Ruud J L F Loffeld

Zaans Medical Centre · Internal medicine / gastroenterology

Introduction: Diverticulitis is a clinical diagnosis generally confirmed by a radiological examination. Guidelines recommend routine screening for colorectal cancer after the acute phase. Aim: Patients diagnosed with diverticulitis were studied in order to gain more information on presence of concomitant abnormalities. Material and methods: Inclusi...

Two patients are described with large stones in the common bile duct. Standard ERCP was not possible. Both patients were successfully treated with percutaneous access and use of the ureteroscope with the holmium laser.

Background: Not much is known of the yield of endoscopy in relation to ethnic descent. The aim is to study endoscopy of the lower digestive tract in relation to the ethnicity. Methods: A prospectively collected dataset was used. Presence four endoscopic findings (diverticuli, polyps, colorectal cancer, and signs of inflammation) was studied. The...

Casus: Een 88-jarige vrouw kwam naar de Spoedeisende Hulp met plotseling ontstane, hevige misselijkheid en braken, zonder duidelijk uitlokkend moment. Zij had een eindstandig colostoma na een curatieve resectie van een rectumcarcinoom 6 jaar eerder. Ze had geen andere buikoperaties in de voorgeschiedenis. De patiënte had vier maal gebraakt, zonder...

An 88-year old woman had a sudden onset of nausea and vomiting. She had an end colostomy following a curative resection of rectal cancer six years earlier. As we suspected a high gastrointestinal obstruction, an abdominal CT scan was made. This showed a paracolostomic herniation, including herniation of the stomach.

A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia co...

Background: Years ago, it was established that removal of adenomas will lead to a lower incidence of colorectal cancer. This study aims to establish the occurrence of colorectal cancer in unselected patients after index colonoscopy with polyp removal. Methods: A prospectively collected dataset on colonoscopy covering 25 consecutive years was use...

This short communication describes the results with respect to stage of colorectal cancer in people detected via screening and patients with clinical complaints.

Background: Fludeoxyglucose positron-emission tomography (FDG-PET) shows colic uptake regularly. Complementary colonoscopy is done. Aim: study the findings of colonoscopy. Methods: All consecutive scans in 5 years were studied. Focal FDG uptake in colon and/or rectum were scored as + or ++. Clinical files and endoscopy reports were studied for f...

Aim Extramural venous invasion (EMVI) is a prognostic indicator in patients with colorectal cancer. However, its additional value in patients with stage 1 and 2 colorectal cancer is uncertain. In the present study, the incidence of EMVI and the hazard ratio for recurrence in patients with stage 1 and 2 colon cancer were studied. Methods 184 patien...

Gallstone disease is the most common risk factor for cholangitis. In an anatomically normal bile duct system, cholangitis does not occur without the presence of stones. Endoscopic retrograde cholangiography with papillotomy and stone extraction is a well-established curative therapy for gallstones in the common bile duct. More important, papillotom...

Background: Evaluate the preoperative TN stage with MR and the postoperative stage with histology. Methods: Patients diagnosed with rectal cancer (2002-2015) and a pre-operative MR were included. A chart review was done. Pathology reports were evaluated for the post-operative tumor stage. Down staging was defined as a lower disease stage in the...

Disseminated intravascular coagulation (DIC) is a syndrome characterised by simultaneous bleeding and thromboembolic formation. Its acute form is associated with severe bacterial infections and hematological malignancies. It has a fulminant presentation with prolonged bleeding times and diffuse thrombosis. On the other hand, chronic DIC can be asym...

An 84-year-old woman was seen with symptoms of an obstructive ileus. CT imaging revealed a volvulus of her intrathoracic stomach. This was successfully treated with gastroscopic detorsion. The patient recovered well.

Introduction. Duodenal diverticuli alter the anatomy of the papillary region and can make an ERCP difficult. Aim. To study the outcome of ERCP in cases of duodenal diverticuli. Patients and Methods. Consecutive ERCPs in a period of 24 years were included. Endoscopy reports were studied for presence of diverticuli. Success of the procedure and findi...

Background: Radiotherapy and surgery have shown to improve local control and survival in rectal cancer. There are two applied schedules; radiotherapy with a long or short waiting period before surgery. The effect on survival and recurrence of both schedules was studied. Methods: All consecutive patients with rectal cancer in the period 2002-2008...

Background: Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symp...

Abstract Background: Colorectal cancers (CRCs) often occur in octogenarians. However, data on treatment and survival are sparse. Objectives: Octogenarians were studied in order to gain data on treatment, outcomes, and survival related to CRC. Patients and Methods: All consecutive octogenarians with CRC in the period of 2002 - 2008 were included. An...

