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  • 1
    Electronic Resource
    Electronic Resource
    Endoskopische intraluminale Valvuloplastik – Eine Therapie der Zukunft für die gastrooesophageale Refluxkrankheit (1998)
    Springer
    Der Chirurg 69 (1998), S. 158-162 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Gastroesophageal reflux disease ; Antireflux surgery ; Minimally invasive surgery ; Endoscopic intervention. ; Schlüsselwörter: Gastrooesophageale Refluxkrankheit ; Antirefluxchirurgie ; minimal-invasive Chirurgie ; endoskopische Intervention.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Eine neue endoskopische, intraluminale Valvuloplastik wird beschrieben. Es handelt sich hierbei um einen einfachen, ambulant durchführbaren Antirefluxeingriff, der bei Patienten mit frühen Stadien der gastrooesophagealen Refluxkrankheit eine Alternative zur lebenslangen medikamentösen Dauertherapie bieten könnte. Die Technik des Eingriffs, die Effektivität und erste Langzeitergebnisse im Tierversuch an Pavianen werden dargestellt.
    Notes: Summary. A new endoscopic intraluminal valvuloplasty is described. The procedure provides a simple, easy outpatient approach for antireflux surgery and is applicable to patients with early gastroesophageal reflux disease as an alternative to chronic life-long medical therapy. The feasibility, durability and efficacy of the procedure in baboons are reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050390
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  • 2
    Electronic Resource
    Electronic Resource
    Endoscopic grading of the gastroesophageal valve in patients with symptoms of gastroesophageal reflux disease (GERD) (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 1184-1188 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Endoscopy — Gastroesophageal valve — Gastroesophageal reflux disease — GERD — Esophagus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: It has been suggested that endoscopic grading of the gastroesophageal flap valve is a good predictor of the reflux status. Methods: To test this hypothesis, 268 symptomatic patients underwent endoscopic grading of the gastroesophageal valve using Hill's classification, with grades I through IV. Esophageal acid exposure, lower esophageal sphincter characteristics, and the degree of esophageal mucosal injury were compared among the groups. Results: The prevalence of a mechanically defective sphincter, abnormal esophageal acid exposure, erosive esophagitis, and Barrett's esophagus increased with increasing alteration of the gastroesophageal valve. The presence of a grade IV valve indicated increased esophageal acid exposure in 75% of patients. As a predictor, this is similar to lower esophageal sphincter pressure but not as good as the presence of esophageal mucosal injury. Conclusions: Endoscopic grading of the gastroesophageal valve provides useful information about the reflux status but is less useful as an indicator of gastroesophageal reflux disease (GERD) than the presence of esophageal mucosal injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00009617
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Patient response to marketing minimally invasive surgery for heartburn (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 261-265 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Antireflux surgery — Laparoscopic antireflux surgery — Heartburn — Marketing and antireflux surgery — Medical vs surgical antireflux therapy — Laparoscopic Nissen fundoplication — Marketing and laparoscopic Nissen fundoplication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Over 40% of Americans suffer from ``heartburn'' at least once a month. This and other manifestations of gastroesophageal reflux (GERD) are often treated with neglect by both patients and their primary care physicians. Diagnostic evaluation is all too often sought only in late stages of the disease. We studied the response to a media campaign promoting minimally invasive surgery as a cure for longstanding heartburn. Methods: The information was publicized on 14 TV and six radio stations over 4 weeks. Patients were referred to an 800-number and data on the following topics were obtained using a standardized questionnaire: demographics, reflux symptoms, previous specialist referral, diagnostic evaluation and treatment, insurance information, and reasons for and expectations in calling. All questionnaires were screened for likelihood of GERD (high, medium, low). A return call was placed to triage patients (surgical or medical appointment, information only, no contact). Results: We received calls from 1,389 potential patients. Based on symptoms, medical therapy, and previous evaluation, 891 (64%) were judged to likely have GERD and assigned high-priority status. Of the patients providing insurance information, 32% were enrolled in an HMO; 29% commercial; 16% Medicare; 14% employer based; and 9% had no insurance. Six hundred ninety-eight high-priority patients were contacted. Of these, 402 (58%) wanted information only; 228 (33%) desired surgical and 68 (%) medical appointments. Two hundred fifteen patients (16% of callers) were seen by a surgical or medical consultant. One hundred thirty-five underwent diagnostic studies, of which 77 (57%) had pathologic esophageal acid exposure. Eighty-three patients have undergone surgery to date—60 laparoscopic and 14 open antireflux procedures; nine had other surgical procedures. Conclusions: Surprisingly, 64% of patients responding to a marketing campaign for heartburn have typical symptoms of GERD, have consulted one or more physicians and/or received medical treatment. More than half the patients tested (77/135) were found to have a positive 24-h pH study, and 78% (60/77) of these elected antireflux surgery to control their reflux symptoms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900647
