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Article ; Online: Black esophagus und black duodenum – seltene Ursache einer oberen gastrointestinalen Blutung.

Fleischmann, Carola Christina / Gölder, Stephan Karl / Messmann, Helmut

2021 Volume 59, Issue 5, Page(s) 457–459

Abstract: We present the case of a 73-year-old female patient with acute esophageal necrosis, or black esophagus, and consecutive distal esophageal perforation. Additionally, the patient had the rare coincidence of duodenal necrosis or black duodenum. Black ... ...

Title translation	Black esophagus and black duodenum - rare cause of an upper gastrointestinal bleeding.
Abstract	We present the case of a 73-year-old female patient with acute esophageal necrosis, or black esophagus, and consecutive distal esophageal perforation. Additionally, the patient had the rare coincidence of duodenal necrosis or black duodenum. Black esophagus is usually diagnosed endoscopically and is characterized by a circular necrosis of the esophagus with abrupt normalization at the gastroesophageal junction. Black esophagus is a rare cause of symptoms of upper gastrointestinal bleeding with a mortality rate of up to 30 %. Complications include esophageal perforation and esophageal stricture formation. No causal therapy is available.
MeSH term(s)	Acute Disease ; Aged ; Duodenum/diagnostic imaging ; Esophagus/diagnostic imaging ; Female ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Humans ; Necrosis
Language	German
Publishing date	2021-04-08
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	201387-3
ISSN	1439-7803 ; 0172-8504 ; 0044-2771
ISSN (online)	1439-7803
ISSN	0172-8504 ; 0044-2771
DOI	10.1055/a-1397-8135
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Zs.A 111: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.A 111/X: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Endoscopic treatment of early esophageal squamous neoplasia.

Fleischmann, Carola / Messmann, Helmut

Minerva chirurgica

2018 Volume 73, Issue 4, Page(s) 378–384

Abstract: Esophageal squamous cell carcinoma (ESCC) remains the most common esophageal cancer in the world, though a rising incidence of esophageal adenocarcinoma could be seen during the last decade in the western world. There are several known risk factors for ... ...

Abstract	Esophageal squamous cell carcinoma (ESCC) remains the most common esophageal cancer in the world, though a rising incidence of esophageal adenocarcinoma could be seen during the last decade in the western world. There are several known risk factors for ESCC, such as smoking, alcohol consumption, radiation or others. As there is a risk of lymph node metastasis already in early stages, early endoscopic detection is crucial for curative endoscopic treatment options. Therefore, newest technical improvements such as enhancement techniques or virtual chromoendoscopy are helpful for the diagnosis of mucosal carcinoma. Lugol's iodine remains the gold standard to detect early esophageal cancer, however, it should be combined with these newer techniques. For the prediction of invasion depth, a new classification was developed by the Japan Esophageal society. By using magnifying endoscopy and Narrow Band Imaging, the microvascular morphology allows a prediction of invasion depth of early squamous cell carcinoma. Endoscopic resection is suitable for patients with early-stage ESCC (m1-m2), because of the low risk of lymph node metastasis. EMR should be performed if the lesion is smaller than 15 mm, because a R0 resection can be achieved. Larger lesions (>15 mm) should be resected via endoscopic submucosal dissection to reach an en bloc resection, a lower recurrence rate and a R0 situation.
MeSH term(s)	Esophageal Squamous Cell Carcinoma/pathology ; Esophageal Squamous Cell Carcinoma/surgery ; Esophagoscopy ; Humans ; Neoplasm Staging
Language	English
Publishing date	2018-05-29
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	123603-9
ISSN	1827-1626 ; 0026-4733
ISSN (online)	1827-1626
ISSN	0026-4733
DOI	10.23736/S0026-4733.18.07805-7
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Article: Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center.

Probst, Andreas / Ebigbo, Alanna / Eser, Stefan / Fleischmann, Carola / Schaller, Tina / Märkl, Bruno / Schiele, Stefan / Geissler, Bernd / Müller, Gernot / Messmann, Helmut

Clinical endoscopy

2023 Volume 56, Issue 1, Page(s) 55–64

Abstract: Background/aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to ... ...

