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  • 1
    Language: English
    In: Visceral Medicine, April 2018, Vol.34(2), pp.90-91
    Keywords: Editorial
    ISBN: 9783318063226
    ISBN: 3318063223
    ISSN: 2297-4725
    E-ISSN: 2297-475X
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  • 2
    Language: English
    In: Visceral Medicine, April 2018, Vol.34(2), pp.116-121
    Description: Background: Indications for benign esophageal surgery and postoperative follow-up need to be highly elaborated with differentiated and structured algorithms, based on objective functional workup in the esophageal laboratory. Functional outcome is of utmost interest and has to be driven by the need for comprehensive but purposeful diagnostic methods. Methods: Preoperative diagnostic workup procedures by the functional laboratory include 24-h pH-monitoring, impedance testing, and high-resolution manometry (HRM) - in addition to upper gastrointestinal endoscopy and barium swallow/timed barium esophagogram. Results: The most frequent indications for benign esophageal surgery are gastroesophageal reflux disease and achalasia; quite rare indications are esophageal diverticula and benign tumors. Esophageal motility testing in addition to 24-h pH-monitoring is crucial before antireflux surgery (ARS) in order to rule out ineffective esophageal motility and to tailor the wrap. With respect to achalasia surgery, the exact type of achalasia (I-III) has to be labeled according to the Chicago classification, and other motility disorders have to be excluded. The postoperative functional evaluation in the early phase (6 months) after either ARS or Heller's myotomy serves as the new baseline motility testing in case of later occurring disturbances in the follow-up. Conclusion: A complete and proper preoperative esophageal function assessment is crucial in order to rule out a primary motility disorder and to avoid postoperative functional complications.
    Keywords: Review Article ; Functional Esophageal Assessment ; Surgery for Benign Esophageal Disease ; High-Resolution Impedance Manometry ; 24-H Ph-Monitoring ; Timed Barium Esophagogram ; Functional Outcome ; Quality of Life
    ISBN: 9783318063226
    ISBN: 3318063223
    ISSN: 2297-4725
    E-ISSN: 2297-475X
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  • 3
    Language: English
    In: Visceral Medicine, October 2016, Vol.32(5), pp.369-374
    Description: Background: Despite an increasing understanding of the pathophysiology of achalasia, the etiology of this esophageal motility disorder remains largely unknown. However, the occurrence of familial achalasia, its association with well-defined genetic syndromes, the candidate gene approach, and recent presentation of the first systematic genome-wide association study on achalasia suggest the involvement of genetic factors. Methods: In this study we analyzed the frequency with which symptoms associated with esophageal function (swallowing difficulties, regurgitations, retrosternal cramps/pain, heartburn) occur in first-degree relatives of patients with achalasia to determine if screening is useful and justified against the background of early diagnosis in a genetically predisposed population. The survey of data was carried out in 759 relatives of the 359 achalasia patients included in this study by means of structured interviews. Results: Swallowing difficulties as the principal symptom of achalasia were found to occur at least occasionally in 11.2% of first-degree relatives. In comparison with the prevalence of dysphagia in the general population of 7-10% up to 22%, as described in the literature, the frequency of swallowing difficulties does not seem to be increased in our population of relatives. Conclusion: Screening measures do not appear to be justified in spite of the potential genetic background of achalasia.
