Zeitschrift fur Gastroenterologie最新文献

{"title":"Laparoscopic Living donor liver transplantation in irresectable intrahepatic cholangiocarcinoma in primary sclerosing cholangitis associated liver cirrhosis.","authors":"Jan Bednarsch, Sven A Lang, Daniel Heise, Pavel Strnad, Ulf P Neumann, Tom F Ulmer","doi":"10.1055/a-2221-6126","DOIUrl":"10.1055/a-2221-6126","url":null,"abstract":"<p><p>Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor and usually associated with a poor oncological prognosis. The current gold standard is the surgical resection of the tumor with subsequent adjuvant therapy. However, in case of irresectability e.g. in case of liver cirrhosis, a palliative treatment regime is conducted.This report demonstrates the case of an irresectable iCCA in liver cirrhosis due to primary sclerosing cholangitis (PSC) treated by living-donor liver transplantation (LDLT) facilitated by minimal invasive donor hepatectomy. No postoperative complications were observed in the donor and the donor was released on the 6^th postoperative day. Further, after a follow-up of 1.5 years, no disease recurrence was detected in the recipient.According to the recent international literature, liver transplantation can be evaluated in case of small solitary iCCA (< 3 cm) in cirrhosis. Less evidence is provided for transplantation in advanced tumors which are surgically not resectable due to advanced liver disease or infiltration of major vessels, however some reports display adequate long-term survival after strict patient selection. The selection criteria comprise the absence of distant metastases and locoregional lymph node metastases as well as partial remission or stable disease after neoadjuvant chemotherapy. Due to no established graft allocation for iCCA in Germany, LDLT is currently the best option to realize transplantation in these patients. Developments in the last decade indicate that LDLT should preferentially be performed in minimal invasive manner (laparoscopic or robotic) as this approach is associated with less overall complications and a shorter hospitalization. The presented case illustrates the possibilities of modern surgery and the introduction of transplant oncology in the modern therapy of patients combining systemic therapy, surgical resection and transplantation to achieve optimal long-term results in patients which were initially indicated for palliative treatment.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation meets Cancer.","authors":"Dieter P Hoyer, Ulf Neumann","doi":"10.1055/a-2179-3157","DOIUrl":"10.1055/a-2179-3157","url":null,"abstract":"","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living-Donor Liver Transplantation for a Large Hepatocellular Carcinoma in a Genetically Identical Twin Sister.","authors":"Ger Koek, Sophia M Schmitz, Jan Bednarsch, Daniel Heise, Thomas Longerich, Frank Bakers, Christian Trautwein, Tom Luedde, Tom Florian Ulmer, Ulf Peter Neumann","doi":"10.1055/a-2214-1712","DOIUrl":"10.1055/a-2214-1712","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is, to date, the most common malignant tumor of the liver and is commonly staged with the Milan criteria. While deceased-donor liver transplantations (DDLT) are reserved for patients within the Milan criteria, living-donor liver transplantation (LDLT) might be a curative option for patients outside the Milan criteria. We here report a case of a 32-year-old woman who developed a giant, unresectable HCC out of a hepatocellular adenoma (HCA) after a pregnancy. The genetically identical twin sister donated her left hemi-liver after ethical approval and preoperative screening. No long-term immunosuppressive therapy was necessary, and after more than eight years, both are in perfect health and the recipient gave birth to a second child. This case shows that in certain situations large HCCs outside the standard criteria can be cured by LT. Careful evaluation of both donor and recipient should be performed for indications like this to assure optimal clinical outcome.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10783995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms“ – Langversion 4.0.","authors":"Michael Bitzer, Sabrina Groß, Jörg Albert, Susanne Blödt, Judit Boda-Heggemann, Thomas Brunner, Reiner Caspari, Enrico De Toni, Frank Dombrowski, Matthias Evert, Markus Follmann, Paul Freudenberger, Cihan Gani, Andreas Geier, Eleni Gkika, Martin Götz, Thomas Helmberger, Ralf-Thorsten Hoffmann, Peter Huppert, David Krug, Christian La Fougère, Hauke Lang, Thomas Langer, Philipp Lenz, Tom Lüdde, Andreas Mahnken, Silvio Nadalin, Hoa Huu Phuc Nguyen, Monika Nothacker, Johann Ockenga, Karl Oldhafer, Philipp Paprottka, Philippe Pereira, Thorsten Persigehl, Ruben