Publikationen

Comparison of new colonoscopy devices with standard forward viewing (SFV) high definition colonoscopes in daily practice

Martin Geyer1, Dominik Leiner2 1 Gastroenterologie Wettingen, Switzerland, 2 Ludwig-Maximilians University Munich, Germany

Introduction: For years efforts have been made to improve the quality of colonoscopy. Cap assisted colonoscopy has been shown in some studies to increase the adenoma detection rate (ADR). Full-spectrum colonoscopes (FUSE) with 330°angle of view showed by initial studies a significantly lower adenoma missrate and higher ADR. Our practice-based, randomized study compares the efficiency of the relatively inexpensive cap assisted, the FUSE or SFV colonoscopy.

Method: From March 2015 through February 2018 patients referred for ambulant colonoscopy were randomly allocated to either colonoscopy with high definition SFV Pentax i10 (n=958) or FUSE instruments (n=1552). The group of patients assigned to SFV endoscopy was since March 2017 examined with the additional use of Endocuff, making up another 339 patients. All procedures were performed by one experienced endoscopist.

Results: Baseline characteristics of the 2849 patients were similar within the three groups. Mean age was 64 (CI 63-66), BBPS score 7.23 (CI 7.2-7.3). Ileum intubation rate was 99% in all groups. With multivariate analysis male sex, diabetes and age were significant risk factors for more adenomas. Better bowel cleansing was also significantly associated with higher adenoma detection. ADR was 50% for FUSE, 54% for SFV and 47% for Endocuff (ns). Adenoma per colonoscopy (APC) were 1.1 in FUSE vs 1.2 in SFV vs 1 with Endocuff (ns). Time to ileum was 5.4 (FUSE), 5.5 (SFV) and 6.3 min (Endocuff); withdrawal time 16.3, 18.1 and 14.1 respectively (p =0.04).

Conclusion: Neither FUSE nor Endocuff could increase the ADR in a significant way. Key factor for a high ADR seems to be long withdrawal times. FUSE and Endocuff show significant shorter endoscopy times, Endocuff even significantly less medication for sedation.

Swiss Medical Weekly 2018; 148 (Suppl 232) O21

Übersicht als PDF, Präsentation als PDF.

Comparison of two bowel preparations for colonoscopy Moviprep and Citrafleet in daily practice

Martin Geyer, Gastroenterologie Wettingen, Dominik Leiner, Ludwig-Maximilians University Munich, Germany

Background: The success of any colonoscopy depends upon the quality of bowel preparation. Low volume preps (Moviprep with 2 l, CitraFleet with twice 0.15 l) are increasingly used. The scope of our study was to evaluate possible differences between the two products and the type of application (e.g. same day or split dosing) in routine gastroenterology.

Methods: From February 2015 through December 2016 we tested two types of bowel preparation (CitraFleet and Moviprep) in two different ways of application as split (Dose 1 8 pm the day before; Dose 2 4 - 6 hours before colonoscopy) or same day dosing (Dose 1 8 am the day of colonoscopy; Dose 2 4 hours before colonoscopy) in a typical colon carcinoma screening population of a private practice. We compared 450 randomly assigned CitraFleet cases with 1111 patients taking Moviprep. The efficacy of the two regimens was judged according to Boston bowel preparation scale (BBPS).

Results: The BBPS Score (best score of 9) for Moviprep was 7.2, for CitraFleet 7.1 (p=0.03). The Scores for the right colon were 2.34 for CitraFleet and 2.35 for Moviprep, for the transverse colon 2.31 vs 2.4 respectively and 2.44 vs 2.45 for the left colon. The two groups slightly differed in average age (61 years for CitraFleet vs 66 years for Moviprep) and in gender (42% males vs 51%) - with identical BMI (mean 25). The effect of gender, age and obesity on quality of preparation was negligible (R 2 < 1%). Split dose or same day dosing did not significantly differ with 7.2 vs 7.2.

Conclusion: Our data revealed no clinically relevant difference neither for split or same day dosing nor for the two preps used, especially not in what concerns cleaning of the right colon.

