Zeitschrift für Gastroenterologie
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The rapid scientific progress in the past years has evoked debates about ethical limitations of technical innovations. Especially, high-end medicine for patients at the end of life gets in the focus of criticism whereas the idea of palliative care gains more importance. Gastroenterologists are an important partner in the setting of palliative care since many malignant tumors are found in the GI-tract; furthermore, about 80 % of all patients with advanced progressive illnesses being in a palliative care situation suffer from gastrointestinal symptoms. ⋯ A return to the core values of medical competence is essential. In this paper, the curriculum of "palliative care" in Germany shall be introduced. The aim of this work is to explain why it is worthwhile for physicians and especially for gastroenterologists to be trained in palliative care.
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Obscure gastrointestinal bleeding (OGIB) that cannot be established applying traditional endoscopic methods represents 5 % of all gastrointestinal bleedings. Earlier, in cases of recurrent, overt bleedings the surgeons had to perform a laparotomy "blind" without diagnosis. The aim of our retrospective study was to analyse the effectiveness of surgical therapy in patients with OGIB investigated with capsule endoscopy (CE). ⋯ CE offers a high impact on the surgical results in patients with OGIB. Through our CE examinations the correct localization of the bleeding sources always provided a reasonable support to perform an optimal small bowel resection.
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Peripancreatic fluid collections are common complications of acute pancreatitis or acute exacerbations of chronic pancreatitis. Surgery is required when these fluid collections become infected or cause obstruction or pain. However, morbidity and mortality after surgery in these cases are still too high, therefore minimally invasive approaches have been encouraged. The aim of this study was to evaluate the feasibility of endoscopic ultrasound-guided transmural drainage with intracystic endoscopy and necrosectomy. ⋯ Endoscopic treatment of infected pseudocysts and infected postacute pancreatic necrosis using transgastral retroperitoneal endoscopy with fluid and necrosis removal is a minimally invasive and effective procedure in patients with acute pancreatitis or acute exacerbation of chronic pancreatitis. However, the mortality rate of 6.6 % has to be taken into account.
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Patients with advanced liver disease show increased morbidity and mortality after hepatic resection and non-hepatic digestive surgery. Furthermore, postoperative liver failure is associated with a poor outcome, representing an important clinical problem. For evaluation of the perioperative mortality and the hepatic function, several scoring systems, clinical parameters, and static and dynamic tests are available. ⋯ In patients with Child Turcotte Pugh class A cirrhosis and MELD scores of
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Multicenter Study
[Complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions - results of a survey among German centers].
Endoscopic ultrasonography is a widely used technique in Germany and not restricted to highly specialised centres. Complementary to the traditional radial scanners, longitudinally scanning echo endoscopes have gained considerable acceptation. Multicentre data on the complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions at German centres do not exist. ⋯ Under the specific circumstances in Germany, endoscopic ultrasound, both conventional and interventional, was confirmed to be a safe diagnostic and therapeutic technique. In future, the prospective assessment of complications should become an essential part of quality management of endoscopic ultrasound.