Peter B F Mensink

Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands

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Publications (92)445.97 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background&aims Chronic gastrointestinal ischemia (CGI) is more common than previously thought. Visible light spectroscopy (VLS) allows for non-invasive measurements of mucosal capillary hemoglobin oxygen saturation during endoscopy. We evaluated the response of patients with occlusive CGI to treatment following evaluation by radiologic imaging of the vasculature and VLS. We also identified factors associated response to treatment in these patients. Methods In a prospective study, we collected data from 212 referred for evaluation of suspected CGI, from November 2008 through January 2011. Patients were underwent an extensive evaluation that included visualization of GI arteries and assessments of mucosal perfusion by means of VLS. Treatment response was evaluated in patients with occlusive CGI. Factors associated with response to therapy were assessed using multivariate logistic regression analysis. Results Occlusive CGI was diagnosed in 107 of the patients (50%); 96 were offered treatment (90%). After a median follow-up period of 13 months, data on treatment response were available from 89 patients (93%); 62 patients had a sustained response (70%). Weight loss before treatment (odds ratio [OR], 1.93), presence of an abdominal bruit (OR, 2.36), and a corpus mucosal saturation level <56% (OR, 4.84) were the strongest predictors of a positive response to treatment. Conclusion Treatment of CGI, diagnosed by a multimodal approach, provides a substantial long- term rate of response (70% in 13 months). Weight loss, abdominal bruit, and low corpus mucosal saturation identify patients most likely to respond to treatment. Multiple techniques should therefore be used to assess patients with CGI, including VLS measurements, to detect mucosal hypoxia.
    Clinical Gastroenterology and Hepatology. 01/2014;
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    ABSTRACT: BACKGROUND: The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI. METHODS: Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI. RESULTS: In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms. CONCLUSION: In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup.
    European journal of gastroenterology & hepatology 02/2013; · 1.66 Impact Factor
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    ABSTRACT: Acute pancreatitis is a significant potential complication with double-balloon enteroscopy. Hyperamylasemia is frequently observed after both double-balloon enteroscopy and single-balloon enteroscopy but often without associated pancreatitis. Whether the same phenomenon occurs with spiral enteroscopy is currently unknown. To determine the incidence of pancreatitis and hyperamylasemia following spiral enteroscopy. A prospective cohort study of consecutive patients undergoing proximal spiral enteroscopy was conducted. Serum amylase levels were measured immediately before and following the procedure, combined with observation for clinical signs of pancreatitis. A total of 32 patients underwent proximal spiral enteroscopy, with a mean total procedure time of 51 min (range 30 min to 100 min) and mean depth of insertion of 240 cm (range 50 cm to 350 cm). The diagnostic yield was 50%, with 31% of all procedures being therapeutic. While no patients exhibited signs that raised suspicion of pancreatitis, hyperamylasemia was common (20%). Hyperamylasemia was not significantly associated with procedure duration or depth of insertion but was linked to patients with Peutz-Jeghers syndrome and with the use of propofol sedation, suggesting that it may be more common in difficult cases. Postprocedural hyperamylasemia occurred frequently with proximal spiral enteroscopy, while no associated pancreatitis was observed. This finding suggests that hyperamylasemia may not necessarily reflect pancreatic injury nor portend a risk for pancreatitis.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 09/2012; 26(9):603-6. · 1.53 Impact Factor
  • Endoscopy 08/2012; 44(8):799; author reply 800. · 5.74 Impact Factor
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    ABSTRACT: We determined the prevalence of classical risk factors for atherosclerosis and mortality risk in patients with CGI. A case-control study was conducted. Patients referred with suspected CGI underwent a standard work-up including risk factors for atherosclerosis, radiological imaging of abdominal vessels and tonometry. Cases were patients with confirmed atherosclerotic CGI. Controls were healthy subjects previously not known with CGI. The mortality risk was calculated as standardized mortality ratio derived from observed mortality, and was estimated with ten-year risk of death using SCORE and PREDICT. Between 2006 and 2009, 195 patients were evaluated for suspected CGI. After a median follow-up of 19 months, atherosclerotic CGI was diagnosed in 68 patients. Controls consisted of 132 subjects. Female gender, diabetes, hypercholesterolemia, a personal and family history of cardiovascular disease (CVD), and current smoking are highly associated with CGI. After adjustment, female gender (OR 2.14 95% CI 1.05-4.36), diabetes (OR 5.59, 95% CI 1.95-16.01), current smoking (OR 5.78, 95% CI 2.27-14.72), and history of CVD (OR 21.61, 95% CI 8.40-55.55) remained significant. CGI patients >55 years had a higher median ten-year risk of death (15% vs. 5%, P = 0.001) compared to controls. During follow-up of 116 person-years, standardized mortality rate was higher in CGI patients (3.55; 95% CI 1.70-6.52). Patients with atherosclerotic CGI have an increased estimated CVD risk, and severe excess mortality. Secondary cardiovascular prevention therapy should be advocated in patients with CGI.