Swiss Medical Weekly 2018; 148 (Suppl 232) G5

Performance comparison of full-spectrum versus forward-viewing colonoscopy: a randomized controlled trial

M. Geyer1, L. Dominik2, F. Bannwart3
1 Gastroenterologie Wettingen, Wettingen/Switzerland
2 Ludwig-Maximilians University, Munich/Germany
3 Medica Laboratories, Zurich/Switzerland

Introduction: Technology of colonoscopy is constantly evolving. New full-spectrum colonoscopes (FUSE) with 330° angle of view showed a significantly lower adenoma miss rate (7% vs 41%) to standard forward-viewing endoscopes (FVE). The objective of the present investigator-initiated randomized controlled trial was to assess the utility of this new technique regarding polyp detection rate as well as duration of the procedure in daily practice.

Aims & Methods: From March 2015 trough December 2016 patients referred to ambulant colonoscopy were randomly assigned to either a colonoscopy with high definition FVE Pentax i10 or FUSE instruments. 974 patients were allocated to FUSE and 882 to FVE. All procedures were performed by one experienced endoscopist.

Results: 51% of the FUSE and 52% of the FVE patients were female, mean age were 64 (CI 62–66) and 66 years (CI 63–70), respectively. 36% of the FUSE and 30% of the FVE patients were screening, 56 vs 61% were surveillance colonoscopies. 7 vs 8% had a positive family history for CRC. There was no significant difference for all baseline characteristics. Adenoma detection rate (ADR) was 51% for all FUSE cases vs 53% in FVE (ns 1?4 not significant). Mean adenoma per colonoscopy (APC) were 1.1 in FUSE vs 1.2 in FVE (ns). In the whole FUSE group 1.8 polyps per patients were found overall increasing to 1.9 with newer FUSE generation and 1. 9 with Lumos (tissue enhancement technology from Endochoice) compared to 1.8 in FVE (ns). 96 to 95% of the polyps were sessile lesions; 84.4 vs 83.7% below 5 mm of size, 12.8 vs 12.5 % between 5–9 mm and 3.2 respectively 3.8% bigger than 1 cm. 34.2 vs 34.1% were right sided, 21.9 vs 20.2% located in the tansverse colon. 48% of the extracted FUSE polyps and 50% of the polyps in the FVE group were tubular adenomas, 0.6 vs 1.2% were villous, 17.5% vs 23.6% serrated (SSA) adenomas and 15 respectively 11.8% were hyperplastic polyps. In 0.7% a CRC and in 0.02% an anal carcinoma was found in the FUSE group vs 0.8% CRCs in the FVE group. There was no significant difference in histology. Time to ileum was with 5.3 min (CI 5.0–5.5) slightly faster with FUSE (overall) even more pronounced with the at that time newest FUSE generation (gen2) and a mean time of 5.0 min (CI 4.7–5.3) compared to 5.5 min (CI 5.2–5.7) with the FVE (p 1?4 0.02). Withdrawal time was significantly shorter with FUSE with a time of 15.8 min (CI 15.3–16.3) in FUSE and 19.1 min (CI 16.8–21.4) in FVE (p 1?4 0.01). Time for intervention was identical in both groups (3.3 (CI 2.8–3.4) vs 3.4 min (CI 2.8–3.6); ns). Depending on FUSE generation the overall examination time gain was 3 to 4.1 min (p < 0.05).

Conclusion: Our randomized controlled trial with the largest FUSE examined patient cohort in the literature revealed significantly shorter examination time compared to conventional high definition colonoscopy with equal adenoma detection rates for both types of instruments. Due to the wider field of view (330° for FUSE endoscopes) polyps might be detected faster and easier during the withdrawal, resulting in the same high adenoma detection rate of 51 up to 52% for FUSE compared to 53% for FVE but with significantly shorter pullback time.

Disclosure of Interest: All authors have declared no conflicts of interest.

