, Medical Faculty Augsburg, Institute of Pathology and Molecular Diagnostics, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Andreas Hauser
- Biomedical Informatics, Data Mining and Data Analytics, Faculty of Applied Computer Science and Medical Faculty, University of Augsburg, Augsburg, Germany
| | | | | | - Dmytro Vlasenko
- General and Visceral Surgery, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Andreas Probst
- Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Alexander Novotny
- Department of Surgery, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Gisela Keller
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Schlesner
- Biomedical Informatics, Data Mining and Data Analytics, Faculty of Applied Computer Science and Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Pathology, Medical Faculty Augsburg, Institute of Pathology and Molecular Diagnostics, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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8
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Probst A, Ebigbo A, Märkl B, Wolf S, Messmann H. Enterocolonic Fistula After Endoscopic Full-Thickness Resection of an Adenoma at the Appendiceal Orifice. Am J Gastroenterol 2024; 119:22. [PMID: 37725689 DOI: 10.14309/ajg.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Institute of Pathology and Molecular Diagnostics, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Wolf
- Gastroenterologie Heidenheim, Heidenheim, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
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9
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Ebigbo A, Tadic V, Schlottmann J, Braun G, Prinz F, Wanzl J, Ayoub M, Kraus L, Scheppach M, Nagl S, Schnoy E, Weber T, Probst A, Messmann H, Römmele C. Evaluation of a single-use gastroscope in patients presenting with suspected upper gastrointestinal hemorrhage: a pilot feasibility study (One-Scope I). Endoscopy 2023; 55:940-944. [PMID: 37160261 DOI: 10.1055/a-2089-5969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND : Outbreaks of multidrug-resistant bacteria due to contaminated duodenoscopes and infection risks during the COVID-19 pandemic have driven the development of single-use endoscopes. The first single-use gastroscope is now available in Europe. Besides waste disposal and cost issues, the infection risk and performance remain unclear. We aimed to evaluate a single-use gastroscope in patients with signs of upper gastrointestinal bleeding. METHODS : 20 consecutive patients presenting with clinical signs of upper gastrointestinal bleeding between October and November 2022 were included in this case series. The primary aim was technical success, defined as access to the descending duodenum and adequate assessment of the upper gastrointestinal tract for the presence of a bleeding site. RESULTS : The primary aim was achieved in 19/20 patients (95 %). The bleeding site was identified in 18 patients. A therapeutic intervention was performed in six patients (two cap-mounted clips, one standard hemostatic clip, two variceal band ligations, one hemostatic powder, two adrenaline injections); technical and clinical success were achieved in all six patients. Two crossovers to a standard gastroscope occurred. CONCLUSIONS : Use of single-use gastroscopes may be feasible for patients presenting for urgent endoscopic evaluation and treatment of upper gastrointestinal bleeding.
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Affiliation(s)
- Alanna Ebigbo
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Vidan Tadic
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Jakob Schlottmann
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Georg Braun
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Friederike Prinz
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Julia Wanzl
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Mousa Ayoub
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Lisa Kraus
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Markus Scheppach
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Sandra Nagl
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Tobias Weber
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Probst
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Gastroenterology, Faculty of Medicine, University Hospital of Augsburg, Augsburg, Germany
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10
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Probst A, Schwarz F, Sommer F, Ayoub M, Messmann H. Hemorrhagic Shock After Endoscopic Biopsy of Sigmoid Cancer: Pseudoaneurysm of the Rectal Superior Artery. ACG Case Rep J 2023; 10:e01074. [PMID: 37324830 PMCID: PMC10266513 DOI: 10.14309/crj.0000000000001074] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplant Surgery, University of Augsburg, Augsburg, Germany
| | - Mousa Ayoub
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
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11
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van Munster SN, Leclercq P, Haidry R, Messmann H, Probst A, Ragunath K, Bhandari P, Repici A, Munoz-Navas M, Seewald S, Lemmers A, Fernández-Esparrach G, Pech O, Schoon EJ, Kariv R, Neuhaus H, Weusten BLAM, Siersema PD, Correale L, Meijer SL, de Hertogh G, Bergman JJGHM, Hassan C, Bisschops R. Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrett's esophagus: a multicenter randomized study. Endoscopy 2023; 55:303-310. [PMID: 36150646 DOI: 10.1055/a-1949-9542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current surveillance for Barrett's esophagus (BE), consisting of four-quadrant random forceps biopsies (FBs), has an inherent risk of sampling error. Wide-area transepithelial sampling (WATS) may increase detection of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). In this multicenter randomized trial, we aimed to evaluate WATS as a substitute for FB. METHODS Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice versa. All WATS samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Diagnostics laboratory. Similarly, all FBs were examined by two expert pathologists. The primary end point was concordance/discordance for detection of HGD/EAC between the two techniques. RESULTS 172 patients were included, of whom 21 had HGD/EAC detected by both modalities, 18 had HGD/EAC detected by WATS but missed by FB, and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (P = 0.36). Using WATS as an adjunct to FB significantly increased the detection of HGD/EAC vs. FB alone (absolute increase 10 % [95 %CI 6 % to 16 %]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95 %CI 5.9 to 7.1), 4.9 (95 %CI 4.1 to 5.4), and 11.2 (95 %CI 10.5 to 14.0), respectively. CONCLUSIONS Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for the detection of HGD/EAC as single modality.
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Affiliation(s)
- Sanne N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Rehan Haidry
- Department of Gastroenterology and Hepatology, University Hospital London, London, UK
| | - Helmut Messmann
- Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
| | - Krish Ragunath
- Department of Gastroenterology and Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Pradeep Bhandari
- Department of Gastroenterology and Hepatology, Queen Alexandra Hospital Solent Centre for Digestive Diseases, Portsmouth, UK
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Miguel Munoz-Navas
- Department of Gastroenterology, University of Navarra Clinic. Pamplona, Spain
| | - Stefan Seewald
- Department of Gastroenterology and Hepatology, Hirslanden Private Clinic Group, Zurich, Switzerland
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Oliver Pech
- Department of Gastroenterology and Hepatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Revital Kariv
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Horst Neuhaus
- Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Loredana Correale
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Sybren L Meijer
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gert de Hertogh
- Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cesare Hassan
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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12
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Scheppach MW, Rauber D, Stallhofer J, Muzalyova A, Otten V, Manzeneder C, Schwamberger T, Wanzl J, Schlottmann J, Tadic V, Probst A, Schnoy E, Römmele C, Fleischmann C, Meinikheim M, Miller S, Märkl B, Stallmach A, Palm C, Messmann H, Ebigbo A. Detection of duodenal villous atrophy on endoscopic images using a deep learning algorithm. Gastrointest Endosc 2023; 97:911-916. [PMID: 36646146 DOI: 10.1016/j.gie.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/01/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Celiac disease with its endoscopic manifestation of villous atrophy (VA) is underdiagnosed worldwide. The application of artificial intelligence (AI) for the macroscopic detection of VA at routine EGD may improve diagnostic performance. METHODS A dataset of 858 endoscopic images of 182 patients with VA and 846 images from 323 patients with normal duodenal mucosa was collected and used to train a ResNet18 deep learning model to detect VA. An external dataset was used to test the algorithm, in addition to 6 fellows and 4 board-certified gastroenterologists. Fellows could consult the AI algorithm's result during the test. From their consultation distribution, a stratification of test images into "easy" and "difficult" was performed and used for classified performance measurement. RESULTS External validation of the AI algorithm yielded values of 90%, 76%, and 84% for sensitivity, specificity, and accuracy, respectively. Fellows scored corresponding values of 63%, 72%, and 67% and experts scored 72%, 69%, and 71%, respectively. AI consultation significantly improved all trainee performance statistics. Although fellows and experts showed significantly lower performance for difficult images, the performance of the AI algorithm was stable. CONCLUSIONS In this study, an AI algorithm outperformed endoscopy fellows and experts in the detection of VA on endoscopic still images. AI decision support significantly improved the performance of nonexpert endoscopists. The stable performance on difficult images suggests a further positive add-on effect in challenging cases.
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Affiliation(s)
- Markus W Scheppach
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - David Rauber
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Anna Muzalyova
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Vera Otten
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Carolin Manzeneder
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Tanja Schwamberger
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Julia Wanzl
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Jakob Schlottmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Vidan Tadic
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Probst
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Carola Fleischmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Michael Meinikheim
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Silvia Miller
- Department of Pathology, University Hospital of Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Department of Pathology, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Helmut Messmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
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13
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Probst A, Ebigbo A, Eser S, Fleischmann C, Schaller T, Märkl B, Schiele S, Geissler B, Müller G, Messmann H. Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center. Clin Endosc 2023; 56:55-64. [PMID: 36634965 PMCID: PMC9902687 DOI: 10.5946/ce.2022.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/29/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. METHODS Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. RESULTS R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). CONCLUSION Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.
