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Bremers A.j.a. - One of the best experts on this subject based on the ideXlab platform.
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:AIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
'Baishideng Publishing Group Inc.', 2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:Contains fulltext : 174852.pdf (publisher's version ) (Open Access)AIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
'Baishideng Publishing Group Inc.', 2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:Item does not contain fulltextAIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
Daniel Zips - One of the best experts on this subject based on the ideXlab platform.
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Cost analysis of a wait-and-see strategy after radiochemotherapy in distal rectal cancer
Strahlentherapie und Onkologie, 2018Co-Authors: Cihan Gani, Ulrich Grosse, Stephan Clasen, Andreas Kirschniak, Martin Goetz, Claus Rödel, Daniel ZipsAbstract:Hintergrund Das nichtoperative Management (NOM) des Rektumkarzinoms im Fall einer klinischen Komplettremission nach Radiochemotherapie ist eine intensiv diskutierte Option mit dem Ziel der Verbesserung der Lebensqualität, ohne die Heilungschancen zu beeinträchtigen. Allerdings wird zur frühzeitigen Detektion eines lokalen Nachwachsens („local regrowth“, LR) des Tumors eine engmaschige Überwachung mittels Rektoskopie und Magnetresonanztomographie (MRT) empfohlen. Ziel der gegenwärtigen Arbeit ist es daher, die Kosten dieser Verlaufskontrollen, wie sie in der bevorstehenden CAO/ARO/AIO-16 Studie zum Einsatz kommen werden, denen der operativen Strategie gegenüberzustellen. Methoden Die Kosten für die MRT und Rektoskopie bei Patienten mit einer klinischen Komplettremission nach Radiochemotherapie (RtChx) wurden über 5 Jahre hinweg simuliert und mit denen einer Operation nach RtChx verglichen. Die Übergangswahrscheinlichkeiten zwischen Erkrankungsstadien (vollständige Remission, LR mit Salvage-Operation, distante Metastasierung) wurden aus der Literatur übernommen. Die Kosten für ambulante Bildgebung und Rektoskopien wurden nach der Gebührenordnung für Ärzte (GOÄ) berechnet, die Kosten für eine Operation basieren auf dem Diagnosis-Related-Groups-System (DRG). Drei verschiedene Szenarien mit höheren Kosten für die Salvage-OP oder höheren Wahrscheinlichkeiten für das Wiederauftreten der Erkrankung wurden simuliert. Ergebnisse Für einen Patienten, der kein Rezidiv entwickelt, entstehen über 5 Jahre Kosten für MRT und Rektoskopie von 6344 € im Vergleich zu Kosten von 14.511 € für eine Operation. Wird eine LR-Rate von 25 % mit anschließender Salvage-Op. berücksichtigt, betragen die durchschnittlichen Kosten pro Patient 8299 €. In der gegenwärtigen Studie war eine NOM-Strategie in allen Szenarien kostensparend gegenüber dem operativen Ansatz. Schlussfolgerung Eine NOM-Strategie mit engmaschiger Überwachung mittels MRT und Rektoskopie verursacht Kosten, die höchstwahrscheinlich unter denen des operativen Vorgehens liegen. Background Nonoperative management (NOM) of rectal cancer after radiochemotherapy (RtChx) in patients with a clinical complete response is an emerging strategy with the goal to improve quality of life without compromising cure rates. However close monitoring with both magnetic resonance imaging (MRI) and Rectoscopy is required for the early detection of possible local regrowths. We therefore performed a cost analysis comparing the costs of immediate surgery with the costs for MRI and Rectoscopy during surveillance as in the upcoming CAO/ARO/AIO-16 trial. Methods MRIs and rectoscopies of patients with a clinical complete response after RtChx over the course of 5 years were simulated and compared with immediate surgery after RtChx. Transition probabilities between health stages (no evidence of disease, local regrowth and salvage surgery, distant failure) were derived from the literature. Costs for ambulatory imaging and endoscopic studies were calculated according to the “Gebührenordnung für Ärzte” (GOÄ), costs for surgery based on the diagnosis-related groups system. Three different scenarios with higher costs for salvage surgery or higher regrowth rates were simulated. Results A patient without disease recurrence will generate costs for MRI and Rectoscopy of 6344 € over 5 years compared with costs of 14,511 € for immediate radical surgery. When 25% local regrowths with subsequent salvage surgery were included in the model, the average costs per patient are 8299 €. In our simulations a NOM strategy was cost-saving compared with immediate surgery in all three scenarios. Conclusion A NOM strategy with an intensive surveillance using MRI and Rectoscopy will produce costs that are expected to remain below those of immediate surgery.