    Atherosclerosis 07/2012; 224(1):235-41. · 3.71 Impact Factor
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    ABSTRACT: Background and aim:  To prospectively determine patient burden and patient preference for magnetic resonance enteroclysis (MRE), capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE) in patients with suspected or known Crohn's disease (CD) or occult gastrointestinal bleeding (OGIB). Subjects and Methods:  Consecutive consenting patients with CD or OGIB underwent MRE, CE and BAE. CE was only performed if MRE showed no high-grade small bowel stenosis. Patient preference and burden was evaluated by means of standardized questionnaires at 5 moments in time. Results:  From January 2007 until March 2009, 76 patients were included (M/F 31/45; mean age 46.9 y; range 20.0-78.4y): 38 patients with OGIB and 38 with suspected or known CD. Seventeen patients did not undergo CE because of high-grade stenosis. Ninety-five percent (344/363) of the questionnaires were suitable for evaluation. CE was significantly favored over MRE and BAE with respect to bowel preparation, swallowing of the capsule (compared to insertion of the tube/scope), burden of the entire examination, duration and accordance with the pre-study information. CE and MRE were significantly preferred over BAE for clarity of explanation of the examination, and MRE was significantly preferred over BAE for bowel preparation, painfulness and burden of the entire examination. BAE was significantly favored over MRE for insertion of the scope and procedure duration. Pre- and post-study the order of preference was CE, MRE and BAE. Conclusion:  CE was preferred to MRE and BAE, it also had the lowest burden. MRE was preferred over BAE for clarity of explanation of the examination, bowel preparation, painfulness and burden of the entire examination, and BAE over MRE for scope insertion and study duration. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
    Journal of Gastroenterology and Hepatology 06/2012; · 3.33 Impact Factor
  • Huseyin Aktas, Peter B Mensink
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    ABSTRACT: The small intestine has been difficult to examine by traditional endoscopic and radiologic techniques. Until the end of the last century, the small bowel follow through was the primary diagnostic tool for suspected small bowel disease. In recent years capsule endoscopy, deep enteroscopy using balloon-assisted or spiral techniques, computerized tomography and magnetic resonance enteroclysis or enterography have facilitated the diagnosis, monitoring, and management of patients with small bowel diseases. These technologies are complementary, each with its advantages and limitations. In the present article, we will discuss the different options and indications for modern diagnostic methods for visualization of the small bowel. We also try to provide a clinical rationale for the use of these different diagnostic options in less established, newly emerging, indications for small bowel evaluation.