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Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany,Correspondence: Andreas Probst Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany E-mail:
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Eser
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Carola Fleischmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tina Schaller
- Institute of Pathology and Molecular Diagnostics, University Hospital Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Institute of Pathology and Molecular Diagnostics, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics and Computational Statistics, University of Augsburg, Augsburg, Germany
| | - Bernd Geissler
- Department of General, Visceral and Transplant Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gernot Müller
- Institute of Mathematics and Computational Statistics, University of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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14
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Ebigbo A, Mendel R, Scheppach MW, Probst A, Shahidi N, Prinz F, Fleischmann C, Römmele C, Goelder SK, Braun G, Rauber D, Rueckert T, de Souza LA, Papa J, Byrne M, Palm C, Messmann H. Vessel and tissue recognition during third-space endoscopy using a deep learning algorithm. Gut 2022; 71:2388-2390. [PMID: 36109151 PMCID: PMC9664130 DOI: 10.1136/gutjnl-2021-326470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/29/2022] [Indexed: 01/26/2023]
Abstract
In this study, we aimed to develop an artificial intelligence clinical decision support solution to mitigate operator-dependent limitations during complex endoscopic procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy, for example, bleeding and perforation. A DeepLabv3-based model was trained to delineate vessels, tissue structures and instruments on endoscopic still images from such procedures. The mean cross-validated Intersection over Union and Dice Score were 63% and 76%, respectively. Applied to standardised video clips from third-space endoscopic procedures, the algorithm showed a mean vessel detection rate of 85% with a false-positive rate of 0.75/min. These performance statistics suggest a potential clinical benefit for procedure safety, time and also training.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Markus W Scheppach
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Neal Shahidi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Friederike Prinz
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Carola Fleischmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | | | - Georg Braun
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - David Rauber
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tobias Rueckert
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Luis A de Souza
- Department of Computing, Federal University of São Carlos, São Carlos, Brazil
| | - Joao Papa
- Department of Computing, São Paulo State University, Botucatu, Brazil
| | - Michael Byrne
- Vancouver General Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
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15
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Ebigbo A, Mendel R, Probst A, Meinikheim M, Byrne MF, Messmann H, Palm C. Multimodal imaging for detection and segmentation of Barrett's esophagus-related neoplasia using artificial intelligence. Endoscopy 2022; 54:E587. [PMID: 34933360 DOI: 10.1055/a-1704-7885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/10/2023]
Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing Lab, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Michael Meinikheim
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Michael F Byrne
- Department of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing Lab, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
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16
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Krause J, Rösch T, Steurer S, Clauditz T, Sehner S, Schumacher U, Neuhaus H, Messmann H, Schumacher B, Probst A, Schachschal G, Ehlken H, Vieth M, Schmitz R. Quantitative analysis of submucosal excision depth in endoscopic resection for early Barrett's cancer. Endoscopy 2022; 54:565-570. [PMID: 34856621 DOI: 10.1055/a-1659-3514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Abstract
BACKGROUND : Following endoscopic resection of early-stage Barrett's esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens. METHODS : In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated. RESULTS : No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections. CONCLUSION : The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.
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Affiliation(s)
- Jenny Krause
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Clauditz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Department of Epidemiology and Statistics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Udo Schumacher
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Horst Neuhaus
- Department of Internal Medicine, Evangelic Hospital Düsseldorf, Düsseldorf, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine, Evangelic Hospital Düsseldorf, Düsseldorf, Germany.,Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Guido Schachschal
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Ehlken
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Rüdiger Schmitz
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Probst A, Scheurig-Münkler C, Gölder S, Huang B, Messmann H, Braun G. Esophageal adenocarcinoma on esophageal varices - endoscopic resection after transjugular intrahepatic portosystemic shunt. Endoscopy 2022; 54:E7-E8. [PMID: 33592651 DOI: 10.1055/a-1346-8473] [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: 12/10/2022]
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | | | - Stefan Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Bei Huang
- Institute of Pathology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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18
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Tziatzios G, Gkolfakis P, Papadopoulos V, Papanikolaou IS, Fuccio L, Facciorusso A, Ebigbo A, Gölder SK, Probst A, Messmann H, Triantafyllou K. Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions. Ann Gastroenterol 2021; 34:757-769. [PMID: 34815641 PMCID: PMC8596214 DOI: 10.20524/aog.2021.0647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/24/2021] [Indexed: 11/13/2022] Open
Abstract
Endoscopic mucosal resection (EMR) is a technique allowing efficacious and minimally invasive resection of precancerous lesions across the entire gastrointestinal tract. However, conventional EMR, involving injection of fluid into the submucosal space, is imperfect, given the high rate of recurrence of post-endoscopic resection adenoma, especially after piecemeal resection. In light of these observations, modifications of the technique have been proposed to overcome the weakness of conventional EMR. Some of them were designed to maximize the chance of en bloc resection—cap-assisted EMR, underwater EMR, tip-in EMR, precutting, assisted by ligation device—while others were designed to minimize the complications (cold EMR). In this review, we present their modes of action and summarize the evidence regarding their efficacy and safety.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Vasilios Papadopoulos
- Department of Gastroenterology, Koutlimbaneio & Triantafylleio General Hospital, Larissa, Greece (Vasilios Papadopoulos)
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy (Lorenzo Fuccio)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Italy (Antonio Facciorusso)
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Stefan Karl Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
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19
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Nagl S, Ebigbo A, Goelder SK, Roemmele C, Neuhaus L, Weber T, Braun G, Probst A, Schnoy E, Kafel AJ, Muzalyova A, Messmann H. Underwater vs Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colorectal Polyps: A Prospective Randomized Controlled Trial. Gastroenterology 2021; 161:1460-1474.e1. [PMID: 34371000 DOI: 10.1053/j.gastro.2021.07.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Conventional endoscopic mucosal resection (CEMR) with submucosal injection is the current standard for the resection of large, nonmalignant colorectal polyps. We investigated whether underwater endoscopic mucosal resection (UEMR) is superior to CEMR for large (20-40mm) sessile or flat colorectal polyps. METHODS In this prospective randomized controlled study, patients with sessile or flat colorectal polyps between 20 and 40 mm in size were randomly assigned to UEMR or CEMR. The primary outcome was the recurrence rate after 6 months. Secondary outcomes included en bloc and R0 resection rates, number of resected pieces, procedure time, and adverse events. RESULTS En bloc resection rates were 33.3% in the UEMR group and 18.4% in the CEMR group (P = .045); R0 resection rates were 32.1% and 15.8% for UEMR vs CEMR, respectively (P = .025). UEMR was performed with significantly fewer pieces compared to CEMR (2 pieces: 45.5% UEMR vs 17.7% CEMR; P = .001). The overall recurrence rate did not differ between both groups (P = .253); however, subgroup analysis showed a significant difference in favor of UEMR for lesions of >30 mm to ≤40 mm in size (P = .031). The resection time was significantly shorter in the UEMR group (8 vs 14 minutes; P < .001). Adverse events did not differ between both groups (P = .611). CONCLUSIONS UEMR is superior to CEMR regarding en bloc resection, R0 resection, and procedure time for large colorectal lesions and shows significantly lower recurrence rates for lesions >30 mm to ≤40 mm in size. UEMR should be considered for the endoscopic resection of large colorectal polyps.
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Affiliation(s)
- Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Lukas Neuhaus
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Weber
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | | | - Anna Muzalyova
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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20
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Miller S, Bauer S, Schrempf M, Schenkirsch G, Probst A, Märkl B, Martin B. Semiautomatic analysis of tumor proportion in colon cancer: Lessons from a validation study. Pathol Res Pract 2021; 227:153634. [PMID: 34628263 DOI: 10.1016/j.prp.2021.153634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022]
Abstract
The tumor stroma ratio (TSR) is a promising histopathologic prognostic biomarker, which could allow for more accurate risk stratification and improved patient management in colorectal cancer. The purpose of our research was to validate the results of a previous study, which had suggested that not only a low but also a high tumor proportion (TP) might be an independent risk factor for occurrence of distant metastasis and worse overall survival using a semiautomatic image analysis approach with the open-source software ImageJ. We investigated 253 pT3 and pT4 adenocarcinomas of no special type. The previously established thresholds (PES-cut-offs) used to classify the patients (previous 3-tiered-classification) according to the tumor proportion (TP) in a highTP (TP ≥ 54%), a mediumTP (TP < 54% ∩ TP >15%) and a lowTP (TP ≤ 15%) group did not show a significant risk stratification. Even the adjustment of these threshold revealed no significant results. Therefore, a receiver-operating characteristic (ROC) analysis was performed to establish the cut-off with the most significant predictive power and a "new 2-tiered-classification" using this cut-off (40% at MinTP) showed a significantly shorter absence of metastasis for patients with a low TP (p = 0.007). These results confirm that a low TP is associated with an adverse prognosis. This study did not confirm the previous assumption that a high TP might also be a risk factor for occurrence of metastasis. Furthermore, it demonstrates that this semiautomatic technique is not superior to the established method, so that approaches to enhance prognostic techniques should continue.