Abstract	Background/aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). Conclusion: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.
Language	English
Publishing date	2023-01-13
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2643507-X
ISSN	2234-2443 ; 2234-2400
ISSN (online)	2234-2443
ISSN	2234-2400
DOI	10.5946/ce.2022.093
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Article: Black esophagus und black duodenum – seltene Ursache einer oberen gastrointestinalen Blutung

Fleischmann, Carola Christina / Gölder, Stephan Karl / Messmann, Helmut

Zeitschrift für Gastroenterologie

2021 Volume 59, Issue 05, Page(s) 457–459

Abstract: Wir berichten über den fulminanten Verlauf eines black esophagus mit konsekutiver distaler Ösophagusperforation sowie eines black duodenum bei einer 73-jährigen Patientin. Die Diagnose des black esophagus erfolgt anhand des endoskopischen Bildes und ist ... ...

Abstract	Wir berichten über den fulminanten Verlauf eines black esophagus mit konsekutiver distaler Ösophagusperforation sowie eines black duodenum bei einer 73-jährigen Patientin. Die Diagnose des black esophagus erfolgt anhand des endoskopischen Bildes und ist charakterisiert durch die zirkuläre Nekrose des Ösophagus mit abruptem Übergang in regelrecht perfundierte Schleimhaut ab der Z-Linie. Der black esophagus ist eine seltene Ursache einer oberen gastrointestinalen Blutung und ist mit einer hohen Mortaliät von über 30 % verknüpft. Komplikativ können sich eine Ösophagusperforation und im langfristigen Verlauf eine Ösophagusstenose entwickeln. Eine kausale Therapie existiert nicht.
Keywords	Black esophagus ; Nekrose ; Ösophagusperforation ; Ischämie ; black esophagus ; necrosis ; perforation ; ischemia
Language	German
Publishing date	2021-04-08
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	201387-3
ISSN	1439-7803 ; 0044-2771 ; 0172-8504
ISSN (online)	1439-7803
ISSN	0044-2771 ; 0172-8504
DOI	10.1055/a-1397-8135
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Zs.A 111: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.A 111/X: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Endoscopic Submucosal Dissection for Early Esophageal Adenocarcinoma: Low Rates of Metastases in Mucosal Cancers with Poor Differentiation.

Probst, Andreas / Kappler, Felix / Ebigbo, Alanna / Albers, David / Faiss, Siegbert / Steinbrück, Ingo / Wannhoff, Andreas / Allgaier, Hans-Peter / Denzer, Ulrike / Rempel, Viktor / Reinehr, Roland / Dakkak, Dani / Mende, Matthias / Pohl, Jürgen / Schaller, Tina / Märkl, Bruno / Muzalyova, Anna / Fleischmann, Carola / Messmann, Helmut

Gastrointestinal endoscopy

2024

Abstract: Background and aims: Endoscopic resection (ER) is accepted as standard treatment for intramucosal esophageal adenocarcinoma (EAC) with well or moderate differentiation. Poor differentiation (PD) is judged as a risk factor for lymph node metastasis (LNM) ...

Abstract	Background and aims: Endoscopic resection (ER) is accepted as standard treatment for intramucosal esophageal adenocarcinoma (EAC) with well or moderate differentiation. Poor differentiation (PD) is judged as a risk factor for lymph node metastasis (LNM) and surgery is recommended. However, the evidence for this recommendation is weak. Study aim was to analyze the clinical course of patients after ER of EAC with PD. Patients and methods: Patients undergoing endoscopic submucosal dissection for EAC were included from 16 German centers. Inclusion criteria were PD in the resection specimen, R0 resection and endoscopic follow-up. Primary outcome was the metastasis rate during follow-up. Analysis was performed retrospectively in a prospectively collected database. Results: 25 patients with PD as single risk factor (group A) and 15 patients with PD and additional risk factors (submucosal invasion and/or lymphovascular invasion) were included. The metastasis rate was was 1/25 (4.0%; 95%CI 0.4-17.2) in group A and 3/15 (20.0%; 95%CI 6.0-44.4%) in group B, respectively (p=0.293). The rate of EAC-associated deaths was 1/25 (4%; 95%CI 0.4-17.2%) versus 3/15 (20%; 95%CI 6.0-44.4%) in group B (p=0.293) while the overall death rate was 7/25 (28.0%; 95%CI 13.5-47.3%) versus 3/15 (20%; 95%CI 6.0-44.4%) (p=0.715). Median follow-up was 30 months (IQR 15-53). Conclusions: During long-term follow-up the risk of metastasis is low after ER of mucosal EAC with PD as single risk factor. A conservative approach seems justified in this small patient group. However, the treatment strategy has to be determined on an individualized basis until further prospective data are available.
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2024.03.013
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Zs.B 283: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 519: Show issues

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Article: Efficacy and Safety of Vedolizumab in Patients with Inflammatory Bowel Disease in Association with Vedolizumab Drug Levels.