    Best practice & research. Clinical gastroenterology 06/2012; 26(3):209-20. · 2.48 Impact Factor
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    ABSTRACT: New modalities are available for visualization of the small bowel in patients with possible obscure gastrointestinal bleeding (OGIB), but their performance requires further comparison. This study compared the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy in patients with OGIB, using balloon-assisted enteroscopy (BAE) as the reference standard. Consecutive consenting patients who were referred for evaluation of OGIB were prospectively included. Patients underwent MRE followed by capsule endoscopy and BAE. Patients with high grade stenosis at MRE did not undergo capsule endoscopy. The reference standard was BAE findings in visualized small-bowel segments and expert panel consensus for segments not visualized during BAE.Results: Over a period of 26 months, 38 patients were included (20 female [53 %]; mean age 58 years, range 28 - 75 years). Four patients (11 %) did not undergo capsule endoscopy due to high grade small-bowel stenosis at MRE (n = 3; 8 %) or timing issues (n = 1; 3 %). Capsule endoscopy was non-diagnostic in one patient. The reference standard identified abnormal findings in 20 patients (53 %). MRE had sensitivity, specificity, and positive and negative likelihood ratios of 21 %, 100 %, infinity, and 0.79, respectively. The corresponding values for capsule endoscopy were 61 %, 85 %, 4.1, and 0.46. The reference standard and capsule endoscopy did not differ in percent positive findings (P = 0.34), but MRE differed significantly from the reference BAE (P < 0.001). Capsule endoscopy was superior to MRE for detecting abnormalities (P = 0.0015). Capsule endoscopy performed better than MRE in the detection of small-bowel abnormality in patients with OGIB. MRE may be considered as an alternative for the initial examination in patients with clinical suspicion of small-bowel stenosis.
    Endoscopy 04/2012; 44(7):668-73. · 5.74 Impact Factor
  • H Aktas, P B F Mensink, E J Kuipers, H van Buuren
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    ABSTRACT: Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of single-balloon enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24-83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92%). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.
    Endoscopy 02/2012; 44(2):210-2. · 5.74 Impact Factor
  • Endoscopy 12/2011; 43(12):1089. · 5.74 Impact Factor
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    ABSTRACT: New modalities are available to visualize the small bowel in patients with Crohn's disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20-74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.
    Abdominal Imaging 11/2011; 37(3):397-403. · 1.91 Impact Factor
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    ABSTRACT: The usefulness of single-balloon enteroscopy (SBE) has not been evaluated in children with known or suspected Crohn's disease (CD). The objectives of this study are to evaluate the diagnostic yield of SBE for pediatric CD by comparing it with US and magnetic resonance enterography (MRE). Single-center prospective study. Tertiary-care referral hospital. Between February 2009 and April 2010, 20 pediatric patients (ages 8-18 years) with suspected inflammatory bowel disease (IBD) or with a previous diagnosis of CD with suspected persistent small-bowel disease were enrolled. All patients underwent proximal and distal SBE, 17 patients also underwent US combined with Doppler flow measurements, and 18 underwent MRE. The findings of US with Doppler flow measurements and MRE were compared with those with SBE. The mean patient age was 15.0 years (range 11.3-18 years, 70% male). Of 14 patients with suspected IBD, 8 had a diagnosis of CD made after SBE. Activity in the small bowel was found in 14 patients (70%) with both suspected and previously diagnosed CD. Twelve patients (60%) had small-bowel disease that was out of reach of conventional endoscopy. Three patients (15%) had small-bowel activity solely in the jejunum, which was not detected by either MRE or US. Single-center study with small sample size. SBE can be used in children to accurately assess small-bowel disease and CD. Small-bowel activity may be identified by SBE in some patients in whom it may not be apparent despite use of conventional upper endoscopy, ileocolonoscopy, US with Doppler flow measurements, or MRE.
    Gastrointestinal endoscopy 09/2011; 75(1):87-94. · 6.71 Impact Factor
  • Article: Response.