Background: The goal of surgery for colorectal cancer is cure. Unfortunately post-operative mortality occurs. This study aims to identify co-morbidity and causes of mortality in the post-operative period in relation to direct technical complications of surgery. Methods: All consecutive patients who underwent surgery for colorectal cancer were in...

Background: Patients with colorectal cancer are often excluded from clinical trials based on age or a poor performance score. However, 70% of colorectal cancer is diagnosed in patients over 65. Evaluation on the influence of age and comorbidity on survival and cause of death in a non-selected population. Methods: Included were 621 consecutive pa...

Introduction Diverticulosis of the colon is the most occurring abnormality in the digestive tract. Little is known on the risk of developing diverticulitis. Aim The study aims to assess the risk of diverticulitis. Patients and methods All patients undergoing colonoscopy in the years 1998, 1999, and 2000 were studied. Patients with cancer, inflammat...

Follow-up surgery for colorectal cancer is recommended. The yield of endoscopy is unknown and was therefore studied. Patients with colorectal cancer in the years 2003, 2004 and 2005 were included. Evaluation was done in July 2014. Cancer was diagnosed in 267 patients. These were divided into three groups: group 1-still alive (n = 88), group 2-died...

Patients with stage 2 and stage 3 colon cancer often are treated with adjuvant chemotherapy. However, patients seen in daily practice have more comorbidity than those enrolled in clinical trials. This study aims to evaluate prognostic factors for recurrence and to ascertain the benefit of adjuvant chemotherapy on recurrence-free survival (RFS) of p...

Objective Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance. Design We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression...

A patient with status epilepticus after long-distance running is described. The patient, a young woman, was brought to our hospital with status epilepticus after completing in a running event, probably caused by an extremely low phosphate level of 0.30 mmol÷l. Hypophosphataemia is a rare complication of running and can be caused by the use of phosp...

The adenoma detection rate (ADR), a marker of endoscopic quality, is confounded by selection bias. It is not known what the ADR is in normal daily practice. To study the polyp detection rate (PDR) in different endoscopists in the course of years. All consecutive endoscopies of the colon done in 11 years were included. Endoscopies in the regular sur...

There is a difference in approach between colon and rectal cancer. EVALUATE THE METHODS OF LOCALISATION: endoscopy and radiology. Patients with cancer in the sigmoid or rectum diagnosed with endoscopy, were included. Patients underwent additional radiological examinations. The resection specimen served as the gold standard. A tumour surrounded by s...

Background. Adenomas are missed during colonoscopy. Aim. Assess the occurrence of colorectal cancer (CRC) and polyps in patients with a negative index colonoscopy (IC). Patients and Methods. All patients with a IC in 1992-1994, aged 40 and 60 years, were included. Exclusion criterion was presence of abnormalities, a family history, or surveillance....

A patient with gastroparesis is presented. Ultimately the diagnosis of paraneoplastic gastroparesis due to an occult small cell cancer of the lung was made. The difficulties in the diagnostic process and the pathogenesis of this very rare manifestation are discussed.

Introduction. Colorectal cancer (CRC) has a high incidence. Removal of adenomas, the precursor lesion, could be helpful in the prevention of cancer. Aim. To investigate the yearly incidence of CRC in consecutive years. Patients and Methods. All patients diagnosed with CRC in the years 1990 till 2010 were studied. Date of diagnosis, age at time of d...

A 78-year-old woman presented at the emergency room with abdominal pain and diarrhea. At physical examination an abdominal tumour was palpated. The CT-scan showed an invagination of the colon, whereupon an explorative laparatomy was performed. A right-hemicolectomy was conducted and pathology showed an invasive mucineus cystadenocarcinoma in the ca...

Introduction. Studied patients with oesophageal cancer do not represent normal daily presentation. Aim. A retrospective study was done in all consecutive patients in order to describe presentation, treatment, and survival. Patients. All patients in a ten-year period were included. Patients were grouped in three groups. Group 1: no metastases and po...

Background. Failure of anti-Helicobacter therapy is the result noncompliance and resistance to the prescribed antibiotics. Aim. Antibiotic susceptibility of H. pylori was determined in native Dutch patients and patients of Turkish descent. Methods. In a period of eight years a total of 925 strains of H. pylori were cultured. Bacterial susceptibilit...

Obstruction of the gastrointestinal tract due to cancer can be treated with stenting. The aim was to review the local experience with endoscopic stenting. All patients treated with stenting in a ten years period from 2001-2010 were studied. Fifty one patients received 57 stents because of oesophageal cancer. Mean survival after stent placement was...

Diverticulairlijden omvat alle vormen van presentatie van divertikels in het colon , van asymptomatische diverticulosis tot gecompliceerde diverticulitis .

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of...

Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonosc...

