N Soehendra

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

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Publications (352)1226.98 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Current endoscopic therapy for neoplastic Barrett's oesophagus (BO) consists of complete resection/ablation of all Barrett's tissue including neoplastic lesions. Recurrence seems to be frequent after thermal therapy, such as radiofrequency ablation. To analyse long-term recurrence of neoplasia and BO after successful widespread endoscopic mucosal resection (EMR). In a retrospective analysis, all patients undergoing widespread EMR of neoplastic BO between 2002 and 2007 at two referral centres were followed for at least 3 years after completion of endotherapy. Recurrence was diagnosed if neoplasia and/or BO were detected following previous successful complete removal, defined as at least two negative endoscopies and biopsies. Ninety patients undergoing widespread EMR were included (mean age 63 years; 82 male), 58% of whom underwent additional thermal ablation for minor residual disease. Complete eradication of neoplasia and Barrett's tissue was achieved in 90% of patients. On further follow-up (mean 64.8 months), recurrence of neoplastic and non-neoplastic BO was found in 6.2% and 39.5%, respectively. Recurring neoplasia (3 adenocarcinomas, 1 low-grade and 1 high-grade dysplasia) were found after a median of 44 months (range 38-85) and could be retreated endoscopically. In a multivariate analysis, Barrett's length was the only factor significantly associated with recurrence (OR 2.73). Even after seemingly complete endoscopic resection, recurrence of BO is frequent and independent of additional thermal therapy. Due to the possibility of neoplasia recurrence even after long disease-free intervals, follow-up should be extended beyond 5 years.
    Gut 01/2014; · 13.32 Impact Factor
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    ABSTRACT: Endoscopic ultrasonography (EUS) has been shown to be the most accurate test for locoregional staging of upper gastrointestinal tumors; however, recent studies have questioned its accuracy level in daily clinical application. The present retrospective study analyzes the accuracy of EUS in guiding interdisciplinary treatment decisions. 123 primarily operated patients (63 % men, mean age 61.4 years) were included; only cases with tumor-free resection margins and without evidence of distant metastases were selected. EUS and histopathological findings were compared. Main outcome parameter was the distinction between tumors to be primarily operated (T1 /2N0) and those to be treated by neoadjuvant or perioperative chemotherapy (T3/4, or any N + ), based on an assumed algorithm for treatment stratification. Overall staging accuracy of EUS was 44.7 % for T and 71.5 % for N status irrespective of tumor location. Overstaging was the main problem (44.9 % for T, 42.9 % for N staging). The overall EUS classification was correct in 79.7 % (accuracy), with a sensitivity 91.9 % and specificity 51.4 %; only 19 out of 37 cases with histopathological T1/2N0 were correctly classified by EUS. Positive and negative predictive values of EUS in diagnosing advanced tumor stage for assignment to neoadjuvant therapy were 81.4 % and 73.1 %, respectively. Whereas EUS has a high sensitivity in the diagnosis of locally advanced gastric cancer, endosonographic overstaging of T2 cancers appears to be a frequent problem. EUS stratification between local (T1 /2N0) and advanced (T3/4 or any N + ) tumors would thus result in incorrect assignment to neoadjuvant treatment in half of cases.