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Affiliation(s)
- Silvia Miller
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
| | - Svenja Bauer
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
| | - Matthias Schrempf
- Department of Visceral Surgery, University Hospital Augsburg, Augsburg, Germany
| | | | - Andreas Probst
- Medicine III - Gastroenterology, Medical Faculty Augsburg, University Augsburg, Germany
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany.
| | - Benedikt Martin
- General Pathology and Molecular Diagnostics, Medical Faculty Augsburg, University Augsburg, Germany
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21
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Fleischmann C, Probst A, Ebigbo A, Faiss S, Schumacher B, Allgaier HP, Dumoulin FL, Steinbrueck I, Anzinger M, Marienhagen J, Muzalyova A, Messmann H. Endoscopic Submucosal Dissection in Europe: Results of 1000 Neoplastic Lesions From the German Endoscopic Submucosal Dissection Registry. Gastroenterology 2021; 161:1168-1178. [PMID: 34182002 DOI: 10.1053/j.gastro.2021.06.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD. METHODS The German ESD registry is a prospective uncontrolled multicenter study. During a 35-month period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤20 ESDs/y), middle-volume (20-50/y), and high-volume centers (>50/y). A multivariate analysis investigating risk factors for noncurative resection was performed. RESULTS Overall, en bloc, R0, and curative resection rates of 92.4% (95% confidence interval [CI], 0.90-0.94), 78.8% (95% CI, 0.76-0.81), and 72.3% (95% CI, 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI, 0.067-0.102), whereas the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, and recurrence rates and lower complication rates than middle- or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for noncurative ESD. CONCLUSION In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center's yearly case volume.
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Affiliation(s)
- Carola Fleischmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany
| | | | - H-P Allgaier
- Medical Department, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - F L Dumoulin
- Department of Medicine/Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Ingo Steinbrueck
- Department of Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Michael Anzinger
- Department of Gastroenterology, Barmherzige Brüder Krankenhaus München, München, Germany
| | | | - Anna Muzalyova
- Chair of Health Care Operations/ Health Information Management, UNIKA-T, University of Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
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22
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Grosser B, Glückstein MI, Dhillon C, Schiele S, Dintner S, VanSchoiack A, Kroeppler D, Martin B, Probst A, Vlasenko D, Schenkirsch G, Märkl B. Stroma AReactive Invasion Front Areas (SARIFA) - a new prognostic biomarker in gastric cancer related to tumor-promoting adipocytes. J Pathol 2021; 256:71-82. [PMID: 34580877 DOI: 10.1002/path.5810] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Compared to other malignancies, there is a lack of easy-to-evaluate biomarkers for gastric cancer, which is associated with an adverse clinical outcome in many cases. Here, we present Stroma AReactive Invasion Front Areas (SARIFA) as a new histological prognostic marker. We defined SARIFA as the direct contact between a cluster of tumor glands/cells comprising at least five tumor cells and inconspicuous surrounding adipose tissue at the invasion front. A total of 480 adenocarcinomas of the stomach and the gastroesophageal junction from two different collections were classified according to SARIFA. To understand the potential underlying mechanisms, a transcriptome analysis was conducted using digital spatial profiling (DSP). It was found that 20% of the tumors were SARIFA-positive. Kappa values between the three pathologists were good in both collections: 0.74 and 0.78. Patients who presented SARIFA-positive tumors had a significantly lower overall survival in Collections A (median: 20.0 versus 44.0 months; p = 0.014, n = 160) and B (median: 15.0 versus 41.0 months; p < 0.0001, n = 320). SARIFA positivity emerged as a negative independent prognostic factor for overall survival (HR 1.638, 95% CI 1.153-2.326, p = 0.006). Using DSP, the most upregulated genes in SARIFA-positive cases were those associated with triglyceride catabolism and endogenous sterols. COL15A1, FABP2, and FABP4 were differentially expressed in positive cases. At the protein level, the expression of proteins related to lipid metabolism was confirmed. SARIFA combines low inter-observer variability, minimal effort, and high prognostic relevance, and is therefore an extremely promising biomarker related to tumor-promoting adipocytes in gastric cancer. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Bianca Grosser
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Marie-Isabelle Glückstein
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Christine Dhillon
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics and Computational Statistics, University of Augsburg, Augsburg, Germany
| | - Sebastian Dintner
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | | | | | - Benedikt Martin
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | | | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
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23
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Ebigbo A, Mendel R, Rückert T, Schuster L, Probst A, Manzeneder J, Prinz F, Mende M, Steinbrück I, Faiss S, Rauber D, de Souza LA, Papa JP, Deprez PH, Oyama T, Takahashi A, Seewald S, Sharma P, Byrne MF, Palm C, Messmann H. Endoscopic prediction of submucosal invasion in Barrett's cancer with the use of artificial intelligence: a pilot study. Endoscopy 2021; 53:878-883. [PMID: 33197942 DOI: 10.1055/a-1311-8570] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 02/07/2023]
Abstract
BACKGROUND The accurate differentiation between T1a and T1b Barrett's-related cancer has both therapeutic and prognostic implications but is challenging even for experienced physicians. We trained an artificial intelligence (AI) system on the basis of deep artificial neural networks (deep learning) to differentiate between T1a and T1b Barrett's cancer on white-light images. METHODS Endoscopic images from three tertiary care centers in Germany were collected retrospectively. A deep learning system was trained and tested using the principles of cross validation. A total of 230 white-light endoscopic images (108 T1a and 122 T1b) were evaluated using the AI system. For comparison, the images were also classified by experts specialized in endoscopic diagnosis and treatment of Barrett's cancer. RESULTS The sensitivity, specificity, F1 score, and accuracy of the AI system in the differentiation between T1a and T1b cancer lesions was 0.77, 0.64, 0.74, and 0.71, respectively. There was no statistically significant difference between the performance of the AI system and that of experts, who showed sensitivity, specificity, F1, and accuracy of 0.63, 0.78, 0.67, and 0.70, respectively. CONCLUSION This pilot study demonstrates the first multicenter application of an AI-based system in the prediction of submucosal invasion in endoscopic images of Barrett's cancer. AI scored equally to international experts in the field, but more work is necessary to improve the system and apply it to video sequences and real-life settings. Nevertheless, the correct prediction of submucosal invasion in Barrett's cancer remains challenging for both experts and AI.
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Affiliation(s)
- Alanna Ebigbo
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Regensburg, Germany
| | - Tobias Rückert
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany
| | - Laurin Schuster
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany
| | - Andreas Probst
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | | | - Friederike Prinz
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | - Matthias Mende
- Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Ingo Steinbrück
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Siegbert Faiss
- Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - David Rauber
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Luis A de Souza
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - João P Papa
- Department of Computing, São Paulo State University, São Paulo, Brazil
| | - Pierre H Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tsuneo Oyama
- Saku Central Hospital Advanced Care Center, Nagano, Japan
| | | | | | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, United States
| | - Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
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24
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Probst A, Schaller T, Braun G. Duodenal Metastases of an Angiosarcoma of the Thyroid Gland. Clin Gastroenterol Hepatol 2021; 19:e93. [PMID: 32544618 DOI: 10.1016/j.cgh.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tina Schaller
- Institute of Pathology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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25
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Kuellmer A, Behn J, Beyna T, Schumacher B, Meining A, Messmann H, Neuhaus H, Albers D, Birk M, Probst A, Faehndrich M, Frieling T, Goetz M, Thimme R, Caca K, Schmidt A. Endoscopic full-thickness resection and its treatment alternatives in difficult-to-treat lesions of the lower gastrointestinal tract: a cost-effectiveness analysis. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000449. [PMID: 32816955 PMCID: PMC7437695 DOI: 10.1136/bmjgast-2020-000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/05/2022] Open
Abstract
Objective Endoscopic full-thickness resection (EFTR) has shown efficacy and safety in the colorectum. The aim of this analysis was to investigate whether EFTR is cost-effective in comparison with surgical and endoscopic treatment alternatives. Design Real data from the study cohort of the prospective, single-arm WALL RESECT study were used. A simulated comparison arm was created based on a survey that included suggested treatment alternatives to EFTR of the respective lesions. Treatment costs and reimbursement were calculated in euro according to the coding rules of 2017 and 2019 (EFTR). R0 resection rate was used as a measure of effectiveness. To assess cost-effectiveness, the average cost-effectiveness ratio (ACER) and the incremental cost-effectiveness ratio (ICER) were determined. Calculations were made both from the perspective of the care provider as well as of the payer. Results The cost per case was €2852.20 for the EFTR group, €1712 for the standard endoscopic resection (SER) group, €8895 for the surgical resection group and €5828 for the pooled alternative treatment to EFTR. From the perspective of the care provider, the ACER (mean cost per R0 resection) was €3708.98 for EFTR, €3115.10 for SER, €8924.05 for surgical treatment and €7169.30 for all pooled and weighted alternatives to EFTR. The ICER (additional cost per R0 resection compared with EFTR) was €5196.47 for SER, €26 533.13 for surgical resection and €67 768.62 for the pooled rate of alternatives. Results from the perspective of the payer were similar. Conclusion EFTR is cost-effective in comparison with surgical and endoscopic treatment alternatives in the colorectum.