Colorectal cancer screening by fecal immunochemical tests (FITs) is hampered by frequent false-positive (FP) results and thereby the risk of complications and strain on colonoscopy capacity. Hemorrhoids might be a plausible cause of FP results. To determine the contribution of hemorrhoids to the frequency of FP FIT results. Retrospective analysis f...

Upper gastrointestinal (GI) endoscopy is increasingly applied in daily practice. Not many data are available on yearly changes in diagnostic yield, nor on changes in morbidity. To study the possible changes in occurrence of abnormalities in the oesophagus, stomach and duodenum. All consecutive upper GI endoscopies performed over a period of 20 year...

A high diagnostic yield of colonoscopy has been reported in elderly patients, but there is no data on the yearly yield. Our aim was to detect the yearly yield of colonoscopy in elderly patients. All consecutive endoscopies in the years 1992-2009 were included. Important endoscopic diagnoses were defined as colorectal cancer (CRC), polyps, diverticu...

The aetiology of colonoscopic perforation and factors related to poor outcome of surgical treatment were studied. A single-centre review was conducted of all patients who underwent surgical treatment of a colonoscopic perforation, identified from a prospective registry of 21,981 consecutive colonoscopies carried out between 1993 and 2009. There wer...

Patients with gastroesophageal reflux disease (GERD) need long-term treatment with acid-suppressive therapy. Data on long-term follow-up are very rare. For this reason, a study was performed to detect complaints many years after diagnosis. All patients diagnosed with reflux oesophagitis in the years 1998-2000 were included. In the summer of 2010, t...

Reflux esophagitis needs maintenance therapy. Data on comparison between trademark and generic medications are not available. Complaints and use of acid-suppressive therapy 10 years after diagnosis were determined. A total of 672 patients with esophagitis between 1998 and 2000 were reviewed. Patients received a questionnaire regarding the use of ac...

Adjusting the threshold for positivity of quantitative fecal immunochemical tests (FIT) allows for controlling the number of follow-up colonoscopies in a screening program. However, it is unknown to what extent higher cutoff levels affect detection rates of screen-relevant neoplasia. This study aimed to assess the effect of higher cutoff levels of...

A 52-year-old man was admitted to hospital with abdominal pain, erythema and mild eosinophilia. Medical history revealed fatigue and dyspnoea on exertion after returning from the Gambia a year previously, and allergic rhinitis with nasal polyps that were surgically excised. Before a cause of the abdominal symptoms was determined he developed monone...

Perforations are known to occur after colonoscopy. In a consecutive study the localization of the perforation was determined, and the etiology of the perforation was classified as: therapeutic, barotraumatic or mechanical. A colonic perforation occurred in 26 of 19,135 patients (0.14%). In 13 cases (50.0%) the cause of perforation was mechanical, i...

Do patients with hyperplastic polyps (HP) have an increased risk for developing adenomas and colorectal cancer (CRC)? A study was done to detect the number of patients developing adenomas and CRC. From 1990-1995 all patients with a HP diagnosed via endoscopy and significant follow-up were studied. The patients were separated in three groups; Group...

Cecal intubation is not achieved in 2 - 23 % of colonoscopies. The efforts made by physicians to visualize the remaining colon and the number of missed significant lesions are unknown. This study evaluates 1) the reasons for incomplete colonoscopy, 2) the rates of complete colonic evaluation after incomplete colonoscopy, and 3) the number of (pre-)...

Haemorrhoids are a common problem in daily practice. However, symptoms may also be caused by other abnormalities in the rectum or colon. Data on the presence of these abnormalities in patients with haemorrhoids is sparse. To examine the prevalence of abnormalities of the colon or rectum in patients with and without haemorrhoids, stratified for age....

From an epidemiological point of view it is interesting to study changing morbidity patterns in disease, especially in upper gastrointestinal diseases. It was previously noted that there was a difference in yield of upper gastrointestinal endoscopy in consecutive years. It was also noticed that there was a difference in occurrence of reflux disease...

Rectal bleeding is a very common clinical sign. It is often caused by haemorrhoids. However, it can be a symptom of other pathology in the rectum or colon. There are little data coincidental pathology in patients with haemorrhoids and rectal bleeding. To examine coincidental pathology in patients with rectal bleeding and haemorrhoids, especially wi...

Colorectal cancer is one of the most common malignancies in the Western world. Screening and detection of its precursor lesion, the adenoma could prevent development of colorectal cancer. Many studies have been done to evaluate the prevalence of colorectal cancer in different countries. In daily practice, it was noticed that colorectal cancer was r...

Colonoscopy is an important diagnostic procedure for screening as well as for patients presenting with complaints. The completion of a colonoscopy is defined as cecal intubation. A large single center study was done in order to evaluate the completion rate of colonoscopy and identify reasons for failure. We reviewed all consecutive endoscopies of t...