United European Gastroenterology Journal 5(5S), OP243

Performance comparison of full-spectrum versus forward-viewing colonoscopy: a randomized controlled trial

Martin Geyer, Gastroenterologie Wettingen, Dominik Leiner, Munich, Fridonlin Bannwart, Medica Laboratories Zurich

Background: New full-spectrum colonoscopes (FUSE) with 330°angle of view showed a significantly lower adenoma miss-rate. The objective of the present investigator-initiated randomized controlled trial was to assess the utility of this new technique in daily practice.

Method: From 3/2015 to 12/2016 patients referred to ambulant colonoscopy were randomly assigned to either a colonoscopy with high definition (HD) FVE Pentax i10 or FUSE instruments. 974 patients were allocated to RUSE and 882 to FVE. All procedures were performed by the first author.

Results: There was no significant difference for all baseline characteristics. Adenoma detection rate (ADR) was 51% for all FUSE cases vs 53% in FVE(ns). Mean adenoma per colonoscopy (APC) were 1.1 in FUSE vs 1.2 in FVE (ns). In the whole FUSE group 1.8 polyps per patients were found overall increasing to 1.9 with newer FUSE generation compared to 1.9 in FVE (ns). 84.4 vs 83.7% Polyps were below 5 mm of size and only 3.2 respectively 3.8% bigger than 1 cm. 48% of the extracted FUSE polyps and 50% of the polyps in the FVE group were tubular adenomas, 0.6 vs 1.2% were villous, 17.5% vs 23.6% serrated adenomas (SSA). There was no significant difference in histology. Time to ileum was with the at that time newest FUSE generation 5.0 min (CI 4.7-5.3) compared to 5.5 min (CI 5.2-5.7) with the FVE (p =0.02). Withdrawal time was significantly shorter with FUSE with as time of 15.8 (CI 15.3-16.3) in FUSE and 19.1 min (CI 16.8-21.4) in FVE (p=0.01). Time for intervention was identical in both groups (3.3 vs 3.4 min). Depending on FUSE generation the overall examination time gain was 3 to 4.1 min (p<0.05).

Conclusion: Our RCT with the largest FUSE examined patient cohort in the literature revealed signif. shorter examination time compared to conventional HD colonoscopy with equal adenoma detection rates for both types of instruments 51 vs 53%.

SWISS MEDICAL WEEKLY 2017;147 (SUPPL 225), O14

Comparison of two bowel preparations for colonoscopy Moviprep and Citrafleet in daily practice

Martin Geyer, Gastroenterologie Wettingen, Dominik Leiner, Ludwig-Maximilians University Munich, Germany

Background: The success of any colonoscopy depends upon the quality of bowel preparation. Low volume preps (Moviprep with 2 l, CitraFleet with twice 0.15 l) are increasingly used. The scope of our study was to evaluate possible differences between the two products and the type of application (e.g. same day or split dosing) in routine gastroenterology.

Methods: From February 2015 through December 2016 we tested two types of bowel preparation (CitraFleet and Moviprep) in two different ways of application as split (1 st Dose 8 pm the day before; 2 nd Dose 4 - 6 hours before colonoscopy) or same day dosing (1 st Dose 8 am the day of colonoscopy; 2 nd Dose 4 hours before colonoscopy) in a typical colon carcinoma screening population of a private practice. We compared 450 randomly assigned CitraFleet cases with 1111 patients taking Moviprep. The efficacy of the two regimens was judged according to Boston bowel preparation scale (BBPS).

Results: The BBPS Score (best score of 9) for Moviprep was 7.2, for CitraFleet 7.1 (p=0.03). The Scores for the right colon were 2.3 for CitraFleet and 2.3 for Moviprep, for the transverse colon 2.3 vs 2.4 respectively and 2.4 vs 2.4 for the left colon. The two groups slightly differed in average age (61 years for CitraFleet vs 66 years for Moviprep) and in gender (42% males vs 51%) - with identical BMI (mean 25). The effect of gender, age and obesity on quality of preparation was negligible (R 2 < 1%). Split dose or same day dosing did not significantly differ with 7.2 vs 7.2.

Conclusion: Our data revealed no clinically relevant difference neither for split or same day dosing nor for the two preps used, especially not in what concerns cleaning of the right colon.