    Endoscopy 04/2012; 44(6):572-6. · 5.20 Impact Factor
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    ABSTRACT: La ligature endoscopique de varices (LEV) s’est avérée être un traitement efficace des hémorragies par rupture de varices œsophagiennes avec un faible taux de complications. En cas d’hémorragie massive de varices œsophagiennes ou gastriques, l’injection de N-butyl(2)-cyanoacrylate est considérée comme le traitement le plus efficase aussi bien pour obtenir l’hémostase primaire que pour obtenir une réduction du taux de récidives. En cas d’hémorragie, les varices doivent être traitées par endoscopie en raison du risque élevé de récidive. La LEV s’est avérée supérieure à la sclérothérapie endoscopique par injection (SEV) en ce qui concerne le taux de complications. Cependant, le défaut majeur de la LEV est le taux élevé de récidive de varices. Pour éviter les complications du traitement et cette récidive variqueuse, une combinaison métachrone de la LEV et de la SEV semble être une stratégie efficace. Après élimination des grosses varices œsophagiennes par la LEV, les varices plus petites peuvent être traitées par SEV. Le traitement endoscopique pourrait devenir le traitement préférentiel pour la prophylaxie primaire des varices à haut risque si d’autres études viennent confirmer son bénéfice par rapport à une thérapie par béta-bloquants. Endoscopic variceal ligation (EVL) has been demonstrated to be an effective treatment modality for bleeding esophageal varices with the lowest complication rate. In cases of massive bleeding from esophageal or gastric varices, injection of N-butyl(2)-cyanoacrylate has been shown to be the most effective treatment in terms of maintaining primary hemostasis and decreasing rebleeding rate. Once bleeding occurs, varices have to be treated endoscopically due to this high risk of rebleeding. EVL has been demonstrated to be superior to endoscopic injection sclerotherapy (EIS) in terms of complication rates. However, the major drawback of EVL is the high rate of variceal recurrence. To avoid treatment complications as well as early variceal recurrence, metachronous combination therapy of EVL and EIS seems to be an effective strategy. After elimination of large esophageal varices by EVL, smaller varices can be treated by EIS. Endoscopic treatment may become the preferential treatment for primary prophylaxis of high risk varices, if further studies can confirm a benefit as compared to β-blocker therapy.
    Acta Endoscopica 04/2012; 30(5):511-517. · 0.16 Impact Factor
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    ABSTRACT: To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%). Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.
    Digestive Endoscopy 01/2012; 24(1):36-41. · 1.61 Impact Factor
  • Gastrointestinal Endoscopy 04/2011; 73(4). · 4.90 Impact Factor
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    ABSTRACT: Endoscopic stenting (ES) is a minimally invasive alternative to surgical gastroenterostomy (GE) for palliation of malignant gastroduodenal obstructions. This consecutive, retrospective analysis compares the clinical outcome of all patients undergoing ES or GE in the same period. ES was performed at the Endoscopy Department, University Hospital Mannheim or at the Interdisciplinary Endoscopy Department, University Hospital Hamburg-Eppendorf. GE was performed at the Surgical Department, University Hospital Mannheim. All palliative ES or GE on patients with malignant gastroduodenal obstruction without earlier gastric resections between January 2001 and April 2007 were evaluated. Main outcome measurements were ability of solid food intake (gastric outlet obstruction score), persistence of nausea and vomiting (gut function score), length of hospital stay, morbidity, mortality and re-interventions. A total of 44 ES and 43 GE were performed. Nausea and vomiting--measured by means of the gut function score--persisted in significantly more patients in the GE group than in those who underwent stent placement (p = 0.0102). The gastric outlet obstruction score at discharge from the hospital revealed no significant difference in the ability of solid food intake between the groups. The hospital stay was significantly longer in the GE group (p = 0.0003). There was no significant difference in mortality and the rates of complications and re-interventions. In this study, ES is a generally equivalent--and in several points superior--alternative to GE for palliation of malignant gastroduodenal obstruction. ES seems to be the less invasive alternative for symptomatic patients. GE has good results in patients with longer survival and can be practiced within abdominal explorations.
    Scandinavian Journal of Gastroenterology 03/2011; 46(5):583-90. · 2.33 Impact Factor
  • Techniques in Gastrointestinal Endoscopy 01/2011; 13(1):50-52.