Hüttemann, Eva / Muzalyova, Anna / Gröhl, Katharina / Nagl, Sandra / Fleischmann, Carola / Ebigbo, Alanna / Classen, Johanna / Wanzl, Julia / Prinz, Friederike / Mayr, Patrick / Schnoy, Elisabeth

Journal of clinical medicine

2023 Volume 13, Issue 1

Abstract: Background: Vedolizumab (VDZ) is a well-established and important therapeutic option in the treatment of patients with inflammatory bowel disease (IBD). However, the significance of therapeutic drug monitoring (TDM) with VDZ remains a contradictory ... ...

Abstract	Background: Vedolizumab (VDZ) is a well-established and important therapeutic option in the treatment of patients with inflammatory bowel disease (IBD). However, the significance of therapeutic drug monitoring (TDM) with VDZ remains a contradictory field in daily clinical practice. Our study aims to clarify the predictive impact of VDZ drug levels in long-term clinical outcomes in a real-world cohort. Methods: Patients with moderate to severe ulcerative colitis (UC) and Crohn's disease (CD) from a tertiary IBD referral center at the University Hospital Augsburg, Germany, were enrolled in this single-center retrospective data analysis. Clinical and endoscopic data were collected at month 6, month 12, and at the last time of follow-up, and outcomes were correlated with VDZ levels at week 6. Results: This study included 95 patients, 68.4% ( Conclusions: This study demonstrated efficacy and safety for VDZ in a real-world cohort. Although, for some parameters, a clear trend for higher VDZ levels at week 6 was seen, the efficacy of VDZ was not significantly correlated to VDZ level at week 6, which questions the predictive value of VDZ levels in the real world.
Language	English
Publishing date	2023-12-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13010140
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Article ; Online: Antibody Response to SARS-CoV-2 Vaccination in Patients with Inflammatory Bowel Disease: Results of a Single-Center Cohort Study in a Tertiary Hospital in Germany.

Classen, Johanna Maria / Muzalyova, Anna / Nagl, Sandra / Fleischmann, Carola / Ebigbo, Alanna / Römmele, Christoph / Messmann, Helmut / Schnoy, Elisabeth

Digestive diseases (Basel, Switzerland)

2021 Volume 40, Issue 6, Page(s) 719–727

Abstract: Background: COVID-19 is a viral disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first described in 2019, with a significant impact on everyday life since then. In December 2020, the first vaccine against COVID-19 from ... ...