    Keywords: Original Article ; Esophagus-Related Symptoms ; First-Degree Relatives ; Achalasia Patients ; Screening
    ISBN: 9783318058130
    ISBN: 3318058130
    ISSN: 2297-4725
    E-ISSN: 2297-475X
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  • 4
    Language: English
    In: Oncology Research and Treatment, February 2018, Vol.41(3), pp.122-128
    Description: Background: Despite the announcement of the 8th edition of TNM classification, the 7th edition (2010) is still being used for prognostic assessment in gastric cancer patients. A proposed new staging system (termed as the Kiel proposal) claims to offer a better prognostic stratification. Our objective was to retrospectively evaluate the Kiel proposal and compare it with the 6th and 7th TNM editions on a collected database. Methods: We retrospectively analyzed gastric cancer patients who had undergone surgical resection without any previous treatment from selected randomized trials and from a cohort of patients operated at the University Hospital of Mainz, Germany. All patients were restaged using the 3 staging systems and overall survival was estimated and compared. Results: A study population of 491 patients was identified. Relevant changes in stage distribution between the 6th and 7th TNM and the Kiel staging systems were observed. The 6th classification appears to display the best discriminatory measures. The Kiel staging system is slightly less prognostic than the TNM editions, but provides clearly separated strata as with the 6th edition. Conclusions: The Kiel staging system for gastric cancer appears promising in terms of simplicity, predictability and applicability and should be taken into consideration in future TNM revisions.
    Keywords: Research Article ; Gastric Cancer ; Staging System ; Prognosis ; Medicine
    ISSN: 2296-5270
    E-ISSN: 2296-5262
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  • 5
    Language: English
    In: Digestive Diseases, April 2005, Vol.22(4), pp.345-350
    Description: Despite surgical R0 resections, patients with gastric cancer stage UICC II–III have a high risk of recurrence and metachronic metastases. Preliminary evidence exists that adjuvant chemotherapy or neoadjuvant chemo(radio)therapy protocols may improve the prognosis of these patients undergoing surgery of gastric cancer with curative intention. As for palliative regimens, 5-fluorouracil and cisplatin are integral components of such (neo)adjuvant strategies. Upcoming cytostatic agents, i.e. irinotecan, docetaxel, oxaliplatin, and oral fluoropyridines are currently under investigation in new multimodality treatment regimens and may further increase R0 resection rates and may prolong disease-free and overall survival in the treatment of advanced localized gastric cancer.
    Keywords: Review Article ; Gastric Cancer ; Chemotherapy ; Adjuvant/Neoadjuvant Therapy ; Chemoradiation ; Taxanes ; Irinotecan ; Oxaliplatin ; Docetaxel ; Medicine
    ISBN: 9783805579230
    ISBN: 3805579233
    ISSN: 0257-2753
    E-ISSN: 1421-9875
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  • 6
    Language: English
    In: Digestive Diseases, April 2005, Vol.22(4), pp.396-401
    Description: Background: Esophagectomy for motility disorders is performed infrequently. It is indicated after failed medical therapy, pneumatic dilation, non-resecting surgical and redo procedures. Patient selection in this group is challenging and the operative risk has to be weighted carefully against the poor quality of life with persistent or recurrent dysphagia. Patients and Methods: Between September 1985 and April 2004, subtotal esophageal resections for advanced esophageal motility disorders of the esophagus not responding to previous therapy were carried out in 8 patients (6 females, 2 males). The median age of these patients was 59.5 (43–78) years. Six patients had a megaesophagus secondary to achalasia; 1 patient had a non-specific esophageal motility disorder with a stenosis of the distal esophagus, and a further patient displayed a recurrent huge epiphrenic diverticulum, which occurred in the context of a collagen disease. A transhiatal esophageal resection was performed in 6, a transthoracic procedure in 2 patients. Results: Outcome assessment was done after a follow-up of 43.5 (3–92) months in median. The resection and reconstruction of the esophagus in advanced and decompensated esophageal motility disorders led to a marked functional improvement with disappearance of dysphagia. Despite previous therapeutic failures, alimentation could be restored in all patients. Conclusion: Favourable long-term results with significant improvement of symptoms can be achieved by esophageal resection even if endoscopic therapy or non-resecting surgical measures are unsuccessful. Transhiatal esophagectomy with gastric pull-up should be the preferred procedure and can be performed with low morbidity.
    Keywords: Original Paper ; Long-Term Results ; Motility Disorders of the Esophagus ; Advanced and Decompensated Stage ; Subtotal Esophageal Resection ; Perioperative Course ; Medicine
    ISBN: 9783805579230
    ISBN: 3805579233
    ISSN: 0257-2753
    E-ISSN: 1421-9875
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