    Christopher W Teshima, Huseyin Aktas, Peter B F Mensink
    Gastrointestinal endoscopy 04/2011; 73(4):855. · 6.71 Impact Factor
  • Gastrointestinal Endoscopy 04/2011; 73(4). · 5.21 Impact Factor
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    ABSTRACT: Antibiotic-based regimens are frequently used for the treatment of Helicobacter pylori infection. These regimens fail to eradicate H pylori in 15% to 40% of patients, primarily due to antimicrobial resistance and insufficient patient compliance. Effective prevention and eradication of H pylori by passive immunization with orally administered bovine antibodies has been demonstrated in animal studies, and may serve as an alternative therapy in humans. To study the efficacy and safety of orally administered bovine anti-H pylori antibodies for the reduction of intragastric bacterial load and eradication of H pylori in humans. Dairy cows were immunized against H pylori. After confirmation of the presence of anti-H pylori antibodies in the milk, the milk was subsequently processed into a whey protein concentrate (WPC). In a prospective, double-blind, placebo-controlled randomized clinical trial, H pylori-infected subjects were randomly assigned to treatment with the WPC preparation or placebo. Study medication was continued for 28 days; subjects were followed-up for 56 days. Of the 30 subjects included, 27 completed the protocol. Of these 27 evaluable subjects, 14 were treated with WPC and 13 with placebo. There was no significant difference in urea breath test decrease between the WPC- and placebo-treated group (P=0.75). H pylori-associated gastritis and density were not significantly reduced in either group after treatment (P>0.05 for all). Bovine antibody-based oral immunotherapy appears to be safe, but does not significantly reduce intragastric density in humans. Further studies are needed to determine whether WPC treatment has additional value to conventional antibiotic treatment for H pylori.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 04/2011; 25(4):207-13. · 1.53 Impact Factor
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    ABSTRACT: The diagnosis of chronic gastrointestinal ischemia (CGI) remains a clinical challenge. We aimed to assess the diagnostic value of clinical features, visualization of the gastrointestinal arteries, and evaluation of mucosal perfusion in patients clinically suspected of CGI. A total of 186 patients referred for suspicion of CGI were prospectively included and followed up. All patients had an extensive diagnostic work-up, including visualization of the gastrointestinal arteries with computed tomography, magnetic resonance, or conventional angiography, and mucosal perfusion with tonometry. The reference standard for CGI was persistent clinical response after adequate therapy. The diagnostic value of individual and combined tests was assessed with multivariable logistic regression analysis. A total of 116 (62%) patients were diagnosed with CGI. In a multivariable model solely based on clinical features, the strongest predictors for CGI were the presence of postprandial pain, weight loss per month in kilograms, concomitant cardiovascular disease, and presence of an abdominal bruit. However, this model showed limited discriminative ability for the presence or absence of CGI (c-statistic, 0.62). Adding radiologic imaging to the prediction model improved the discriminative ability substantially (c-statistic, 0.81). Adding tonometry to the prediction model further improved the discriminative ability of the model (c-statistic, 0.90). The combination of clinical features and tonometry with a c-statistic of 0.88 approximated the discriminative ability of the latter model. Clinical features alone have a limited value to assess CGI correctly. Visualization of the gastrointestinal arteries and evaluation of mucosal perfusion substantially improve the diagnosis of CGI. The strongest diagnostic contribution comes from mucosal perfusion assessment.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2011; 9(3):234-41. · 5.64 Impact Factor
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    ABSTRACT: Double-balloon enteroscopy (DBE) is the first choice endoscopic technique for small-bowel visualization. However, preparation and handling of the double-balloon enteroscope is complex. Recently, a single-balloon enteroscopy (SBE) system has been introduced as being a simplified, less-complex balloon-assisted enteroscopy system. This study was a randomized international multicenter trial comparing two balloon-assisted enteroscopy systems: DBE vs. SBE. Consecutive patients referred for balloon-assisted enteroscopy were randomized to either DBE or SBE. Patients were blinded with regard to the type of instrument used. The primary study outcome was oral insertion depth. Secondary outcomes included complete small-bowel visualization, anal insertion depth, patient discomfort, and adverse events. Patient discomfort during and after the procedure was scored using a visual analog scale. A total of 130 patients were included over 12 months: 65 with DBE and 65 with the SBE technique. Patient and procedure characteristics were comparable between the two groups. Mean oral intubation depth was 253 cm with DBE and 258 cm with SBE, showing noninferiority of SBE vs. DBE. Complete visualization of the small bowel was achieved in 18 % and 11 % of procedures in the DBE and SBE groups, respectively. Mean anal intubation depth was 107 cm in the DBE group and 118 cm in the SBE group. Diagnostic yield and mean pain scores during and after the procedures were similar in the two groups. No adverse events were observed during or after the examinations. This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel.