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Affiliation(s)
- Armin Kuellmer
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juliane Behn
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Baden-Württemberg, Germany
| | - Torsten Beyna
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Nordrhein-Westfalen, Germany
| | - Alexander Meining
- Department of Medicine II, Interventional and Experimental Endoscopy (InExEn), University Hospital Wurzburg, Wurzburg, Bayern, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - David Albers
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Nordrhein-Westfalen, Germany
| | - Michael Birk
- Department of Gastroenterology, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Martin Faehndrich
- Department of Gastroenterology, Klinikum Dortmund, Dortmund, Nordrhein-Westfalen, Germany
| | - Thomas Frieling
- Department of Gastroenterology, HELIOS Klinikum Krefeld, Krefeld, Nordrhein-Westfalen, Germany
| | - Martin Goetz
- Department of Gastroenterology/Oncology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Baden-Württemberg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Baden-Württemberg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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26
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de Souza LA, Mendel R, Strasser S, Ebigbo A, Probst A, Messmann H, Papa JP, Palm C. Convolutional Neural Networks for the evaluation of cancer in Barrett's esophagus: Explainable AI to lighten up the black-box. Comput Biol Med 2021; 135:104578. [PMID: 34171639 DOI: 10.1016/j.compbiomed.2021.104578] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/10/2023]
Abstract
Even though artificial intelligence and machine learning have demonstrated remarkable performances in medical image computing, their level of accountability and transparency must be provided in such evaluations. The reliability related to machine learning predictions must be explained and interpreted, especially if diagnosis support is addressed. For this task, the black-box nature of deep learning techniques must be lightened up to transfer its promising results into clinical practice. Hence, we aim to investigate the use of explainable artificial intelligence techniques to quantitatively highlight discriminative regions during the classification of early-cancerous tissues in Barrett's esophagus-diagnosed patients. Four Convolutional Neural Network models (AlexNet, SqueezeNet, ResNet50, and VGG16) were analyzed using five different interpretation techniques (saliency, guided backpropagation, integrated gradients, input × gradients, and DeepLIFT) to compare their agreement with experts' previous annotations of cancerous tissue. We could show that saliency attributes match best with the manual experts' delineations. Moreover, there is moderate to high correlation between the sensitivity of a model and the human-and-computer agreement. The results also lightened that the higher the model's sensitivity, the stronger the correlation of human and computational segmentation agreement. We observed a relevant relation between computational learning and experts' insights, demonstrating how human knowledge may influence the correct computational learning.
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Affiliation(s)
- Luis A de Souza
- Department of Computing, São Carlos Federal University - UFSCar, Brazil; Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Sophia Strasser
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Alanna Ebigbo
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - Andreas Probst
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - Helmut Messmann
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - João P Papa
- Department of Computing, São Paulo State University, UNESP, Brazil.
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Germany
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27
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Wu X, Probst A. Influence of ponds on hazardous metal distribution in sediments at a catchment scale (agricultural critical zone, S-W France). J Hazard Mater 2021; 411:125077. [PMID: 33485232 DOI: 10.1016/j.jhazmat.2021.125077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Eight potentially toxic trace elements were investigated together with the physicochemical characteristics of sediments collected upstream, downstream, and from various ponds from three adjacent carbonated agricultural catchments in southwestern France. Geochemical indices with local references and multivariate data analysis revealed a significant enrichment of Cd, followed by Ni and Cu in sediments, originating from agricultural practices, especially in the upper catchments sensitive to erosion processes. Five other PTEs (As, Pb, Co, Cr, and Zn) mostly originated from the weathering process of the molasse. Clay minerals and/or iron oxides were the main controlling factors for most PTEs. In ponds, Cd was regulated by Ca co-precipitation favoured by the long hydraulic retention time and increased pH, whereas it was mostly controlled by silicates in stream sediments. Copper, Pb, and Cd were the highly extractable metals, suggesting the risk of a hazardous environment. Multivariate analysis revealed that several environmental factors affected the spatial variation of PTE concentrations in sediments as well as the trapping role of ponds (texture, slope, soil erosion, pond size and position, discharge, hydraulic retention time) in this area of intensive agricultural practices. Our conclusions are useful for pond management in a context of increasing water demand and climate warming.
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Affiliation(s)
- X Wu
- Laboratoire écologie fonctionnelle et environnement, Université de Toulouse, CNRS, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UPS), Toulouse, France
| | - A Probst
- Laboratoire écologie fonctionnelle et environnement, Université de Toulouse, CNRS, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UPS), Toulouse, France.
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28
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Prinz F, Ebigbo A, Probst A, Messmann H. Gastric cancer- endoscopic treatment of early lesions, the West learns from the East. Best Pract Res Clin Gastroenterol 2021; 50-51:101739. [PMID: 33975685 DOI: 10.1016/j.bpg.2021.101739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 01/31/2023]
Abstract
Gastric cancer still has one of the highest incidence rates worldwide. Screening programs have been established in high incidence regions, especially in Asia, but in the West, screening for gastric cancer is not generally recommended. Gastroscopy is the gold standard for diagnosing gastric cancer. For the treatment of early gastric cancer, endoscopic resection is the method of choice. With the ESD technique, larger lesions can be resected en-bloc. Guideline and extended guideline criteria for the choice of lesions for ESD have been evaluated extensively, initially in Asia and later in the West as well. For lesions which are out of indication, a surgical approach must be recommended. To detect early recurrence or metachronous lesions, follow-up should be performed after ER.
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Affiliation(s)
- Friederike Prinz
- University Hospital Augsburg, Department of Gastroenterology, Germany.
| | - Alanna Ebigbo
- University Hospital Augsburg, Department of Gastroenterology, Germany
| | - Andreas Probst
- University Hospital Augsburg, Department of Gastroenterology, Germany
| | - Helmut Messmann
- University Hospital Augsburg, Department of Gastroenterology, Germany
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29
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Greimelmaier K, Wohlschläger J, Probst A, Hager T, Wardelmann E, Werlein C, Jonigk D, Müller KM. [Mesothelial proliferation of the tunica vaginalis testis]. Pathologe 2020; 41:406-410. [PMID: 32472158 DOI: 10.1007/s00292-020-00797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Proliferative changes seen in reactive mesothelial hyperplasia of a hydrocele sac may mimic malignant mesothelioma. There is no immunohistochemical staining that reliably separates benign from malignant mesothelial proliferations. However, the combined analysis of BAP1 by immunohistochemistry and CDKN2A by FISH has been reported to yield both a high specificity and sensitivity in this differential diagnosis. In addition, the evaluation of risk factors such as asbestos exposure or prior traumata may be helpful for the correct diagnosis. Exclusion of stromal invasion, which is diagnostic for malign mesothelioma, is of utmost importance. Therefore, extended histological workup is essential.