SWISS MEDICAL WEEKLY 2017;147 (SUPPL 225), PG25

Übersicht als PDF.

Ein praxisorientiertes Update zum Reizdarmsyndrom

Der Informierte Arzt 2.2014.

Geyer Martin.

Magendarmbeschwerden – wenn der Bauch schmerzt und der Stuhl sich ändert

Es gibt ausser dem Wetter kein Thema, über das so uninformiert gesprochen wird, wie über die Darmfunktion, hält W. Grant fest. Also höchste Zeit, um Klartext zu sprechen und einiges über das Thema Reizdarm klar zu stellen. Jede Behandlung beginnt mit der richtigen Diagnose. Zur Diagnose benötigen wir eine Definition.

Endlich existiert eine brauchbare Definition des Reizdarmsyndroms (RDS). Für den klinischen Alltag heisst dies Abschied von Rom (Rom II- oder III-Kriterien, in der Praxis oft schwierigzu gebrauchen!).

Die Krankheit liegt vor, wenn alle 3 Punkte erfüllt sind:

  1. Es bestehen chronische (d.h. länger als 3 Monate) anhaltende Beschwerden (z.B. Bauchschmerzen, Blähungen), die vom Patienten und dem Arzt auf den Darm bezogen werden und in der Regel mit einer Stuhlgangsveränderung einhergehen.
  2. Die Beschwerden sollen begründen, dass der Patient deswegen Hilfe sucht und/oder sich sorgt
  3. und so stark sein, dass die Lebensqualität hierdurch relevant beeinträchtigt wird.
  4. Voraussetzung ist, dass keine für andere Krankheitsbilder charakteristischen Veränderungen vorliegen, welche wahrscheinlich für die Symptome verantwortlich sind.

Artikel als PDF.

Wenn es beim Stuhlgang schmerzt: Analfissur praktisch

Schweizerisches Medizin-Forum 2013/38.

Martin Geyer, Daniel Bimmler.

Gastroenterologie Wettingen / Praxis für Viszeralchirurgie, Zürich.

Abstract

Analfissuren sind häufig und vor allem durch eine schmerzhafte Defäkation mit Frischblutbeimengung gekennzeichnet - im Unterschied zur schmerzlosen Hämorrhoidalblutung. Die Schmerzen stehen in der (sub-)akuten Phase der Fissur im Vordergrund, während bei chronischen Fissuren eher über Juckreiz oder leichtes Brennen mit Blutspuren am Papier geklagt wird.

Die Therapie umfasst Laxativa zwecks atraumatischer Stuhlpassage, Calcium-Antagonisten oder ein Nitrat in Salbenform zur Relaxation des Sphincter ani, bei ungenügendem Erfolg die intrasphinktere Applikation von Botulinumtoxin sowie eine adäquate Analgesie (lokal und systemisch).

Bei schlechter Heilung und chronifizierter Fissur ist das Fissur-Debridement die Therapie der Wahl, bei persistierend spastischem Sphinkter mit gleichzeitiger Verabreichung von Botulinumtoxin intrasphinkter.

Artikel als PDF.

Carbon dioxide insufflation in colonoscopy is safe: a prospective trial of 347 patients.

Diagn Ther Endosc. 2012;2012:692532. doi: 10.1155/2012/692532. Epub 2012 Sep 29.

Geyer M., Guller U., Beglinger Ch.

Gastroenterologie Wettingen, Rosengartenstrasse 2, 5430 Wettingen, Switzerland.