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  • 4
    Electronic Resource
    Electronic Resource
    Ultrasonic epithelial ablation of the lower esophagus without stricture formation (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 342-347 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Barrett's esophagus—Epithelial ablation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The premalignant potential of Barrett's esophagus has stimulated efforts to find a way to ablate the columnar epithelium in order to reheal the area with squamous epithelium, thus obviating the cancer risk. This study describes and evaluates a new technique using ultrasonic energy to ablate the epithelium of the lower esophagus in a porcine model. Methods: Eight young farm pigs were used to develop the technique of applying a laparoscopic Cavitron Ultrasonic Surgical Aspirator (CUSA) to the lower esophageal mucosa through an operating gastrostomy. A further 11 Yakutan minipigs then underwent CUSA epithelial ablation, followed by a laparoscopic Nissen fundoplication or postoperative acid suppression therapy. We then assessed the healing response in these subjects. Results: Optimal CUSA energy settings enabled complete ablation of the squamous epithelium with preservation of the muscularis mucosa and submucosa. The integrity of the aspirated cells was sufficient for cytological analysis. Healing occurred by squamous regeneration without stricture formation. Conclusions: The CUSA technique holds promise for complete ablation of the Barrett's epithelium in a single setting. The unique tissue-selective nature of the ablative process allows complete mucosal reepithelialization without stricture formation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900667
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  • 5
    Electronic Resource
    Electronic Resource
    A contemporaneous comparison of hospital charges for laparoscopic and open Nissen fundoplication (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 151-155 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopy cost-effectiveness ; Laparoscopic Nissen fundoplication ; Cost analysis ; Gastroesophageal reflux disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical treatment of gastroesophageal reflux disease is increasingly recognized as a costeffective alternative to long-term medical therapy. This fact, coupled with the advent of laparoscopic fundoplication as a safe and efficacious alternative to open surgery, underscores the importance of determining the costs associated with laparoscopic treatment. Hospital costs and charges of patients undergoing open (N=9) and laparoscopic (N=11) fundoplication were retrospectively analyzed. Both procedures were performed during the same time period (6/91–6/93), at the same hospital, and by the same surgical team. Operative time, and hospital stay, were recorded in addition to total, operating room, anesthesia, sterile supplies, and hospital room charges. Figures are reported as mean values ± standard error of the mean. The Wilcoxon signed rank test was used for comparison of groups. Operative time (221±18 vs 165±12 min, P=0.033) was longer in the laparoscopic group, while hospital stay (5.8±02 vs 8.8±04 days, P〈0.001) was significantly shorter. Total hospital costs were similar for both groups of patients ($14,615±863 vs $15,891±921, P=0.247). Overall hospital charges were nearly identical ($26,634±1376 vs $27,189±1753, P=0.803). A detailed analysis demonstrated cost shifting, with laparoscopic fundoplication resulting in significantly higher charges associated with events in the operating room. Operating room ($6,064±252 vs $4,283±380, P=0.001), sterile supplies ($6,214±508 vs $5,403±390), and anesthesia charges ($1,593±76 vs $1,122±95, P〈0.001) were all greater in the laparoscopic group. This was offset by significantly lower hospital-room charges following laparoscopy ($5,098±355 vs $6,983±511, P=0.006). Laparoscopic Nissen fundoplication is not more expensive than its open counterpart. At present, laparoscopy results in higher operating-room charges which offsets savings from a shorter hospital stay. Improvements in technique and attention to limiting the cost of sterile supplies may ultimately result in a cost savings in favor of laparoscopy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00191956
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  • 6