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Affiliation(s)
- K Greimelmaier
- Institut für Pathologie, Diakonissenkrankenhaus Flensburg, Knuthstr. 1, 24939, Flensburg, Deutschland.
| | - J Wohlschläger
- Institut für Pathologie, Diakonissenkrankenhaus Flensburg, Knuthstr. 1, 24939, Flensburg, Deutschland
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - A Probst
- Urologische Klinik, Diakonissenkrankenhaus Flensburg, Flensburg, Deutschland
| | - T Hager
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Deutschland
| | - C Werlein
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - D Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Deutschland
| | - K M Müller
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Deutschland
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30
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de Souza LA, Passos LA, Mendel R, Ebigbo A, Probst A, Messmann H, Palm C, Papa JP. Assisting Barrett's esophagus identification using endoscopic data augmentation based on Generative Adversarial Networks. Comput Biol Med 2020; 126:104029. [PMID: 33059236 DOI: 10.1016/j.compbiomed.2020.104029] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Barrett's esophagus figured a swift rise in the number of cases in the past years. Although traditional diagnosis methods offered a vital role in early-stage treatment, they are generally time- and resource-consuming. In this context, computer-aided approaches for automatic diagnosis emerged in the literature since early detection is intrinsically related to remission probabilities. However, they still suffer from drawbacks because of the lack of available data for machine learning purposes, thus implying reduced recognition rates. This work introduces Generative Adversarial Networks to generate high-quality endoscopic images, thereby identifying Barrett's esophagus and adenocarcinoma more precisely. Further, Convolution Neural Networks are used for feature extraction and classification purposes. The proposed approach is validated over two datasets of endoscopic images, with the experiments conducted over the full and patch-split images. The application of Deep Convolutional Generative Adversarial Networks for the data augmentation step and LeNet-5 and AlexNet for the classification step allowed us to validate the proposed methodology over an extensive set of datasets (based on original and augmented sets), reaching results of 90% of accuracy for the patch-based approach and 85% for the image-based approach. Both results are based on augmented datasets and are statistically different from the ones obtained in the original datasets of the same kind. Moreover, the impact of data augmentation was evaluated in the context of image description and classification, and the results obtained using synthetic images outperformed the ones over the original datasets, as well as other recent approaches from the literature. Such results suggest promising insights related to the importance of proper data for the accurate classification concerning computer-assisted Barrett's esophagus and adenocarcinoma detection.
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Affiliation(s)
- Luis A de Souza
- Department of Computing, São Carlos Federal University, UFSCar, Brazil; Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Leandro A Passos
- Department of Computing, São Paulo State University, UNESP, Brazil
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - João P Papa
- Department of Computing, São Paulo State University, UNESP, Brazil.
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31
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Probst A, Freund S, Neuhaus L, Ebigbo A, Braun G, Goelder S, Weber T, Märkl B, Anthuber M, Messmann H. Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas. Endoscopy 2020; 52:847-855. [PMID: 32289854 DOI: 10.1055/a-1144-2767] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/07/2023]
Abstract
BACKGROUND : Endoscopic mucosal resection (EMR) is the standard treatment of ampullary and nonampullary duodenal adenomas. EMR of large (10-29 mm) and giant (≥ 30 mm) lesions carries a risk of complications such as delayed bleeding and perforation. Prospective data on duodenal EMR are scarce. This study aimed to evaluate the efficacy of endoscopic procedures (clipping and coagulation of visible vessels) to prevent complications after EMR of large and giant lesions. METHODS : 110 patients with 118 adenomas (29 ampullary and 89 nonampullary) were included prospectively. RESULTS : 15 lesions were small (12.7 %), 68 were large (57.6 %), and 35 were giant (29.7 %). Endoscopic prevention of delayed complications was performed in 81.4 % (n = 96) of all lesions and 94.3 % (n = 33) of giant lesions. Complete resection was achieved in 111 lesions (94.1 %). Complications were 22 delayed bleedings (18.6 %), 3 intraprocedural perforations (2.5 %), 2 delayed perforations (1.7 %), and 1 stricture (0.8 %). Major complications were associated with lesions size ≥ 30 mm (28.6 % vs. 9.6 %; P = 0.02) and ampullary adenomas (27.6 % vs. 11.2 %; P = 0.07). All minor bleeding and 75 % of major bleeding episodes were treated endoscopically; 25 % of major bleedings needed radiologic embolization. Two fatal courses were observed when delayed perforation occurred after EMR of giant lesions. Residual adenoma was detected in 20.4 % at first follow-up. CONCLUSIONS : EMR of giant duodenal neoplasia carries a substantial risk of major complications and recurrences. Resection technique and prevention of delayed complications need to be improved. Further measures should be evaluated in randomized studies.
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Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Simone Freund
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Lukas Neuhaus
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Weber
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Institute of Pathology, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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Ebigbo A, Tziatzios G, Gölder SK, Probst A, Messmann H. Double-endoscope assisted endoscopic submucosal dissection for treating tumors in rectum and distal colon by expert endoscopists: a feasibility study. Tech Coloproctol 2020; 24:1293-1299. [PMID: 32815048 PMCID: PMC7661416 DOI: 10.1007/s10151-020-02308-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is an effective but challenging procedure. To facilitate ESD, several methods that apply traction are available; however, the optimal one remains to be established. The aim of this study was to evaluate the feasibility and safety of the double-endoscope assisted ESD (DEA-ESD) by improving traction to treat complex colorectal lesions. Methods Naïve or previously treated lesions in the rectum and sigmoid colon were included. A grasping forceps advanced through a small-caliber endoscope (GIF-XP190N, Olympus Medical Systems, Tokyo, Japan, 5.4 mm outer diameter) was used to apply traction to the mucosal flap. Lesions were deemed complex when they exceeded a total of nine points on the SMSA scoring system (size, morphology, site, and access) and recurrent when they were previously treated with endoscopic mucosal resection (EMR). Outcome measures included procedural success, total procedure time, complications, and recurrence rate at 3-month follow-up. Results Nine patients (mean age 62.3 ± 14.5 years) were included; five had rectal and four had tumors in the sigmoid colon. The median SMSA score was 14 (SMSA Level IV—complex polyp), while three patients were pre-treated with EMR. DEA-ESD was technically feasible in all cases. En bloc resection and R0 resection rates were 100%, respectively, with a mean procedure time of 128.4 ± 54.1 min. No immediate or delayed complications occurred. Conclusions DEA-ESD is a feasible and safe method for treating complex or recurrent tumors in the rectum and distal colon. Electronic supplementary material The online version of this article (10.1007/s10151-020-02308-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - G Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - S K Gölder
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - A Probst
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - H Messmann
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Ebigbo A, Römmele C, Meisinger C, Probst A, Beyer A, Arnold J, Beer F, Endlicher E, Schiffelholz W, Linseisen J, Messmann H. [Screening gastroscopy in Germany - first results of the pilot phase of the Prä-GIT study]. Z Gastroenterol 2020; 58:761-766. [PMID: 32572870 DOI: 10.1055/a-1190-5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The primary aim of the Prä-GIT study is to collect information on the prevalence and course of precancerous and early malignant lesions in the upper GIT (uGIT) as well as risk factors associated with these lesions in asymptomatic individuals. Study participants presenting for a screening colonoscopy will undergo an additional endoscopic examination of the uGIT in the same session. 5000 participants in 30 endoscopy clinics in Bayern will be included. The pilot study presented here was performed to test the main study protocol as well as the acceptance of an additional uGIT endoscopic examination. METHODS Three endoscopy clinics in Bayern took part in the three-month pilot study between October and December 2018. Patients presenting for a screening colonoscopy in these clinics were offered an additional endoscopic examination of the uGIT which was performed according to a standard operating procedure (SOP). Furthermore, data on dietary habits and lifestyle, as well as biological samples, were collected. RESULTS 52 participants were included in three clinics in Altötting, Augsburg and Regensburg. The average age was 63.4 years. The average time spent per uGIT endoscopy was 11 minutes. No complications occurred. One participant showed a polyp of the recessus piriformis. Refluxesophagitis was seen in 21 participants, four participants had Barrett's esophagus with histological evidence of low-grade dysplasia in one patient, and an esophageal polyp with low-grade dysplasia was seen in one participant. Helicobacter-pylori gastritis was documented in 12 participants. Corpus-dominant atrophy was described in one participant, while a duodenal adenoma with low-grade dysplasia was seen in two participants. 100 % and 89 % of study participants gave a blood or a stool sample, respectively. All participants answered the questionnaire on dietary and lifestyle habits. CONCLUSION The Prä-GIT study was designed to generate a database for premalignant and early cancerous lesions of the uGIT in Germany in asymptomatic individuals presenting for a regular screening colonoscopy. The current pilot study has delivered important insights into the feasibility of the main study protocol. Additionally, the pilot study has shown a high rate of acceptance of an additional uGIT examination in this study population.