Abstract

Available evidence suggests that the use of CO(2) insufflation in endoscopy is more comfortable for the patient. The safety of CO(2) use in colonoscopy remains contentious, particularly in sedated patients. The objective of the present prospective trial was to assess the safety of CO(2) colonoscopies. Methods. 109 patients from our previous randomized CO(2) colonoscopy study and an additional 238 subsequent consecutive unselected patients who had a routine colonoscopy performed in a private practice were enrolled from April 2008 through September 2008. All but 2 patients were sedated. All patients were routinely monitored with transcutaneous CO(2) measurement. Volumes of CO(2) administered were correlated with capnographic measurements from transcutaneous monitoring. Results. Of the 347 patients examined, 57% were women; mean (SD) age of participants was of 60.2 years (12.8). Mean propofol dosage was 136mg (64mg). Mean CO(2) values were 34.7mm Hg (5.3) at baseline, 38.9mm Hg (5.5) upon reaching the ileum, and 36.9mm Hg (5.0) at examination’s end. Mean maximum increase of CO(2) was 4.5mm Hg (3.6). No correlation was observed between volume of CO(2) administered and increase in level of CO(2) (correlation coefficient: 0.01; P value: 0.84). No complications were observed. Conclusions. The present prospective study, which was based on one of the largest sedated patient sample reported to date in this setting, provides compelling evidence that CO(2) insufflation in colonoscopy is safe and unassociated with relevant increases in transcutaneously measured levels of CO(2).

PMID: 23055655, PMCID: PMC3465970.

Artikel bei PubMed, download als PDF.

Carbon dioxide insufflation in routine colonoscopy is safe and more comfortable: results of a randomized controlled double-blinded trial.

Diagn Ther Endosc. 2011;2011:378906. Epub 2011 Jun 15.

Geyer M., Guller U., Beglinger C.

Gastroenterologie Wettingen, 5430 wettingen, Switzerland.

Abstract

Many patients experience pain and discomfort after colonoscopy. Carbon dioxide (CO(2)) can reduce periprocedural pain although air insufflation remained the standard procedure. The objective of this double-blinded, randomized controlled trial was to evaluate whether CO(2) insufflation does decrease pain and bloating during and after colonoscopy compared to room air. Methods. 219 consecutive patients undergoing colonoscopy were randomized to either CO(2) or air insufflation. Propofol was used in all patients for sedation. Transcutaneous CO(2) was continuously measured with a capnograph as a safety parameter. Pain, bloating, and overall satisfaction were assessed at regular intervals before and after the procedure. Results(data are mean ±SD). 110 patients were randomized to CO(2) and 109 to room air. The baseline characteristics were similar in both groups. The mean propofol dose was not different between the treatments, as were the time to reach the ileum and the withdrawal time. pCO(2) at the end of the procedure was 35.2 ± 4.3mmHg (CO(2) group) versus 35.6 ± 6.0mmHg in the room air group (P > .05). No relevant complication occurred in either group. There was significantly less bloating for the CO(2) group during the postprocedural recovery period (P < .001) and over the 24-hour period (P < .001). Also, patients with CO(2) insufflation experienced significantly less pain (P = .014). Finally, a higher overall satisfaction (P = .04 ) was found in the CO(2) group. Conclusions. This trial provides compelling evidence that CO(2) insufflation significantly reduces bloating and pain after routine colonoscopy in propofol-sedated patients. The procedure is safe with no significant differences in CO(2) between the two groups.

PMID: 21747649, PMCID: PMC3123829.

Artikel bei PubMed, download als PDF.

Efficacy and safety of certolizumab pegol in an unselected crohn’s disease population: 26-week data of the FACTS II survey.

Inflamm Bowel Dis. 2011 Jul;17(7):1530-9. doi: 10.1002/ibd.21521. Epub 2010 Dec 22.

Vavricka SR, Schoepfer AM, Bansky G, Binek J, Felley C, Geyer M, Manz M, Rogler G, de Saussure P, Sauter B, Scharl M, Seibold F, Straumann A, Michetti P; Swiss IBDnet.

Division of Gastroenterology, University Hospital of Zurich, Switzerland.

Abstract

BACKGROUND: Certolizumab pegol (Cimzia, CZP) was approved for the treatment of Crohn’s disease (CD) patients in 2007 in Switzerland as the first country worldwide. This prospective phase IV study aimed to evaluate the efficacy and safety of CZP over 26 weeks in a multicenter cohort of practice-based patients.

METHODS: Evaluation questionnaires at baseline, week 6, and week 26 were completed by gastroenterologists in hospitals and private practices. Adverse events were evaluated according to World Health Organization (WHO) guidelines.