    Electronic Resource
    Electronic Resource
    An intraluminal surgical approach to the management of gastric bezoars (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 831-834 
    Details
    ISSN: 1432-2218
    Keywords: Trichobezoar ; Gastrostomy ; Laparoscope instrument ; Foam-rubber stent
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Trichobezoars are difficult to remove endoscopically, often cause nausea and vomiting, and can result in small-bowel obstruction. A patient with a trichobezoar presented to our clinic with symptoms of partial small-bowel obstruction. Multiple attempts at flexible endoscopic removal were unsuccessful. Two large-diameter percutaneous gastrostomies with an inflatable balloon and distal foam-rubber stent to assure intragastric positioning were introduced under general anesthesia. Visualization was provided by a 0° panavision laparoscope placed through one of the gastrostomies. The bezoar was removed through the second gastrostomy using standard laparoscopic instruments. The patient made an uneventful recovery. This is the first reported case of percutaneous removal of a trichobezoar. We conclude large-diameter gastrostomies may serve as a port of access for numerous other intraluminal procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00190094
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    A new form of access for endo-organ surgery (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 738-741 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Endo-organ — Percutaneous endoscopic gastrostomy — Gastric surgery — Intraluminal surgery — Operative port
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Intraluminal gastric surgery provides a new treatment option for various disease processes. This study assesses the safety of a new large-diameter percutaneous endoscopic gastrostomy (PEG) for intraluminal surgery. Methods: Investigators at six institutions were asked to complete a standard questionnaire to assess the difficulties associated with the assembly and introduction of the PEG, plus intraoperative and postoperative problems related to placement of the device. Results: In terms of assembly; 1.9% of respondents reported difficulty obtaining complete vacuum of the balloon tip, and 3.8% had difficulty fitting the graduated dilator to the balloon-tipped cannula. Difficulties associated with introduction of the PEG included disengagement of the dilator from the balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%), difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%). Intraoperatively, 7.5% of respondents reported inadequate skin bolster fitting, 1.9% had CO2 leakage into the peritoneal cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or small intestine. Postoperatively, there was a 9.4% rate of wound infection, a 1.9% rate of gastrocutaneous fistula, and a 1.9% rate of esophageal, colon, or small intestine injury. Conclusions: The large-diameter PEG is safe and effective for endo-organ surgery. Additional preventive measures for PEG site infection should be investigated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901089
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  • 8
    Electronic Resource
    Electronic Resource
    278. Oesophagitis-Hiatushernie, eine Kontroverse? Neue Perspektiven in der Refluxkrankheit (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 898-898 
    Details
    ISSN: 1435-2451
    Keywords: Reflux disease ; Hiatal hernia ; pH Monitoring ; Refluxkrankheit ; Hiatushernie ; pH-Metrie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Um die diagnostische Trefferquote verschiedener Untersuchungen der gastro oesophagealen Refluxkrankheit zu evaluieren, wurden 90 Testpersonen (45 gesunde Probanden und 45 Patienten mit der Erkrankung) in dieser Studie untersucht. Radiographie, Endoskopie, 24-h-pH-Metrie und die Manometrie des unteren oesophagealen Sphincters wurden getestet. Die morphologischen Untersuchungen, Radiographie und Endoskopie erreichten nur begrenzte Sensitivität (78% resp. 62%). Die höchste Sensitivität (96%) und Spezifität (96%) hatte die 24-h-pH-Metrie. Die Manometrie selektiert Patienten mit einem mechanisch insuffizienten Sphincter mit einer Trefferquote von 87%.
    Notes: Summary In this study the diagnostic accuracy of the current investigations regarding gastroesophageal reflux disease was evaluated. Ninety subjects (45 healthy volunteers and 45 patients with the disease) underwent radiography, esophagoscopy, 24-h esophageal pH monitoring, and manometry of the lower esophageal sphincter. Morphologic investigations such as radiography and esophagoscopy showed limited sensitivity (78% vs 62%). The highest accuracy found was 24-h pH monitoring with 96% sensitivity and specificity. Manometry of the sphincter can select patients with a mechanically insufficient sphincter with an accuracy of 87%. The diagnostic workup should include functional studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298062
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    Paper (German National Licenses)
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