Abstract	Background: COVID-19 is a viral disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first described in 2019, with a significant impact on everyday life since then. In December 2020, the first vaccine against COVID-19 from BioNTech/Pfizer was approved for the first time. However, little is known about the immune response to vaccination in patients with inflammatory bowel disease (IBD) and immunomodulators or biologics. The aim of our study was to investigate antibody response to SARS-CoV-2 vaccination in patients with IBD receiving immunomodulators or biologics compared to healthy controls. Methods: This was a single-center study with a retrospective observational design. Seventy-two patients with ulcerative colitis or Crohn's disease were included. Matching data from 72 healthy employees of our hospital were used as the control group. Data were matched by propensity score to patients with IBD. Blood samples were taken from both groups for antibody response, and both groups received an accompanying questionnaire. Results: Sixty-five (90.3%) patients of the IBD group reported taking immunomodulatory therapy. The mean antibody level for all IBD patients was 1,257.1 U/mL (standard deviation [SD] 1,109.626) in males and 1,500.1 U/mL (SD 1142.760) in female IBD patients after full vaccination. Compared to the healthy group, reduced antibody response could be detected (IBD group 1,383.76 U/mL SD 1,125.617; control group 1,885.65 U/mL SD 727.572, p < 0.05). In this group, blood samples were taken with an average of 61.9 days after the first vaccination. There was no vaccination failure in the IBD group after 2 vaccinations. After the first vaccination, side effects, including muscle pain, pain at the injection site, and fatigue, were reported more often in IBD patients than in the control group (total symptoms IBD group 58.3%, control group 34.5%, p < 0.007). The opposite occurred after the second vaccination when side effects were higher in the control group (total symptoms IBD group 55.4%, control group 76%, p = 0.077). There was a trend to a reduced immune response in elderly patients. Disease duration and concomitant immunomodulatory therapy (TNF-alpha blockers, interleukin inhibitors, integrin inhibitors, methotrexate, or azathioprine) had no impact on the immune response. However, longer time to last medication given and time passed to vaccination in patients with IBD seems to have a positive impact on antibody levels. Conclusion: Overall, we could show a high antibody response to vaccination with COVID-19 in all patients with IBD after 2 vaccinations. Vaccination was well tolerated, and no other adverse events were detected. Concomitant immunomodulatory therapy (TNF-alpha blockers, interleukin inhibitors, integrin inhibitors, methotrexate, or azathioprine) had no impact on seroconversion. Further evaluation of antibody titers over time is mandatory to detect early the need for re-vaccination in these patients.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Antibody Formation ; Azathioprine/therapeutic use ; Cohort Studies ; COVID-19/prevention & control ; COVID-19 Vaccines/administration & dosage ; Crohn Disease/drug therapy ; Immunologic Factors ; Immunosuppressive Agents/therapeutic use ; Inflammatory Bowel Diseases/drug therapy ; Inflammatory Bowel Diseases/chemically induced ; Integrins ; Methotrexate/therapeutic use ; Retrospective Studies ; SARS-CoV-2 ; Tertiary Care Centers ; Tumor Necrosis Factor-alpha
Chemical Substances	Azathioprine (MRK240IY2L) ; COVID-19 Vaccines ; Immunologic Factors ; Immunosuppressive Agents ; Integrins ; Methotrexate (YL5FZ2Y5U1) ; Tumor Necrosis Factor-alpha
Language	English
Publishing date	2021-12-10
Publishing country	Switzerland
Document type	Observational Study ; Journal Article
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000521343
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Article ; Online: An artificial intelligence algorithm is highly accurate for detecting endoscopic features of eosinophilic esophagitis.

Scientific reports

2022 Volume 12, Issue 1, Page(s) 11115

Abstract: The endoscopic features associated with eosinophilic esophagitis (EoE) may be missed during routine endoscopy. We aimed to develop and evaluate an Artificial Intelligence (AI) algorithm for detecting and quantifying the endoscopic features of EoE in ... ...

Abstract	The endoscopic features associated with eosinophilic esophagitis (EoE) may be missed during routine endoscopy. We aimed to develop and evaluate an Artificial Intelligence (AI) algorithm for detecting and quantifying the endoscopic features of EoE in white light images, supplemented by the EoE Endoscopic Reference Score (EREFS). An AI algorithm (AI-EoE) was constructed and trained to differentiate between EoE and normal esophagus using endoscopic white light images extracted from the database of the University Hospital Augsburg. In addition to binary classification, a second algorithm was trained with specific auxiliary branches for each EREFS feature (AI-EoE-EREFS). The AI algorithms were evaluated on an external data set from the University of North Carolina, Chapel Hill (UNC), and compared with the performance of human endoscopists with varying levels of experience. The overall sensitivity, specificity, and accuracy of AI-EoE were 0.93 for all measures, while the AUC was 0.986. With additional auxiliary branches for the EREFS categories, the AI algorithm (AI-EoE-EREFS) performance improved to 0.96, 0.94, 0.95, and 0.992 for sensitivity, specificity, accuracy, and AUC, respectively. AI-EoE and AI-EoE-EREFS performed significantly better than endoscopy beginners and senior fellows on the same set of images. An AI algorithm can be trained to detect and quantify endoscopic features of EoE with excellent performance scores. The addition of the EREFS criteria improved the performance of the AI algorithm, which performed significantly better than endoscopists with a lower or medium experience level.
MeSH term(s)	Artificial Intelligence ; Eosinophilic Esophagitis/diagnosis ; Esophagoscopy/methods ; Humans ; Severity of Illness Index
Language	English
Publishing date	2022-07-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-14605-z
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Article ; Online: Vessel and tissue recognition during third-space endoscopy using a deep learning algorithm.

