Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery—outcomes of six consecutive cases in a single institution

Purpose Anastomotic leakages or staple line defects after Roux-en-Y gastric bypass (RYGB) and primary laparoscopic sleeve gastrectomy (LSG), respectively, with consecutive bariatric revisional surgery are associated with relevant morbidity and mortality rates. Endoscopic vacuum therapy (EVT) with or without stent-over-sponge (SOS) has been shown to be a promising therapy in foregut wall defects of various etiologies and may therefore be applied in the treatment of postbariatric leaks. Methods We report the results of six consecutive patients treated with EVT (83% in combination with SOS) for early postoperative leakages in close proximity to the esophagogastric junction (EGJ) after LSG (n = 2) and RYGB (n = 4) from May 2016 to May2018. Results All patients (2/6 male, median age 51 years, median BMI 44.2 kg/m2) were treated successfully without further signs of persisting leakage at the last gastroscopy. The lesions’ size ranged from 0.5 cm2 to 9 cm2, and the leaks were connected to large (max. 225 cm2) abscess cavities in 80% of the cases. Median duration of treatment (= EVT in situ) was 23.5 days (range, 7–89). The number of endoscopic interventions ranged from 1 to 24 (median, n = 7), with a median duration between vacuum sponge replacements of 4 days. Conclusion EVT is an effective and safe treatment for staple line defects or anastomotic leakage after bariatric surgeries and can therefore be adopted for the treatment of midgut wall defects. Further studies with a greater number of patients comparing surgical drainage alone or in combination with EVT versus EVT alone are needed

Pre-Emptive Endoluminal Negative Pressure Therapy at the Anastomotic Site in Minimally Invasive Transthoracic Esophagectomy (the preSPONGE Trial): Study Protocol for a Multicenter Randomized Controlled Trial

Introduction: Anastomotic leakage (AL) accounts for a significant proportion of morbidity following oesophagectomy. Endoluminal negative pressure (ENP) therapy via a specifically designed polyurethane foam (EsoSponge®, B.Braun Medical, Melsungen, Germany) has become the standard of care for AL in many specialized centres. The prophylactic (pENP) application of this technique aims to reduce postoperative morbidity and is a novel approach which has not yet been investigated in a prospective study. The aim of this study is therefore to assess the effect of pENP at the anastomotic site in high-risk patients undergoing minimally invasive transthoracic Ivor Lewis oesophagectomy. Methods and analysis: The study design is a prospective, multi-centre, two-arm, parallel-group, randomised controlled trial and will be conducted in two phases. Phase one is a randomised feasibility and safety pilot trial involving 40 consecutive patients. After definitive sample size calculation, additional patients will be included accordingly during phase two. The primary outcome of the study will be the postoperative length of hospitalization until reaching previously defined “fit for discharge criteria”. Secondary outcomes will include postoperative morbidity, mortality and postoperative AL-rates based on 90-day follow-up. A confirmatory analysis based on intention-to-treat will be performed. Ethics and dissemination: The ethics committee of the University of Zurich approved this study (2019-00562), which has been registered with ClinicalTrials.gov on 14.11.2019 (NCT04162860) and the Swiss National Clinical Trials Portal (SNCTP000003524). The results of the study will be published and presented at appropriate conferences

β6-Integrin Serves as a Potential Serum Marker for Diagnosis and Prognosis of Pancreatic Adenocarcinoma

INTRODUCTION Despite enormous efforts during the past decades, pancreatic adenocarcinoma (PAC) remains one of the most deleterious cancer entities. A useful biomarker for early detection or prognosis of PAC does not yet exist. The goal of our study was the characterization of β6-integrin (ITGB6) as a novel serum tumor marker for refined diagnosis and prognosis of PAC. Serum ITGB6 levels were analyzed in 3 independent PAC cohorts consisting of retrospectively and prospectively collected serum and/or (metastatic) PAC tissue specimens. METHODS Using 2 independent cohorts, we measured serum ITGB6 concentrations in 10 chronic pancreatitis patients, 10 controls, as well as in 27 (cohort 1) and 24 (cohort 2) patients with PAC, respectively. In these patients, we investigated whether ITGB6 serum levels correlate with known clinical and prognostic markers for PAC and whether they might differ between patients with PAC or benign inflammatory diseases of the pancreas. RESULTS We found that elevated serum ITGB6 levels (≥0.100 ng/mL) in patients suffering from metastasizing PAC presented an unfavorable prognostic outcome. By correlating the ITGB6 tissue expression in primary and metastatic PAC with clinical parameters, we found that positive ITGB6 expression in the tumor tissue is linked to increased serum ITGB6 levels in nonmetastatic PAC and correlates with carbohydrate antigen 19-9 and clinical outcome. DISCUSSION Our findings suggest that ITGB6 might serve as a novel serum biomarker for early diagnosis and prognosis of PAC. Given the limited specificity and sensitivity of currently used carbohydrate antigen 19-9-based assays, ITGB6 may have the potential to improve the diagnostic accuracy for PAC