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Affiliation(s)
- Alanna Ebigbo
- III. Medizinische Klinik, Universitätsklinikum Augsburg
| | | | | | | | - Albert Beyer
- Praxis für Gastroenterologie und gastrointestinale Onkologie, Altötting
| | - Jochen Arnold
- Praxis Dr. Arnold, Dr. Beer, Prof. Dr. Endlicher, Prof. Dr. Kreuser, Regensburg
| | - Franz Beer
- Praxis Dr. Arnold, Dr. Beer, Prof. Dr. Endlicher, Prof. Dr. Kreuser, Regensburg
| | - Esther Endlicher
- Praxis Dr. Arnold, Dr. Beer, Prof. Dr. Endlicher, Prof. Dr. Kreuser, Regensburg
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Probst A. Colonic endoscopic submucosal dissection - increasing attraction with improved traction? Endoscopy 2020; 52:336-337. [PMID: 32321185 DOI: 10.1055/a-1129-7533] [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: 12/10/2022]
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Germany
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Ebigbo A, Mendel R, Probst A, Manzeneder J, Prinz F, de Souza Jr. LA, Papa J, Palm C, Messmann H. Real-time use of artificial intelligence in the evaluation of cancer in Barrett's oesophagus. Gut 2020; 69:615-616. [PMID: 31541004 PMCID: PMC7063447 DOI: 10.1136/gutjnl-2019-319460] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/30/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg, Regensburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Johannes Manzeneder
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Friederike Prinz
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Luis A de Souza Jr.
- Department of Computing, Federal University of São Carlos, São Carlos, Brazil
| | - Joao Papa
- Department of Computing, São Paulo State University, Bauru, Brazil
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany .,Regensburg Center of Health Sciences and Technology, OTH Regensburg, Regensburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
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Tziatzios G, Ebigbo A, Gölder SK, Probst A, Messmann H. Methods that Assist Traction during Endoscopic Submucosal Dissection of Superficial Gastrointestinal Cancers: A Systematic Literature Review. Clin Endosc 2020; 53:286-301. [PMID: 31914722 PMCID: PMC7280854 DOI: 10.5946/ce.2019.147] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of early-stage gastrointestinal neoplasms. Adequate submucosal exposure is one of the most significant factors related to an effective and safe dissection. The aim of this systematic review was to evaluate the effcacy and safety of various methods that assist traction during ESD of precancerous and earlystage neoplastic lesions of the gastrointestinal tract. We performed an electronic search of the MEDLINE and the Cochrane Controlled Trials Register databases for relevant studies published up to May 2019. Trials exclusively recruiting patients undergoing ESD for superficial gastrointestinal cancer were considered eligible for inclusion. Thirty-three articles including 3,134 patients met the inclusion criteria. The studies evaluated different approaches for widening the endoscopic view, including magnetic anchor-guided ESD (3 studies), use of a second endoscope (5 studies), clip-involving technique (21 studies), and miscellaneous methods (4 studies). Among them, only 6 were randomized controlled trials evaluating different approaches. Overall, the implementation of methods that assist traction during ESD significantly improved the operating time and R0 resection rate and decreased the rate of complications (bleeding and perforation). Interventions that assist traction seem effcacious in improving tissue traction, thus facilitating ESD performance.
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Affiliation(s)
- Georgios Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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Ebigbo A, Palm C, Probst A, Mendel R, Manzeneder J, Prinz F, de Souza LA, Papa JP, Siersema P, Messmann H. A technical review of artificial intelligence as applied to gastrointestinal endoscopy: clarifying the terminology. Endosc Int Open 2019; 7:E1616-E1623. [PMID: 31788542 PMCID: PMC6882682 DOI: 10.1055/a-1010-5705] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 06/11/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aim The growing number of publications on the application of artificial intelligence (AI) in medicine underlines the enormous importance and potential of this emerging field of research. In gastrointestinal endoscopy, AI has been applied to all segments of the gastrointestinal tract most importantly in the detection and characterization of colorectal polyps. However, AI research has been published also in the stomach and esophagus for both neoplastic and non-neoplastic disorders. The various technical as well as medical aspects of AI, however, remain confusing especially for non-expert physicians. This physician-engineer co-authored review explains the basic technical aspects of AI and provides a comprehensive overview of recent publications on AI in gastrointestinal endoscopy. Finally, a basic insight is offered into understanding publications on AI in gastrointestinal endoscopy.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg – Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg – Germany
| | | | - Friederike Prinz
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Luis A. de Souza
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Department of Computing, Federal University of São Carlos – Brazil
| | - João P. Papa
- Department of Computing, São Paulo State University – Brazil
| | - Peter Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
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Ebigbo A, Freund S, Probst A, Römmele C, Gölder SK, Frauenschuh J, Marienhagen J, Messmann H. Outcomes of endoscopic submucosal dissection (ESD) during live endoscopy events (LEE) - a 13-year follow-up. Endosc Int Open 2019; 7:E1723-E1728. [PMID: 31828208 PMCID: PMC6904243 DOI: 10.1055/a-1035-9240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
Background and study aims There are no data showing the outcome of ESD during live endoscopy events (LEE). ESD performed during the Augsburg Endo-Update LEE were compared with matched routine procedures with the aim of demonstrating non-inferiority of LEE ESD. Patients and methods ESD performed during the Endo-Update between 2006 and 2018 were reviewed. The controls were routine procedures matched according to age, location and lesion size. Resection, recurrence, survival and complication rates, procedure time and propofol sedation were assessed. Clinically relevant margins were assumed for resection and complication rates, procedure time and propofol sedation quantity. Results Thirty-eight ESD were performed in the given time period, and were compared with 38 matched routine ESD. En bloc and curative resection rates in the LEE group and in the control group were 100 % and 87 % as well as 84 % and 71 % respectively, while procedure times were 135 and 125 minutes, respectively. Non-inferiority was demonstrated for resection rates and procedure time. The complication rate was lower in the LEE group as compared with the control group (5 % vs 13 %) while propofol sedation was similar in both groups (863 mg vs 872 mg). Recurrence and 5-year survival rates for both groups were 4 % vs 0 % and 70 % vs 65% respectively. Conclusions The resection rate and procedure time of ESD during LEE was non-inferior to those of routine ESD procedures. Comparison of the complication rates, however, was inconclusive owing to the low patient number and complication risk in both groups.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany,Corresponding author Dr. Alanna Ebigbo Universitätsklinikum AugsburgStenglinstr. 286156 AugsburgGermany+0049-821-400-2748
| | - Simone Freund
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Stefan K. Gölder
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Julia Frauenschuh
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | | | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
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Probst A, Schaller T, Sommer F, Geissler B, Agaimy A, Messmann H, Märkl B. Immunoglobulin G4 (IgG4)-related disease of the stomach - a challenging differential diagnosis in suspected gastric cancer. Z Gastroenterol 2019; 57:1298-1303. [PMID: 31739375 DOI: 10.1055/a-1013-4437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) can involve different organs and is diagnosed by a combination of clinicopathological features, including storiform fibrosclerosis infiltrated by numerous IgG4-positive plasma cells that frequently forms tumor-like lesions with or without associated obliterative phlebitis. Involvement of the stomach is rare and can occur as part of a multiorgan involvement of IgG4-RD or as isolated gastric involvement. CASE REPORT We report 2 female patients with therapy-refractory gastric ulcers associated with gastric wall thickening and lymphadenopathy that were highly suggestive of gastric cancer or lymphoma. Biopsies failed to confirm a diagnosis, and IgG4-RD was diagnosed only after surgical resection in both patients. The previous literature on gastric IgG4-RD is summarized and shows different characteristics in patients with multiorgan IgG4-RD and isolated gastric IgG4-RD. As reported for autoimmune pancreatitis type 1, patients with multiorgan IgG4-RD are mainly elderly men with frequently elevated serum IgG4 concentrations. In contrast, isolated gastric IgG4-RD predominantly affects female patients with normal serum IgG4 levels. Surgical resection is commonly performed due to the clinical suspicion of malignancy and the absence of findings indicative of IgG4-RD on biopsy. Today, diagnosis is confirmed histopathologically only after resection. CONCLUSION IgG4-RD should be taken into account when gastric malignancy is suspected endoscopically or radiologically and biopsies fail to confirm the presence of a malignancy (especially subepithelial tumors or refractory gastric ulcers). Serum IgG4 concentrations are insufficient to confirm localized gastric IgG4-RD. Diagnostic workups need to be improved to avoid unnecessary surgical resections with the attendant potential morbidity and mortality.