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    ABSTRACT: After focal endoscopic resection (ER) of high-grade dysplasia (HGD) or early cancer (EC) in Barrett's oesophagus (BO), eradication of all remaining BO reduces the recurrence risk. The aim of this study was to compare the safety of stepwise radical ER (SRER) versus focal ER followed by radiofrequency ablation (RFA) for complete eradication of BO containing HGD/EC. A multicentre randomised clinical trial was carried out in three tertiary centres. Patients with BO ≤ 5 cm containing HGD/EC were randomised to SRER or ER/RFA. Patients in the SRER group underwent piecemeal ER of 50% of BO followed by serial ER. Patients in the ER/RFA group underwent focal ER for visible lesions followed by serial RFA. Follow-up endoscopy with biopsies (four-quadrant/2 cm BO) was performed at 6 and 12 months and then annually. The main outcome measures were: stenosis rate; complications; complete histological response for neoplasia (CR-neoplasia); and complete histological response for intestinal metaplasia (CR-IM). CR-neoplasia was achieved in 25/25 (100%) SRER and in 21/22 (96%) ER/RFA patients. CR-IM was achieved in 23 (92%) SRER and 21 (96%) ER/RFA patients. The stenosis rate was significantly higher in SRER (88%) versus ER/RFA (14%; p<0.001), resulting in more therapeutic sessions in SRER (6 vs 3; p<0.001) due to dilations. After median 24 months follow-up, one SRER patient had recurrence of EC, requiring ER. In patients with BO ≤ 5 cm containing HGD/EC, SRER and ER/RFA achieved comparably high rates of CR-IM and CR-neoplasia. However, SRER was associated with a higher number of complications and therapeutic sessions. For these patients, a combined endoscopic approach of focal ER followed by RFA may thus be preferred over SRER. Clinical trial number NTR1337.
    Gut 01/2011; 60(6):765-73. · 13.32 Impact Factor
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    ABSTRACT: Endoscopic resection is safe and effective to remove early neoplasia (ie,high-grade intra-epithelial neoplasia/early cancer) in Barrett's oesophagus. To prevent metachronous lesions during follow-up, the remaining Barrett's oesophagus can be removed by stepwise radical endoscopic resection (SRER). The aim was to evaluate the combined experience in four tertiary referral centres with SRER to eradicate Barrett's oesophagus with early neoplasia. Retrospective cohort study. Four tertiary referral centres. 169 patients (151 males, age 64 years (IQR 57-71), Barrett's oesophagus 3 cm (IQR 2-5)) with early neoplasia in Barrett's oesophagus < or = 5 cm, without deep submucosal infiltration or lymph node metastases, treated by SRER between January 2000 and September 2006. Endoscopic resection every 4-8 weeks, until complete endoscopic and histological eradication of Barrett's oesophagus and neoplasia. According to intention-to-treat analysis complete eradication of all neoplasia and all intestinal metaplasia by the end of the treatment phase was reached in 97.6% (165/169) and 85.2% (144/169) of patients, respectively. One patient had progression of neoplasia during treatment and died of metastasised adenocarcinoma (0.6%). After median follow-up of 32 months (IQR 19-49), complete eradication of neoplasia and intestinal metaplasia was sustained in 95.3% (161/169) and 80.5% (136/169) of patients, respectively. Acute, severe complications occurred in 1.2% of patients, and 49.7% of patients developed symptomatic stenosis. SRER of Barrett's oesophagus < or = 5 cm containing early neoplasia appears to be an effective treatment modality with a low rate of recurrent lesions during follow-up. The procedure, however, is technically demanding and is associated with oesophageal stenosis in half of the patients.