Ebigbo, Alanna / Mendel, Robert / Scheppach, Markus W / Probst, Andreas / Shahidi, Neal / Prinz, Friederike / Fleischmann, Carola / Römmele, Christoph / Goelder, Stefan Karl / Braun, Georg / Rauber, David / Rueckert, Tobias / de Souza, Luis A / Papa, Joao / Byrne, Michael / Palm, Christoph / Messmann, Helmut

Gut

2022 Volume 71, Issue 12, Page(s) 2388–2390

Abstract: In this study, we aimed to develop an artificial intelligence clinical decision support solution to mitigate operator-dependent limitations during complex endoscopic procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy, for ... ...

Abstract	In this study, we aimed to develop an artificial intelligence clinical decision support solution to mitigate operator-dependent limitations during complex endoscopic procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy, for example, bleeding and perforation. A DeepLabv3-based model was trained to delineate vessels, tissue structures and instruments on endoscopic still images from such procedures. The mean cross-validated Intersection over Union and Dice Score were 63% and 76%, respectively. Applied to standardised video clips from third-space endoscopic procedures, the algorithm showed a mean vessel detection rate of 85% with a false-positive rate of 0.75/min. These performance statistics suggest a potential clinical benefit for procedure safety, time and also training.
MeSH term(s)	Humans ; Artificial Intelligence ; Deep Learning ; Endoscopy, Gastrointestinal ; Endoscopic Mucosal Resection
Language	English
Publishing date	2022-09-15
Publishing country	England
Document type	Journal Article
ZDB-ID	80128-8
ISSN	1468-3288 ; 0017-5749
ISSN (online)	1468-3288
ISSN	0017-5749
DOI	10.1136/gutjnl-2021-326470
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Article ; Online: Endoscopic Submucosal Dissection in Europe: Results of 1000 Neoplastic Lesions From the German Endoscopic Submucosal Dissection Registry.

Fleischmann, Carola / Probst, Andreas / Ebigbo, Alanna / Faiss, Siegbert / Schumacher, Brigitte / Allgaier, H-P / Dumoulin, F L / Steinbrueck, Ingo / Anzinger, Michael / Marienhagen, Joerg / Muzalyova, Anna / Messmann, Helmut

Gastroenterology

2021 Volume 161, Issue 4, Page(s) 1168–1178

Abstract: Background and aims: Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set ... ...

Abstract	Background and aims: Endoscopic submucosal dissection (ESD) enables the curative resection of early malignant lesions and is associated with reduced recurrence risk. Due to the lack of comprehensive ESD data in the West, the German ESD registry was set up to evaluate relevant outcomes of ESD. Methods: The German ESD registry is a prospective uncontrolled multicenter study. During a 35-month period, 20 centers included 1000 ESDs of neoplastic lesions. The results were evaluated in terms of en bloc, R0, curative resection rates, and recurrence rate after a 3-month and 12-month follow-up. Additionally, participating centers were grouped into low-volume (≤20 ESDs/y), middle-volume (20-50/y), and high-volume centers (>50/y). A multivariate analysis investigating risk factors for noncurative resection was performed. Results: Overall, en bloc, R0, and curative resection rates of 92.4% (95% confidence interval [CI], 0.90-0.94), 78.8% (95% CI, 0.76-0.81), and 72.3% (95% CI, 0.69-0.75) were achieved, respectively. The overall complication rate was 8.3% (95% CI, 0.067-0.102), whereas the recurrence rate after 12 months was 2.1%. High-volume centers had significantly higher en bloc, R0, curative resection rates, and recurrence rates and lower complication rates than middle- or low-volume centers. The lesion size, hybrid ESD, age, stage T1b carcinoma, and treatment outside high-volume centers were identified as risk factors for noncurative ESD. Conclusion: In Germany, ESD achieves excellent en bloc resection rates but only modest curative resection rates. ESD requires a high level of expertise, and results vary significantly depending on the center's yearly case volume.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Clinical Competence ; Colorectal Neoplasms/economics ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Endoscopic Mucosal Resection/adverse effects ; Endoscopic Mucosal Resection/economics ; Endoscopic Mucosal Resection/trends ; Esophageal Neoplasms/economics ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Female ; Germany ; Health Care Costs ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prospective Studies ; Quality Indicators, Health Care ; Registries ; Risk Assessment ; Risk Factors ; Stomach Neoplasms/economics ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2021-06-26
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2021.06.049
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Zs.MO 572: Show issues

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