    Endoscopy 03/2011; 43(6):472-6. · 5.74 Impact Factor
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    ABSTRACT: Diagnosing chronic gastrointestinal ischemia (CGI) is a challenging problem in clinical practice. Serum markers for CGI would be of great diagnostic value as a non-invasive test method. This study investigated serum markers in patients with well-defined ischemia. Furthermore, intestinal mucosal injury was also evaluated in CGI patients. Consecutive patients suspected of CGI were prospectively enrolled and underwent a diagnostic work-up consisting of gastrointestinal tonometry and either CT or MR angiography. Blood samples for analysis of intestinal fatty acid-binding protein (I-FABP), D-dimer, lactate dehydrogenase (LDH), leucocyte counts, C-reactive protein (CRP), and L-lactate were drawn before and after a standard meal. Intestinal mucosal injury was assessed with glutamine, citrulline and arginine in blood samples and compared to a sugar absorption test (SAT). Test reproducibility was validated in healthy subjects. Forty patients and nine healthy subjects were included. Ischemia was diagnosed in 32 patients (80%). I-FABP, leucocyte counts, LDH, CRP, glutamine, citrulline, arginine and SAT levels did not differ between patients with and without ischemia. L-lactate concentration showed a significant elevation in ischemia patients as compared to non-ischemia patients. In ischemia patients, D-dimer levels showed a significant elevation postprandially as compared to D-dimer levels at baseline. However, these ischemia patients did not show intestinal mucosal injury. I-FABP, leucocyte counts, LDH and CRP levels are not clinically useful for the diagnosis of CGI. However, postprandial rises in L-lactate and D-dimer serum levels can serve as non-invasive indicators of CGI.
    Digestive Diseases and Sciences 02/2011; 56(2):506-12. · 2.26 Impact Factor
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    ABSTRACT: The diagnosis of chronic GI ischemia (CGI) remains a clinical challenge. Currently, there is no single simple test with high sensitivity available. Visible light spectroscopy (VLS) is a new technique that noninvasively measures mucosal oxygen saturation during endoscopy. To determine the diagnostic accuracy of VLS for the detection of ischemia in a large cohort of patients. Prospective study, with adherence to the Standards for Reporting of Diagnostic Accuracy. Tertiary referral center. Consecutive patients referred for evaluation of possible CGI. Patients underwent VLS along with the standard workup consisting of evaluation of symptoms, GI tonometry, and abdominal CT or magnetic resonance angiography. VLS measurements and the diagnosis of CGI as established with the standard workup. In 16 months, 121 patients were included: 80 in a training data set and 41 patients in a validation data set. CGI was diagnosed in 89 patients (74%). VLS cutoff values were determined based on the diagnosis of CGI and applied in the validation data set, and the results were compared with the criterion standard, resulting in a sensitivity and specificity of VLS of 90% and 60%, respectively. Repeated VLS measurements showed improvement in 80% of CGI patients after successful treatment. Single-center study; only 43% of patients had repeated VLS measurements after treatment. VLS during upper endoscopy is a promising easy-to-perform and minimally invasive technique to detect mucosal hypoxemia in patients clinically suspected of having CGI, showing excellent correlation with the established ischemia workup.
    Gastrointestinal endoscopy 02/2011; 73(2):291-8. · 6.71 Impact Factor
  • C W Teshima, P B Mensink
    Endoscopy 01/2011; 43(1):38-41. · 5.74 Impact Factor

Publication Stats

677 Citations
445.97 Total Impact Points

Institutions

  • 2008–2014
    • Erasmus Universiteit Rotterdam
      • Department of Gastroenterology and Hepatology
      Rotterdam, South Holland, Netherlands
  • 2011–2012
    • Medisch Centrum Alkmaar
      • Department of Radiology
      Alkmaar, North Holland, Netherlands
    • University of Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2007–2011
    • Erasmus MC
      • Department of Gastroenterology and Hepatology
      Rotterdam, South Holland, Netherlands
  • 2002–2007
    • Medisch Spectrum Twente
      • Hospital Medical Spectrum Twente
      Enschede, Overijssel, Netherlands
    • Universitair Medisch Centrum Groningen
      Groningen, Groningen, Netherlands