Collagenous colitis can be the cause of chronic diarrhoea. Assess the prevalence of collagenous colitis in a single centre. All records of patients with diarrhoea in whom histological examination showed collagenous colitis, were retrieved. Demographic data, clinical presentation, associated diseases and treatment were studied. In a period of 15 yea...

Guaiac-based faecal occult blood tests (g-FOBTs) are most commonly used in colorectal cancer (CRC) screening programmes. Faecal immunochemical tests (FITs) are thought to be superior. To compare performance of a g-FOBT and a quantitative FIT for detection of CRCs and advanced adenomas in a colonoscopy-controlled population. We assessed sensitivity...

Little data is known on morbidity and Helicobacter pylori in the upper part of the gastrointestinal tract in male and female patients of Turkish descent. A study was done in order to assess the presence of H. pylori in Turkish men and women in relation to the diagnostic yield of the endoscopy. All consecutive patients of Turkish descent were includ...

Adenoma is the precursor of colorectal carcinoma (CRC). Patients with longstanding active ulcerative colitis (UC) are at risk of developing CRC. Every patient with UC can also develop adenomas, which is an extra risk factor. A large retrospective cross-sectional study was conducted to identify patients with UC and polyps. All consecutive lower inte...

An unknown number of colorectal cancers could be due to missed adenomas during previous endoscopy. Data in the literature are sparse. A large cross-sectional study was done in a prospective database of all patients diagnosed with colorectal cancer. All consecutive endoscopies over a period of 15 years, in which colorectal cancer was diagnosed were...

Endoscopic retrograde cholangiopancreaticography has been the treatment of choice for stones in the common bile duct. Although the procedure is usually safe, procedure-related complications do occur. A case of pancreatitis following endoscopic retrograde cholangiopancreaticography is described in a 55-year-old woman. After an uneventful recovery th...

Prostate cancer is known to have a tendency to metastasize to bone. Skeletal scintigraphy can be used to show multiple lesions. Diffuse metastasis, which is not infrequent in prostate cancer, can also be suspected on the basis of a 'super scan'. However, this phenomenon in nuclear medicine has several other causes that need to be considered. A pati...

The level of serum ferritin normally parallels the concentration of storage iron within the body. In the absence of chronic diseases elevated serum ferritin levels will lead to the diagnosis congenital haemochromatosis. However, there are genetic disorders with high ferritin levels without any sign of iron overload. A case history of a patient suff...

Effective treatment for irritable bowel syndrome (IBS) is not yet available. Osteopathy is a manual treatment which relies on mobilizing and manipulating procedures in order to relieve complaints. In the present study, a randomized controlled trial was carried out to evaluate the effects of osteopathic treatment for IBS. Eligible IBS patients were...

The clinical work-up of patients with presumed pancreaticobiliary obstruction is usually straightforward including laboratory investigation, abdominal ultrasound and computer tomography. Ultrasound and computer tomography may, however, yield inconclusive findings regarding underlying cause. We report a case series (n=10) demonstrating the usefulnes...

Laparoscopic cholecystectomy has become the preferred surgical technique for symptomatic gallstone disease. The technique generally is safe. probably one of the most common intra-operative complications is gallbladder perforation with stones spreading into the peritoneal cavity. In this paper the sequelae of lost gallstones after laparoscopic chole...

Endoscopy of the colon requires adequate cleansing of the entire bowel. Several laxative regimens have been propagated, but bowel preparation with polyethylene glycol (PEG) solution is popular because of the easy application and good cleansing results. Although very safe in daily use, complications of this bowel-cleansing procedure have been report...

A 45-year-old woman was admitted because of abdominal pain and a feeling of fullness. Ultrasound and CT scan of the abdomen showed a massively enlarged liver with hundreds of cysts and displacement of the right kidney. There were no cysts in the kidneys. Because several members of her family also had multiple cysts in the liver, the diagnosis of au...

Gastro-oesophageal reflux disease is one of the most common medical problems in daily practice, with many guidelines on diagnosis and treatment available. The prevalence and incidence of reflux disease are rising. In a period of 10 years, the incidence of reflux oesophagitis has almost doubled, as has the number of pills and tablets of acid-suppres...

Data on the occurrence of reflux esophagitis and Barrett's esophagus in patients with Billroth I or II resection is sparse. For this reason a cross-sectional study was done in order to assess reflux disease in Billroth resection. Consecutive patients were included in the study. Coincidental pathology (hiatus hernia, ulcer, esophagitis, and cancer)...

Er zijn twee verschillende hernia's van de slokdarm op diafragmaniveau. De ‘sliding’ hiatus hernia (de hernia hiatus esophagi, HHE) en de para-oesofageale hiatus hernia. De eerste is gekenmerkt door een craniale verplaatsing van de overgang van slokdarm naar maag, terwijl bij de tweede vorm de overgang van slokdarm naar maag in principe op niveau v...