Plentz, Jürgen Pohl, Heinrich Recken, Peter Reimer, Jutta Riemer, Ulrike Ritterbusch, Elke Roeb, Jörn Rüssel, Barbara Schellhaas, Peter Schirmacher, Hans Jürgen Schlitt, Irene Schmid, Andreas Schuler, Daniel Seehofer, Marianne Sinn, Andreas Stengel, Nadine Steubesand, Christoph Stoll, Andrea Tannapfel, Anne Taubert, Reina Tholen, Jörg Trojan, Ingo van Thiel, Arndt Vogel, Thomas Vogl, Frank Wacker, Oliver Waidmann, Heiner Wedemeyer, Henning Wege, Dane Wildner, Marcus-Alexander Wörns, Peter Galle, Nisar Malek","doi":"10.1055/a-2189-6353","DOIUrl":"10.1055/a-2189-6353","url":null,"abstract":"","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leitlinienreport der S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms und biliärer Karzinome“.","authors":"Sabrina Groß, Michael Bitzer, Susanne Blödt, Nadine Fischer, Markus Follmann, Paul Freudenberger, Thomas Langer, Petra Lynen Jansen, Monika Nothacker, Nadine Steubesand, Peter R Galle, Nisar P Malek","doi":"10.1055/a-2189-6197","DOIUrl":"10.1055/a-2189-6197","url":null,"abstract":"","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation for HCC in cirrhosis: Are Milan criteria outdated?","authors":"Jan-Paul Gundlach, Mark Ellrichmann, Marieke van Rosmalen, Serge Vogelaar, Christine Eimer, Corinna Rheinbay, Sabina Rösgen, Jost-Philipp Schäfer, Thomas Becker, Michael Linecker, Felix Braun","doi":"10.1055/a-2228-7496","DOIUrl":"10.1055/a-2228-7496","url":null,"abstract":"<p><p>In Germany, organ allocation is based on the MELD-system and lab-MELD is usually low in patients with hepatocellular carcinoma (HCC) in cirrhosis. Higher medical urgency can be achieved by standard exception for HCC (SE-HCC), if Milan criteria (MC) are met. Noteworthy, UNOS T2 reflects MC, but excludes singular lesions < 2 cm. Thus, SE-HCC is awarded to patients with one lesion between 2 and 5 cm or 2 to 3 lesions between 1 and 3 cm. These criteria are static and do not reflect biological properties of HCC.We present a retrospective cohort of 111 patients, who underwent liver transplantation at UKSH, Campus Kiel between 2007 and 2017. No difference was found in overall survival for patient cohorts using Milan, UCSF, up-to-seven, and French-AFP criteria. However, there was a significantly reduced survival, if microvascular invasion was detected in the explanted organ and in patients with HCC-recurrence. The exclusive use of static selection criteria including MC appear to limit the access to liver transplantation.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation meets gastrointestinal cancer.","authors":"Sven H Loosen, Catherine Leyh, Ulf Peter Neumann, Hans Bock, Christian Weigel, Tom Luedde, Christoph Roderburg","doi":"10.1055/a-2226-0123","DOIUrl":"10.1055/a-2226-0123","url":null,"abstract":"<p><p>Liver transplantation (LT) has emerged as a standard of care for patients with end-stage liver disease, providing a life-saving intervention for patients with severely compromised liver function in both the acute and chronic setting. While LT has also become a routine procedure for early-stage hepatocellular carcinoma (HCC), offering a potential cure by treating both the tumor and the underlying liver disease, its relevance in the context of other malignancies such as cholangiocellular carcinoma (CCA), combined hepatocellular-cholangiocarcinoma (cHCC-CCA) or liver metastases is still the subject of intense debate and no definite recommendations have yet been established. This review summarizes the current therapeutic standards in the context of LT for gastrointestinal malignancies and provides a reflection and outlook on current scientific and clinical developments.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms“ – Kurzversion.","authors":"Sabrina Groß, Michael Bitzer, Jörg Albert, Susanne Blödt, Judit Boda-Heggemann, Thomas Brunner, Reiner Caspari, Enrico De Toni, Frank Dombrowski, Matthias Evert, Markus Follmann, Paul Freudenberger, Cihan Gani, Andreas Geier, Eleni Gkika, Martin Götz, Thomas Helmberger, Ralf-Thorsten Hoffmann, Peter Huppert, David Krug, Christian La Fougère, Hauke Lang, Thomas Langer, Philipp Lenz, Tom Lüdde, Andreas Mahnken, Silvio Nadalin, Hoa Huu Phuc Nguyen, Monika Nothacker, Johann Ockenga, Karl Oldhafer, Philipp Paprottka, Philippe Pereira, Thorsten Persigehl, Ruben Plentz, Jürgen Pohl, Heinrich Recken, Peter Reimer, Jutta Riemer, Ulrike Ritterbusch, Elke Roeb, Jörn Rüssel, Barbara Schellhaas, Peter Schirmacher, Hans Jürgen Schlitt, Irene Schmid, Andreas Schuler, Daniel Seehofer, Marianne Sinn, Andreas Stengel, Nadine Steubesand, Christoph Stoll, Andrea Tannapfel, Anne Taubert, Reina Tholen, Jörg Trojan, Ingo van Thiel, Arndt Vogel, Thomas Vogl, Frank Wacker, Oliver Waidmann, Heiner Wedemeyer, Henning Wege, Dane