    Gut 09/2010; 59(9):1169-77. · 13.32 Impact Factor
  • Zeitschrift für Gastroenterologie 09/2009; 47(09). · 1.67 Impact Factor
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    ABSTRACT: Endoscopic ultrasound (EUS)-guided drainage has emerged as the leading treatment modality for symptomatic pancreatic fluid collections. Endoscopic ultrasound-guided endoscopic drainage is less invasive than surgery and avoids local complications related to percutaneous drainage. In addition, unlike non-EUS guided endoscopic drainage, EUS-guided drainage is able to drain non-bulging fluid collections and may reduce the risk of procedure-related bleeding. Excellent treatment success rates exceeding 90% have been reported for pancreatic pseudocysts and abscesses. In the context of infected pancreatic necrosis, adjunctive endoscopic necrosectomy is required for effective treatment. With such an aggressive approach, the treatment success rate may reach 81%-92%. The potential complications of concern for EUS-guided drainage are severe bleeding and perforation. To minimize risk, only fluid collections with a mature wall and within 1 cm of the gastrointestinal lumen should undergo endoscopic drainage. Any coagulopathy, if present, should be corrected. Patients with pseudocysts undergoing drainage should also receive prophylactic antibiotics in order to prevent secondary infection of a sterile collection.
    Digestive Endoscopy 07/2009; 21 Suppl 1:S61-5. · 1.61 Impact Factor
  • Gastrointestinal Endoscopy 04/2009; 69(5). · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 04/2009; 69(5). · 4.90 Impact Factor
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    ABSTRACT: Traditionally abdominal abscesses have been treated with either surgical or radiologically guided percutaneous drainage. Surgical drainage procedures may be associated with considerable morbidity and mortality, and serious complications may also arise from percutaneous drainage. Endoscopic ultrasound (EUS)-guided drainage of well-demarcated abdominal abscesses, with adjunctive endoscopic debridement in the presence of solid necrotic debris, has been shown to be feasible and safe. This multicenter review summarizes the current status of the EUS-guided approach, describes the available and emerging techniques, and highlights the indications, limitations, and safety issues.
    Endoscopy 03/2009; 41(2):166-74. · 5.20 Impact Factor
  • Gastrointestinal endoscopy 03/2009; 69(2 Suppl):S13-21. · 4.90 Impact Factor
  • Gastrointestinal endoscopy 03/2009; 69(2 Suppl):S182-5. · 4.90 Impact Factor
  • Gastrointestinal endoscopy 03/2009; 69(2 Suppl):S78-80. · 4.90 Impact Factor
  • T L Ang, S Seewald, E K Teo, K M Fock, N Soehendra
    Endoscopy 03/2009; 41 Suppl 2:E21-2. · 5.20 Impact Factor
  • Yan Zhong, Stefan Seewald, Nib Soehendra
    Gastrointestinal Emergencies, Second Edition, 02/2009: pages 53 - 56; , ISBN: 9781444303292
  • Yan Zhong, Stefan Seewald, Nib Soehendra
    Gastrointestinal Emergencies, Second Edition, 02/2009: pages 141 - 148; , ISBN: 9781444303292

Publication Stats

7k Citations
1,226.98 Total Impact Points


  • 1982–2012
    • University Medical Center Hamburg - Eppendorf
      • Department of Interdisciplinary Endoscopy
      Hamburg, Hamburg, Germany
  • 1977–2012
    • University of Hamburg
      • • Department of General, Visceral and Thoracic Surgery Department and Clinic
      • • Interdisciplinary Endoscopy Department and Clinic
      Hamburg, Hamburg, Germany
  • 2009
    • Stanford University
      Palo Alto, California, United States
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • Changi General Hospital
      • Department of Gastroenterology
      Singapore, Singapore
  • 2006
    • Hospital Selayang – Government Hospital in Batu Caves, Selayang
      Kuala Lumpor, Kuala Lumpur, Malaysia
    • Gifu University
      Gihu, Gifu, Japan
  • 2002
    • Technische Universität München
      München, Bavaria, Germany
  • 1996
    • Medical University of South Carolina
      • Digestive Disease Center
      Charleston, SC, United States
  • 1994
    • Freie Universität Berlin
      Berlín, Berlin, Germany
  • 1993
    • Christian-Albrechts-Universität zu Kiel
      Kiel, Schleswig-Holstein, Germany
  • 1981
    • Universitätsklinikum Jena
      Jena, Thuringia, Germany