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Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Tina Schaller
- Institute of Pathology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Augsburg, Germany
| | - Bernd Geissler
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Augsburg, Germany
| | - Abbas Agaimy
- Institute of Pathology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Institute of Pathology, Universitätsklinikum Augsburg, Augsburg, Germany
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Probst A, Scheurig-Münkler C, Messmann H, Braun G. Portal vein embolism after injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc 2019; 90:161-162. [PMID: 30910481 DOI: 10.1016/j.gie.2019.03.012] [Citation(s) in RCA: 2] [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] [Received: 12/29/2018] [Accepted: 03/18/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
| | - Christian Scheurig-Münkler
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
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Ebigbo A, Mendel R, Probst A, Manzeneder J, de Souza Jr LA, Papa JP, Palm C, Messmann H. Computer-aided diagnosis using deep learning in the evaluation of early oesophageal adenocarcinoma. Gut 2019; 68:1143-1145. [PMID: 30510110 PMCID: PMC6582741 DOI: 10.1136/gutjnl-2018-317573] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/22/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Alanna Ebigbo
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany
| | - Andreas Probst
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
| | | | - Luis Antonio de Souza Jr
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - João P Papa
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg-Germany, Regensburg, Germany
| | - Helmut Messmann
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
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Gölder S, Neuhas L, Freuer D, Probst A, Ebigbo A, Braun G, Brueckner J, Stueckle J, Meier A, Messmann H. Over-the-scope clip in peptic ulcer bleeding: clinical success in primary and secondary treatment and factors associated with treatment failure. Endosc Int Open 2019; 7:E846-E854. [PMID: 31206010 PMCID: PMC6565427 DOI: 10.1055/a-0898-3357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/09/2018] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims It is unclear if the clinical success rate of the over-the-scope-clip (OTSC) in peptic ulcer bleeding (PUB) is comparable when it is used in the first- or in the second-line of treatment. Patients and methods Data on endoscopic treatment (first- vs. second-line) in PUB with OTSC and clinical data were analyzed. The primary outcome was the clinical success of hemostasis, defined as the absence of recurrent bleeding or further intervention. Secondary outcomes were factors associated with OTSC failure. Results From April 2014 to March 2018, 100 patients (age 72 [20 - 98] y, female 36 %) with PUB in the stomach or the duodenum were treated endoscopically with the OTSC. The OTSC was used as a first-line procedure (primary-OTSC) in 66 pts. Successful hemostasis could be achieved in 90.9 %. After failure of an initial endoscopic treatment, 34 patients were treated with the OTSC (secondary-OTSC) and the treatment was successful in 94.1 %. Recurrent bleeding occurred in n = 10 for primary-OTSC (16.7 %) and in n = 7 pts in the secondary-OTSC (21.9 %) ( P = 0.81). Clinical success in the primary-OTSC was 75.8 % and 73.5 % in the secondary-OTSC respectively. Conclusions The OTSC has a high rate of initial bleeding control in first- and second line treatment of PUB. OTSC failure occurs more often in the duodenum than in the stomach and results in longer intensive care unit stay, higher amount of transfusions, and a higher reimbursement per case.
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Affiliation(s)
- Stefan Gölder
- University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany,Corresponding author Dr. Stefan Karl Gölder University Hospital Augsburg – Department of Internal Medicine IIIStenglinstraße 2Augsburg 86156Germany+498214003331
| | - Lukas Neuhas
- Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
| | - Denis Freuer
- Chair of Epidemiology of the LMU Munich at UNIKA-T, Augsburg, Germany
| | - Andreas Probst
- University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
| | - Alanna Ebigbo
- University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
| | - Georg Braun
- University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
| | - Juliane Brueckner
- Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
| | - Johannes Stueckle
- Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
| | - Alexander Meier
- Klinikum Dritter Orden, Department of Internal Medicine I, Munich, Germany
| | - Helmut Messmann
- University Hospital Augsburg, Department of Internal Medicine III, Augsburg, Germany
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Ebigbo A, Probst A, Messmann H, Märkl B, Nam-Apostolopoulos YC. Topographic mapping of a specimen after endoscopic submucosal dissection. Endosc Int Open 2019; 7:E521-E524. [PMID: 31041368 PMCID: PMC6447407 DOI: 10.1055/a-0846-2043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/18/2018] [Accepted: 12/27/2018] [Indexed: 01/28/2023] Open
Abstract
Background and study aims Mapping of pathologic specimens after endoscopic submucosal dissection (ESD) is common practice in Asian countries, especially in Japan. However, there is a lack of awareness for this technique in Europe. In this report, we demonstrate the feasibility and benefits of topographic mapping in a Western setting.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Klinikum Augsburg, Germany,Corresponding author Dr. Alanna Ebigbo Klinikum AugsburgStenglinstr. 286156 AugsburgGermany+00498214002748
| | - Andreas Probst
- Department of Gastroenterology, Klinikum Augsburg, Germany
| | | | - Bruno Märkl
- Institute of Pathology, Klinikum Augsburg, Germany
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Reinartz G, Pyra RP, Lenz G, Liersch R, Stüben G, Micke O, Willborn K, Hess CF, Probst A, Fietkau R, Jany R, Schultze J, Rübe C, Hirt C, Fischbach W, Bentz M, Daum S, Pott C, Tiemann M, Möller P, Neubauer A, Wilhelm M, Willich N, Berdel WE, Eich HT. Favorable radiation field decrease in gastric marginal zone lymphoma : Experience of the German Study Group on Gastrointestinal Lymphoma (DSGL). Strahlenther Onkol 2019; 195:544-557. [PMID: 30859254 DOI: 10.1007/s00066-019-01446-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Long-term impact of stage-adapted field reduction in a large cohort of gastric marginal zone lymphoma (gMZL) patients treated conservatively with curative radiation therapy (RT). PATIENTS AND METHODS Prospective analysis of paper records of 290 patients with stage IE-IIE gMZL, treated in 78 radiotherapeutic institutions in Germany from 1992-2013. Stage-adapted radiation fields decreased from extended field (EF) to involved field (IF) over the course of three consecutive prospective trials of the German Study Group on Gastrointestinal Lymphoma (DSGL). Treatment results were compared between the three cohorts. RESULTS Overall collective with median age of 60 years, slight male predominance (m:f = 1.1:1) and ratio of disease stage I:stage II = 2.1:1. Median follow-up 6.4 years in total: 13.0 years in the first gastrointestinal study (GIT 1992), 8.2 years in the second (GIT 1996) and 4.7 years in the third study (DSGL 01/2003). Stage-adapted radiation field decrease together with further technological development led to reduced relative frequencies of acute/chronic adverse effects and until now was accompanied by lower disease recurrence. The third study design with smallest field size (IF in stage I, locoregional EF in stage II) achieved the best survival outcome at the 5‑year follow-up (overall survival 92.7%, event-free survival 89.5% and lymphoma-specific survival 100.0%). Disease relapse observed in 10 patients. Cumulative incidence of disease-specific death was 1.7% of the followed patients. Primary disease stage associated with lymphoma-specific survival. CONCLUSION Stage-adapted reduction towards IF in gMZL resulted in favorable adverse effects, local control and survival rates. These results support further decreases in modern RT of gMZL.
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Affiliation(s)
- Gabriele Reinartz
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany.