The Compact Linear Collider (CLIC) - 2018 Summary Report

The Compact Linear Collider (CLIC) is a TeV-scale high-luminosity linear $e^+e^-$ collider under development at CERN. Following the CLIC conceptual design published in 2012, this report provides an overview of the CLIC project, its current status, and future developments. It presents the CLIC physics potential and reports on design, technology, and implementation aspects of the accelerator and the detector. CLIC is foreseen to be built and operated in stages, at centre-of-mass energies of 380 GeV, 1.5 TeV and 3 TeV, respectively. CLIC uses a two-beam acceleration scheme, in which 12 GHz accelerating structures are powered via a high-current drive beam. For the first stage, an alternative with X-band klystron powering is also considered. CLIC accelerator optimisation, technical developments and system tests have resulted in an increased energy efficiency (power around 170 MW) for the 380 GeV stage, together with a reduced cost estimate at the level of 6 billion CHF. The detector concept has been refined using improved software tools. Significant progress has been made on detector technology developments for the tracking and calorimetry systems. A wide range of CLIC physics studies has been conducted, both through full detector simulations and parametric studies, together providing a broad overview of the CLIC physics potential. Each of the three energy stages adds cornerstones of the full CLIC physics programme, such as Higgs width and couplings, top-quark properties, Higgs self-coupling, direct searches, and many precision electroweak measurements. The interpretation of the combined results gives crucial and accurate insight into new physics, largely complementary to LHC and HL-LHC. The construction of the first CLIC energy stage could start by 2026. First beams would be available by 2035, marking the beginning of a broad CLIC physics programme spanning 25-30 years

Braille-Zeile für PC's

Zusammenfassung: Es wurde ein Gerät zur Anzeige von Blindenschrift (Datenendgerät) entwickelt. Durch methodisches Konstruieren konnte ein neuartiges mechanisches Speicherprinzip zur Darstellung von Brailleschrift realisiert werden. Für das Verfahren ist eine Patentanmeldung in Angriff genommen: Die tastbaren Noppen der Braille-Schriftzeichen werden durch einen Prägestempel in ein endlos umlaufendes elastisches Band (Silikonkautschuk) gedrückt. Das Band besitzt u-förmige, geneigte Einschnitte in Matrix-Anordnung, sodaß sich die so gebildeten Laschen unter dem Druck der Stempel herausbiegen und als Noppen in einer tastbaren Position einrasten. In einem Lesefenster kann die so gebildete Textzeile durch Blinde abgelesen werden. Zur erneuten Ausgabe von Text muß das Band während seines Umlaufes zurück zu den Prägestempeln vom alten Text befreit werden. Hierfür wird es an einer Bremsrolle gedehnt, sodaß sich die u-förmigen Löcher längen. Alle Noppen verlieren dadurch ihre formschlüssige Einrastung und springen in die versenkte Ausgangslage zurück. Charakteristische Daten des Gerätes: * Ausgabeformat: Brailleschriftzeichen, 2x4 Punkte, Rastermaß 2,5mm * Ausgabezeile: 40 Zeichen (erweiterbar) * Ausgabegeschwindigkeit: 1 Zeile/Sek * Datenanschluß: Centronics-Port am PC (später RS232

[Liver transplantation - when and for whom it should be performed]