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Cost analysis of a wait-and-see strategy after radiochemotherapy in distal rectal cancer.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2018Co-Authors: Cihan Gani, Ulrich Grosse, Stephan Clasen, Andreas Kirschniak, Martin Goetz, Claus Rödel, Daniel ZipsAbstract:Background Nonoperative management (NOM) of rectal cancer after radiochemotherapy (RtChx) in patients with a clinical complete response is an emerging strategy with the goal to improve quality of life without compromising cure rates. However close monitoring with both magnetic resonance imaging (MRI) and Rectoscopy is required for the early detection of possible local regrowths. We therefore performed a cost analysis comparing the costs of immediate surgery with the costs for MRI and Rectoscopy during surveillance as in the upcoming CAO/ARO/AIO-16 trial.
O. Féres - One of the best experts on this subject based on the ideXlab platform.
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A new proctoscope for transanal endoscopic operations
Techniques in Coloproctology, 2008Co-Authors: J. J. Ribeiro Da Rocha, O. FéresAbstract:Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.
Bokkerink G.m.j. - One of the best experts on this subject based on the ideXlab platform.
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:AIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
'Baishideng Publishing Group Inc.', 2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:Contains fulltext : 174852.pdf (publisher's version ) (Open Access)AIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
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Value of macrobiopsies and transanal endoscopic microsurgery in the histological work-up of rectal neoplasms: A retrospective study
'Baishideng Publishing Group Inc.', 2017Co-Authors: Bokkerink G.m.j., Wilt, G.j. Van Der, D. De ,jong, Krieken H. Van, Bleichrodt R.p., J.h.w. De ,wilt, Bremers A.j.a.Abstract:Item does not contain fulltextAIM: To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology. METHODS: Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid Rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm. RESULTS: One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100. CONCLUSION: The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%
Ma Xinyan - One of the best experts on this subject based on the ideXlab platform.
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Mass screening for rectal neoplasm in Jiashan county, China
Journal of clinical epidemiology, 1991Co-Authors: Zheng Guomin, Bernard C. K. Choi, Yu Xinru, Zou Rongbi, Shao Yuwen, Ma XinyanAbstract:Abstract Jiashan county is a rural area in China with very high incidence and mortality rates of colorectal cancer. From 1980 to 1984, we conducted a mass screening for rectal neoplasm in the 11 people's communes in this county. Of the 72,879 individuals who were eligible for screening, 60,496 participated, presenting an overall participation rate of 83.0%. Both the fecal occult blood (OB) test and Rectoscopy were performed on 47,560 of the participants, and Rectoscopy only was performed on the remaining 12,936 individuals. From the mass screening, 15 rectal cancers, 3 carcinoids, 899 polyps, 98 ulcers, and 7 inflammatory tumors were detected, a total of 1022 cases. Eight of the 15 detected cases of rectal cancer were in Dukes' stage A. We did not find any evidence for an association between schistosomiasis and colorectal cancer. Results from the OB test were found to have a negative correlation with results from Rectoscopy (odds ratio = 0.8, 95% CI = 0.6, 1.1). The OB test had a high false positive rate of 32.7%, and a poor positive predictive value of 3.5 %. Both its positive and negative predictive powers were below 1.0, in other words, its positive likelihood ratio was below 1.0 and negative likelihood ratio was above 1.0, indicating that the OB test is not informative and has a poor predictive accuracy for rectal neoplasm. In addition, there were a number of practical problems concerning the use of the OB test for mass screening in the rural community. We therefore recommend Rectoscopy, but not the OB test, as a simple, feasible and effective procedure in a screening and control program for rectal cancer in the rural areas, at least in China.