RESULTS: Sixty patients (38F/22M) were included; 53% had complicated disease (stricturing or penetrating), 45% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 73% to infliximab, and 43% to adalimumab. A significant decrease of the Harvey-Bradshaw Index (HBI) was observed under CZP therapy (12.2 ± 4.9 at week 0 versus 6.3 ± 4.7 at week 6 and 6.7 ± 5.3 at week 26, both P < 0.001). Response and remission rates were 70% and 40% (week 6) and 67% and 36%, respectively (week 26). The complete perianal fistula closure rate was 36% at week 6 and 55% at week 26. The frequency of adverse drug reactions attributed to CZP was 5%. CZP was continued in 88% of patients beyond week 6 and in 67% beyond week 26.

CONCLUSIONS: In a population of CD patients with predominantly complicated disease behavior, CZP proved to be effective in induction and maintenance of response and remission. This series provides the first evidence of CZP’s effectiveness in perianal fistulizing CD in clinical practice.

Copyright © 2010 Crohn’s & Colitis Foundation of America, Inc.

PMID: 21674709

Artikel bei PubMed, download als PDF.

Efficacy and safety of certolizumab pegol induction therapy in an unselected Crohn’s disease population: results of the FACTS survey.

Inflamm Bowel Dis. 2010 Jun;16(6):933-8.

Schoepfer AM, Vavricka SR, Binek J, Felley C, Geyer M, Manz M, Rogler G, de Saussure P, Sauter B, Seibold F, Straumann A, Michetti P; Swiss IBDnet.

Department of Visceral Surgery and Medicine, Gastroenterology, University of Bern/Inselspital, Switzerland.

Abstract

BACKGROUND: Switzerland was the first country to approve certolizumab pegol (Cimzia, CZP) for the treatment of patients with moderate to severe Crohn’s disease (CD) in September 2007. This phase IV study aimed to evaluate the efficacy and safety of CZP in a Swiss multicenter cohort of practice-based patients.

METHODS: Baseline and Week 6 evaluation questionnaires were sent to all Swiss gastroenterologists in hospitals and private practices. Disease activity was assessed with the Harvey-Bradshaw Index (HBI) and adverse events were evaluated according to WHO guidelines.

RESULTS: Fifty patients (31 women, 19 men) were included; 56% had complicated disease (stricture or fistula) and 52% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 78% to infliximab, and 50% to adalimumab. A significant decrease in HBI was observed at Week 6 (versus Week 0) following induction therapy with CZP 400 mg subcutaneously at Weeks 0, 2, and 4 (12.6 +/- 4.7 Week 0 versus 6.2 +/- 4.4 Week 6, P < 0.001). Response and remission rates at Week 6 were 54% and 40%, respectively. We identified 8/11 CD patients undergoing a 50% fistula response (P = 0.021). The frequency of adverse drug reactions attributed to CZP was 6%. CZP was continued in 80% of patients beyond Week 6.

CONCLUSIONS: In a population of CD patients with complicated disease behavior, CZP induced a response and remission in 54% and 40% of patients, respectively. This series provides the first evidence of the effectiveness of CZP in perianal fistulizing CD.

PMID: 20014021

Artikel bei PubMed, download als PDF.

Effect of yacon (Smallanthus sonchifolius) on colonic transit time in healthy volunteers.

Digestion. 2008;78(1):30-3. Epub 2008 Sep 10.

Geyer M, Manrique I, Degen L, Beglinger C.

Department of Gastroenterology, University Hospital Basel, Basel, Switzerland.

Abstract

BACKGROUND: Yacon is a root crop which contains high amounts of fructooligosaccharides (FOS). The aim of this study was to investigate the effects of yacon syrup on colon transit time in healthy volunteers.

METHODS: In a placebo-controlled, double-blind study yacon was administered to 16 healthy individuals (8 males, 8 females) in a dose of 20 g daily (equal to 6.4 g FOS) in a 2-week crossover design. Each period was interrupted by a 2-week wash-out phase. Transit time was assessed by a radio-opaque marker technique.