Wildner, Marcus-Alexander Wörns, Peter Galle, Nisar Malek","doi":"10.1055/a-2189-8461","DOIUrl":"10.1055/a-2189-8461","url":null,"abstract":"","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumour stage and overall survival in patients with intrahepatic cholangiocarcinoma and primary sclerosing cholangitis - a retrospective cohort study.","authors":"Christoph Schramm, Ayaz Sapuk, Dieter Hoyer, Sonia Radünz, Hartmut Schmidt","doi":"10.1055/a-2207-5519","DOIUrl":"10.1055/a-2207-5519","url":null,"abstract":"<p><strong>Background: </strong>Patients with primary sclerosing cholangitis (PSC) carry increased risks for malignancy, among which cholangiocarcinoma (CCA) is the most frequent. We aimed to characterise a cohort of patients with PSC and intrahepatic CCA (iCCA) and to compare this cohort with CCA in different localisations.</p><p><strong>Methods: </strong>We performed a retrospective analysis of our medical database from 01.01.2007 to 30.06.2023 and differentiated CCA according to its localisation within the biliary tract into iCCA, perihilar CCA (pCCA), distal CCA (dCCA), and gallbladder carcinoma (GBC).</p><p><strong>Results: </strong>We identified 8 (28%) patients with iCCA, 14 (48%) patients with pCCA, 6 (21%) patients with GBC, and 1 (3%) patient with dCCA without significant differences in gender distribution and mean age. Mean time between diagnosis of PSC and CCA was 158±84 months for iCCA, 93±94 months for pCCA, and 77±69 months for GBC (p=0.230). At the time of CCA diagnosis, advanced-stage disease was present in 6 (75%) patients with iCCA, 13 (93%) patients with pCCA, and 2 (40%) patients with GBC (p=0.050). Only 5 (63%) patients with iCCA received curatively intended surgery, of whom 4 (80%) patients developed recurrence after a mean time of 38±31 months. Mean survival time in patients with iCCA (35±33 months) lay between patients with pCCA (14±8 months) and patients with GBC (57±58 months), but the difference was not statistically significant (p=0.131).</p><p><strong>Conclusion: </strong>Patients with PSC and iCCA showed an advanced tumour stage at diagnosis and limited long-time survival, which was classified between pCCA with worse prognosis and GBC with better prognosis.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Climate Crisis: What Gastrointestinal Complications of this Medical Emergency Should We Be Aware Of?]","authors":"Jens Walldorf, Nikolaus Christian Simon Mezger, Lena Weber, Anja Knothe, Michelle Klose, Stefan Moritz, Eva Johanna Kantelhardt, Stephan Feller, Axel Schlitt, Robin Greinert, Patrick Michl","doi":"10.1055/a-2058-8883","DOIUrl":"10.1055/a-2058-8883","url":null,"abstract":"<p><strong>Introduction: </strong>The climate crisis has serious consequences for many areas of life. This applies in particular to human health - also in Europe. While cardiovascular, pneumological and dermatological diseases related to the climate crisis are often discussed, the crisis' significant gastroenterological consequences for health must also be considered.</p><p><strong>Methods: </strong>A literature search (Pubmed, Cochrane Library) was used to identify papers with relevance particularly to the field of gastroenterology in (Central) Europe. Findings were supplemented and discussed by an interdisciplinary team.</p><p><strong>Results: </strong>The climate crisis impacts the frequency and severity of gastrointestinal diseases in Europe due to more frequent and severe heat waves, flooding and air pollution. While patients with intestinal diseases are particularly vulnerable to acute weather events, the main long-term consequences of climate change are gastrointestinal cancer and liver disease. In addition to gastroenteritis, other infectious diseases such as vector-borne diseases and parasites are important in the context of global warming, heat waves and floods.</p><p><strong>Discussion: </strong>Adaptation strategies must be consistently developed and implemented for vulnerable groups. Patients at risk should be informed about measures that can be implemented individually, such as avoiding heat, ensuring appropriate hydration and following hygiene instructions. Recommendations for physical activity and a healthy and sustainable diet are essential for the prevention of liver diseases and carcinomas. Measures for prevention and the promotion of resilience can be supported by the physicians at various levels. In addition to efforts fostering sustainability in the immediate working environment, a system-oriented commitment to climate protection is important.</p>","PeriodicalId":23853,"journal":{"name":"Zeitschrift fur Gastroenterologie","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9290107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}