During the past two decades, orthotopic liver transplantation (OLT) emerged to the treatment of choice for patients with end-stage liver disease. In Switzerland, about 100 liver transplantations are performed every year, while the shortage of cadaveric organs considerably outmatches the demand. Common indications for OLT include cirrhosis due to alcoholic liver disease or chronic viral hepatitis related to hepatitis B or C, and hepatocellular carcinoma. With the advent of the new allocation policy in Switzerland in 2007, patients listed for OLT are mainly stratified based on the Model of End-stage Liver Disease (MELD) score. Using a patient's laboratory values for serum bilirubin, serum creatinin, and the international normalized ratio for prothrombin time (INR), the MELD score accurately predicts three-month mortality among patients on the waiting list. Compared to the pre-MELD era, patients with significantly higher MELD scores undergo transplantation which leads in turn to more complications and higher costs yet with a comparable outcome. Timely referral of potential candidates to a transplant center is crucial since thorough evaluation to rule out contraindications such as uncontrolled infection, extrahepatic malignancy or advanced cardiopulmonary disease is essential. Taken together, every patient presenting with acute liver failure, decompensated cirrhosis or suspected hepatocellular carcinoma should be evaluated in a center with liver transplantation capability

Modified full-thickness resection of a small subepithelial tumor with the help of a corkscrew

With the advent of endoscopic full-thickness resection (EFTR), small subepithelial tumors (SETs) became easily resectable both in upper and lower gastrointestinal tract. Several studies have suggested that complete resection of SETs is achievable in the vast majority of cases and severe complications occur only rarely [1]. Whereas technical success in the case of mucosal or submucosal lesions is easy to accomplish, for tumors arising from the muscularis propria, an R0 resection is more difficult to achieve by EFTR [1]. Grasping these lesions with the Twin Grasper may lead to tenting of the mucosa and submucosa, which in turn leads to incomplete removal of the SET. To overcome this technical problem, we herein present the feasibility of EFTR using a tissue-retracting helix device that was originally designed as part of the OverStitch endoscopic suturing system (Apollo Endosurgery Inc., Austin, Texas, USA). We describe the case of a 75-year-old patient who was referred for removal of an incidental SET in the proximal gastric corpus. Endosonography suggested a small gastrointestinal stromal tumor (GIST) ([Fig. 1]). After the lesion had been marked ([Fig. 2 a]), the gastroduodenal EFTR device (Ovesco, Tübingen, Germany) was mounted onto the endoscope and the helix device was advanced through the working channel. Once the endoscope was centered over the lesion, it was gradually punctured with the helix; the device was then manually rotated (like a corkscrew), resulting in tissue approximation. After this “fixation” procedure, it was easy to retract the lesion into the cap using gentle suction. The SET was then resected in the usual fashion, with adequate closure of the resection site ([Fig. 2 b]; [Video 1]). The resected specimen ([Fig. 3]) was shown histologically to be a completely resected leiomyoma

Die flexible Endosonographie in der Gastroenterologie: die Entwicklung von der Diagnostik zur Therapie

Die Endosonographie (EUS) in der Gastroenterologie hat sich von der rein diagnostischen Modalität zur vielversprechenden therapeutischen Disziplin gewandelt. Erster Schritt in diese Richtung war das EUS-gesteuerte Entnehmen von Gewebsproben an schwierig zugänglichen Lokalisationen; hier ist die Feinnadelpunktion von Pankreasläsionen an vorderster Stelle zu nennen. Mit dem EUS-gesteuertem Punktieren werden aber auch Gefässe erreicht, sodass Varizen gezielt verödet werden können. Kollektionen nach einer Pankreatitis werden ebenfalls minimal-invasiv angegangen und werden so nach luminal drainiert, statt eine chirurgische Intervention nötig zu machen. Durch das Einbringen von Führungsdrähten über die Hohlnadel sind zudem verschiedene Zugänge der Gallenwege intra- und extrahepatisch möglich, sodass interne Drainagen bei frustraner ERCP (endoskopische retrograde Cholangiopankreatikographie) möglich werden. Durch das Einbringen von speziell konfigurierten beschichteten Stents wiederum werden mit der interventionellen EUS neue Zugänge in Hohlorgane minimal-invasiv als Alternative zu chirurgischen Eingriffen geschaffen. Als Beispiel ist hier die endoskopische Gastroenterostomie bei maligner Magenausgangsstenose zu nennen