RESULTS: Transit time (mean +/- SEM) through the gastrointestinal tract was significantly decreased from 59.7 +/- 4.3 to 38.4 +/- 4.2 h (p < 0.001). Yacon was well tolerated with an excellent side effect profile. Bloating is not an uncommon side effect observed with FOS, but bloating-related disturbances were not significantly more often reported with yacon compared to placebo. Stool frequency increased from 1.1 +/- 0.1 to 1.3 +/- 0.2 times per day and the consistency showed a tendency for softer stools as assessed by a numerical depicted stool protocol. Neither parameter did, however, reach statistical significance.

CONCLUSION: Yacon markedly accelerates colonic transit in healthy individuals. Further studies are needed in constipated patients to confirm these preliminary data. Due to the low caloric content of yacon, the root could be a useful treatment in constipated diabetics or obese patients.

2008 S. Karger AG, Basel.

PMID: 18781073

Artikel bei PubMed, download als PDF.

Salmonella enterocolitis and hemorrhagic shock.

Gastrointest Endosc. 2007 Jun;65(7):1077-8; discussion 1078. Epub 2007 Apr 23.

Geyer M, Peter S, Tornillo L, Beglinger C.

Department of Gastroenterology and Hepatology, Universitätsspital Basel, Switzerland.

PMID: 17451705

Artikel bei PubMed.

Application of bleeding prophylactic criteria (NICE) in patients with acute gastrointestinal bleeding. A Swiss prospective study.

Swiss Med Wkly. 2007 Mar 10;137(9-10):146-50.

Geyer M, Peter S, Bühler H, Bertschinger P.

Department of Internal Medicine, City Hospital Waid, Zurich, Switzerland.

Abstract

Multiple treatment guidelines for nonsteroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-related ulcer complications should be prescribed preventive strategies such as acid-suppressive drugs, misoprostol or COX-2-specific inhibitors to reduce their risk of serious ulcer complications. However data are lacking as to how many patients have been on preventive measures in accordance to the National Institute for Clinical Excellence (NICE) criteria in our population. We therefore evaluated the extent to which patients with acute gastrointestinal bleeding have been under ulcer-preventive strategies at the time of hospital entry. In a one-year-bleeding-study at the Waid city hospital, Zürich, ulcer preventive treatment was practiced in only 25% of 214 patients with acute gastrointestinal bleeding. We conclude that ulcer prevention in everyday medical practice is still being seldom applied.

PMID: 17370155

Artikel bei PubMed und SMW, download als PDF.

Serum immunoglobin G4 (IgG4): an important marker in autoimmune pancreatitis?

Swiss Med Wkly. 2006 Aug 19;136(33-34):544-7.

Sulz MC, Geyer M, Peter S, Degen L.

Department of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.

Abstract

A unique form of chronic pancreatitis has recently become widely recognised as an important clinical entity in the spectrum of pancreatic diseases under the term autoimmune pancreatitis (AIP). This entity is characterised by irregular narrowing of the pancreatic duct, swelling of parenchyma, lymphoplasmacytic infiltration and fibrosis as well as favourable response to corticosteroid treatment. In addition, increased concentration of serum immunoglobulin G4 (IgG4) is a notable characteristic marker. Some patients undergoing pancreaticoduodenectomy for presumed pancreatic ductal adenocarcinoma have instead been found to have AIP. Early recognition of AIP can prevent pancreaticoduodenectomy in these patients and effective treatment with steroids can be introduced. Based on an interesting case, we discuss the entity of AIP with the rare combination of sclerosing cholangitis and we focus on the relevance of serum IgG4 as a factor in diagnosis and monitoring therapy of AIP.

PMID: 16983597

Artikel bei PubMed und SMW, download als PDF.

Persistent gastrocutaneous fistula after percutaneous gastrostomy tube removal.

Endoscopy. 2006 May;38(5):539-40.

Peter S, Geyer M, Beglinger C.

PMID: 16767596

Artikel bei PubMed.

Hepatitis C virus in breast milk.

Lancet. 1995 Apr 8;345(8954):928.

Zimmermann R, Perucchini D, Fauchère JC, Joller-Jemelka H, Geyer M, Huch R, Huch A.

PMID: 7707835

Artikel bei PubMed.