| | - Regina P Pyra
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Rüdiger Liersch
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Georg Stüben
- Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - Kay Willborn
- Department of Radiotherapy and Radiation Oncology, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Clemens F Hess
- Department of Radiation Oncology, University Hospital of Göttingen, Göttingen, Germany
| | - Andreas Probst
- Department of Gastroenterology, Central Hospital, Augsburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen, Erlangen, Germany
| | - Ralf Jany
- Department of Radiation Oncology, Saint Marien Hospital, Hamm, Germany
| | - Jürgen Schultze
- Department of Radiation Oncology, University of Schleswig-Holstein, Kiel, Germany
| | - Christian Rübe
- Department of Radiation Oncology, University of Saarland, Homburg, Germany
| | - Carsten Hirt
- Department of Medical Oncology, University of Greifswald, Greifswald, Germany
| | - Wolfgang Fischbach
- Department of Gastroenterology and Oncology, Hospital of Aschaffenburg, Aschaffenburg, Germany
| | - Martin Bentz
- Department of Medical Oncology, Municipal Hospital of Karlsruhe, Karlsruhe, Germany
| | - Severin Daum
- Department of Gastroenterology, University Charité, Berlin, Germany
| | - Christiane Pott
- Department of Medical Oncology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Peter Möller
- Department of Pathology, University of Ulm, Ulm, Germany
| | - Andreas Neubauer
- Department of Medical Oncology, University of Marburg, Marburg, Germany
| | - Martin Wilhelm
- Department of Medical Oncology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Normann Willich
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital of Münster, Münster, Germany
| | - Hans T Eich
- Department of Radiation Oncology, University Hospital of Münster, Building A1, Albert Schweitzer Campus 1, 48149, Münster, Germany
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Passos LA, de Souza Jr. LA, Mendel R, Ebigbo A, Probst A, Messmann H, Palm C, Papa JP. Barrett’s esophagus analysis using infinity Restricted Boltzmann Machines. Journal of Visual Communication and Image Representation 2019; 59:475-485. [DOI: 10.1016/j.jvcir.2019.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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de Souza LA, Afonso LCS, Ebigbo A, Probst A, Messmann H, Mendel R, Hook C, Palm C, Papa JP. Learning visual representations with optimum-path forest and its applications to Barrett’s esophagus and adenocarcinoma diagnosis. Neural Comput Appl 2019. [DOI: 10.1007/s00521-018-03982-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Probst A, Ebigbo A, Märkl B, Ting S, Schaller T, Anthuber M, Fleischmann C, Messmann H. Endoscopic submucosal dissection for rectal neoplasia extending to the dentate line: European experience. Endosc Int Open 2018; 6:E1355-E1362. [PMID: 30410957 PMCID: PMC6221817 DOI: 10.1055/a-0749-8735] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/15/2018] [Accepted: 09/05/2018] [Indexed: 02/08/2023] Open
Abstract
Background and study aims The ideal treatment strategy for rectal neoplasia extending to the dentate line (RNDL) is not well defined. Endoscopic mucosal resection (EMR) and submucosal dissection (ESD) compete with surgical techniques such as transanal endoscopic microsurgery (TEM). Non-Asian data and prospective data on ESD are lacking. The study aim was to evaluate the role of ESD in treatment of RNDL in a Western center. Patients and methods Eighty-six patients with rectal adenomas were included. ESD was performed in 86 rectal adenomas including 24 RNDLs (27.9 %) and 62 lesions distant from the dentate line (72.1 %). Results En bloc resection rate was comparable (91.7 % vs. 93.5 %, P = 0.670) between ESD for RNDL and non-RNDL. R0 resection rate was significantly lower in ESD for RNDL compared to that for non-RNDL (70.8 % vs 88.7 %; P = 0.039), but most non-R0 resection was unclear margin (Rx) and was not obvious positive margin (R1). Accordingly, the recurrence rate after ESD for RNDL (4.5 %) was not statistically different from that for non-RNDL (0 %, P = 0.275) and was lower than that previously reported for EMR. Median procedure time was 127 vs. 110 minutes ( P = 0.182). Risk of delayed bleeding (20.8 % vs. 0 %, P = 0.001) and postinterventional pain (33.3 % vs. 14.5 %, P = 0.07) increased in RNDL cases, but they were managed conservatively. Incidence of stricture (4.2 % vs. 1.6 %, P = 0.483) and perforation (0 % vs. 1.6 %, P = 1.000) were similar. Conclusions ESD is a feasible and safe resection technique for RNDLs. A randomized controlled trial comparing ESD to other methods (EMR or transanal surgery) is warranted.
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Affiliation(s)
- Andreas Probst
- Department of Gastroenterology, Klinikum Augsburg, Germany,Corresponding author Andreas Probst, MD III. Medizinische KlinikKlinikum AugsburgStenglinstrasse 286156 AugsburgGermany+49-821-400-3331
| | - Alanna Ebigbo
- Department of Gastroenterology, Klinikum Augsburg, Germany
| | - Bruno Märkl
- Institute of Pathology, Klinikum Augsburg, Germany
| | - Saskia Ting
- Institute of Pathology, Klinikum Augsburg, Germany
| | | | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, Klinikum Augsburg, Germany
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Neuhaus L, Probst A, Messmann H, Siebert L, Vlasenko D, Agaimy A, Ting S. Invagination as Manifestation of a Perivascular Epithelioid Cell Neoplasm (PEComa) of the Colon. Am J Gastroenterol 2018; 113:1115. [PMID: 29915401 DOI: 10.1038/s41395-018-0147-z] [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: 12/11/2022]
Affiliation(s)
- Lukas Neuhaus
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Probst
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Helmut Messmann
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Lena Siebert
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dmytro Vlasenko
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
| | - Saskia Ting
- Zentralklinikum Augsburg, Augsburg, Germany. Universitätsklinikum Erlangen, Erlangen, Germany
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Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, Neuhaus H, Albers D, Birk M, Thimme R, Probst A, Faehndrich M, Frieling T, Goetz M, Riecken B, Caca K. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67:1280-1289. [PMID: 28798042 DOI: 10.1136/gutjnl-2016-313677] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/14/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Endoscopic full-thickness resection (EFTR) is a novel treatment of colorectal lesions not amenable to conventional endoscopic resection. The aim of this prospective multicentre study was to assess the efficacy and safety of the full-thickness resection device. DESIGN 181 patients were recruited in 9 centres with the indication of difficult adenomas (non-lifting and/or at difficult locations), early cancers and subepithelial tumours (SET). Primary endpoint was complete en bloc and R0 resection. RESULTS EFTR was technically successful in 89.5%, R0 resection rate was 76.9%. In 127 patients with difficult adenomas and benign histology, R0 resection rate was 77.7%. In 14 cases, lesions harboured unsuspected cancer, another 15 lesions were primarily known as cancers. Of these 29 cases, R0 resection was achieved in 72.4%; 8 further cases had deep submucosal infiltration >1000 µm. Therefore, curative resection could only be achieved in 13/29 (44.8%). In the subgroup with SET (n=23), R0 resection rate was 87.0%. In general, R0 resection rate was higher with lesions ≤2 cm vs >2 cm (81.2% vs 58.1%, p=0.0038). Adverse event rate was 9.9% with a 2.2% rate of emergency surgery. Three-month follow-up was available from 154 cases and recurrent/residual tumour was evident in 15.3%. CONCLUSION EFTR has a reasonable technical efficacy especially in lesions ≤2 cm with acceptable complication rates. Curative resection rate for early cancers was too low to recommend its primary use in this indication. Further comparative studies have to show the clinical value and long-term outcome of EFTR in benign colorectal lesions. TRIAL REGISTRATION NUMBER NCT02362126; Results.
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology, Klinikum Ludwigsburg, University of Heidelberg, Ludwigsburg, Germany.,Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torsten Beyna
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Germany
| | | | - Hans-Juergen Richter-Schrag
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
| | - Horst Neuhaus
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Germany
| | - David Albers
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Germany
| | - Michael Birk
- Department of Gastroenterology, University Hospital, Ulm, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
| | - Martin Faehndrich
- Department of Gastroenterology, Klinikum Dortmund, Dortmund, Germany
| | - Thomas Frieling
- Department of Gastroenterology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Martin Goetz
- Department of Gastroenterology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Bettina Riecken
- Department of Gastroenterology, Klinikum Ludwigsburg, University of Heidelberg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, University of Heidelberg, Ludwigsburg, Germany
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Benabdelkader A, Taleb A, Probst JL, Belaidi N, Probst A. Anthropogenic contribution and influencing factors on metal features in fluvial sediments from a semi-arid Mediterranean river basin (Tafna River, Algeria): A multi-indices approach. Sci Total Environ 2018; 626:899-914. [PMID: 29396350 DOI: 10.1016/j.scitotenv.2018.01.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 06/07/2023]
Abstract
Metals in river sediments from a semi-arid Mediterranean basin were investigated from upstream to downstream during contrasting hydrological conditions in 2014 and 2015. The level and origin of the contamination were evaluated using several geochemical and isotopic indicators. Elements were grouped by their level of contamination: high (Pb > Cd > Zn > Cu) and low (Al, Fe, Cr, Co, Ni). Multiple local sources of contamination were identified (industrial, agricultural and domestic waste), as well as very specific ones (gasoline station) and diffuse pollution from atmospheric deposition (gasoline, ores, aerosols). During storm events, the upstream dams can either be secondary sources of contamination or dilutors through particles derived from natural erosion. The contamination was slowed downstream due to the river geomorphology, but eventually washed into the Mediterranean Sea by intense storm events. Naturally derived elements (Co, Ni, Cr, As) were associated with Al, Fe and Mn oxides or clays, and anthropogenic originated metals with phosphorus (Cd and Zn), sulphur (Cu) and POC (Pb enrichment). Cadmium and Pb were the most available metals upstream and at the outlet, but their availability was not strictly related to their degree of contamination. These conclusions could be drawn thanks to an approach by multiple indicators.
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Affiliation(s)
- A Benabdelkader
- EcoLab, Université de Toulouse, CNRS, Toulouse, France; LEcGEN, Université Abou Bekr Belkaid de Tlemcen, Tlemcen, Algeria
| | - A Taleb
- LEcGEN, Université Abou Bekr Belkaid de Tlemcen, Tlemcen, Algeria
| | - J L Probst
- EcoLab, Université de Toulouse, CNRS, Toulouse, France
| | - N Belaidi
- LEcGEN, Université Abou Bekr Belkaid de Tlemcen, Tlemcen, Algeria
| | - A Probst
- EcoLab, Université de Toulouse, CNRS, Toulouse, France.
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