Lukas Degen

Universitätsspital Basel, Bâle, Basel-City, Switzerland

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Publications (58)464.84 Total impact

  • Gastrointestinal Endoscopy 05/2014; 79(5):AB204. DOI:10.1016/j.gie.2014.05.033 · 5.37 Impact Factor
  • Ludwig T. Heuss · S P Sugandha · Lukas P. Degen
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    ABSTRACT: QUESTIONS UNDER STUDY / PRINCIPLES: Colonoscopies are complex procedures that depend greatly on the patient's cooperation and on the correct judgment of a tolerable amount of discomfort by the endoscopy team, even in sedated patients. Little is known regarding the accuracy of the patient comfort level assessments made by medical staff. We prospectively evaluated the degree of agreement between the assessments made by the endoscopists and endoscopy nurses and the assessments made by patients regarding their comfort level during the procedure. A total of 222 patients scheduled for routine colonoscopies assessed their preprocedural anxiety and the tolerability of the procedure. Endoscopists and nurses assessed the difficulty of the examination and the patient's level of discomfort. Assessments were performed using a 100-mm VAS. Overall, patients rated the procedure as tolerable. For 12% (27/222) of the patients, the examination was less tolerable (VAS >50 mm). The patients' judgment of tolerability was not related to the initial level of anxiety (r = 0.15). The scores of the endoscopists and nurses were better correlated with each other (r = 0.58) than with the patients' self-assessments (r = 0.37 and 0.35, respectively). Both endoscopists and nurses tended to overestimate the patients' discomfort. However, in 9% (19/222) of cases, the level of patient discomfort was considerably underestimated by at least one member of the team. Our study shows that the estimation of a patient's discomfort during a colonoscopy is difficult and that the comfort level may not be accurately determined in a considerable number of patients, including sedated patients.
    Schweizerische medizinische Wochenschrift 11/2012; 142. DOI:10.4414/smw.2012.13726 · 2.09 Impact Factor
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    ABSTRACT: In patients undergoing routine upper EGD, propofol is increasingly used without pharyngeal anesthesia because of its excellent sedative properties. It is unclear whether this practice is non-inferior in regard to ease of endoscopic intubation and patient comfort. To assess the relevance of local pharyngeal anesthesia regarding the ease of EGD performance in patients sedated with propofol as monotherapy. Randomized, double-blind, placebo-controlled, non-inferiority trial. One community hospital and one university hospital in Switzerland. We enrolled 300 consecutive adult patients undergoing elective EGD. Pharyngeal anesthesia with 4 squirts of lidocaine spray versus placebo spray immediately before propofol sedation. Number of gag reflexes (primary endpoint), number of intubation attempts, and degree of salivation during intubation (secondary endpoints) assessed by the endoscopists and staff. In the lidocaine group, 122 patients (82%) had no gag events, and 25 patients had a total of 39 gag events, whereas in the placebo group 104 patients (71%) had no gag events, and 43 patients had a total of 111 gag events. The rate ratio of gagging with quasi-likelihood estimation of placebo compared with lidocaine was 2.85 (95% confidence interval [CI], 1.42-6.19; P = .005). In adjusted logistic regression analysis, the odds ratio for gagging for placebo pharyngeal anesthesia compared with lidocaine was 1.9 (95% CI, 1.03-3.54). The number of intubation attempts and the degree of salivation were similar in both groups. Two patients in the placebo group experienced oxygen desaturation and needed short-term mask ventilation. The level of sedation and possible long-term side effects of pharyngeal anesthesia were not assessed. Topical pharyngeal anesthesia reduces the gag reflex in patients sedated with propofol even though it does not seem to have an influence on the ease of the procedure and on patient or endoscopist satisfaction in adequately sedated patients.
    Gastrointestinal endoscopy 12/2011; 74(6):1207-14. DOI:10.1016/j.gie.2011.07.072 · 5.37 Impact Factor
  • Arzneimittel-Forschung 10/2011; 57(10):645-658. DOI:10.1055/s-0031-1296664 · 0.70 Impact Factor
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    ABSTRACT: BACKROUND & AIMS: Topical corticosteroids are effective in inducing clinical and histologic remission in patients with eosinophilic esophagitis (EoE). However, the best long-term management strategy for this chronic inflammatory disease has not been determined. In a randomized, double-blind, placebo-controlled, 50-week trial, we evaluated in 28 patients the efficacy of twice-daily swallowed budesonide (0.25 mg each) to maintain quiescent EoE in remission. Pretreatment and posttreatment activity was assessed clinically, endoscopically, histologically, immunohistologically, and by endosonography. The primary end point was the therapy's ability to maintain EoE in histologic remission. Secondary end points were efficacy in symptom control, prevention of tissue remodeling, and safety. In patients given low-dose budesonide, the load of esophageal eosinophils increased from 0.4 to 31.8 eosinophils/high-power field (P = .017). In patients given placebo, the load increased from 0.7 to 65.0 eosinophils/high-power field (P = .0001); this increase was significantly greater than in patients given budesonide (P = .024). The symptom scores developed in a similar manner in the 2 groups. Budesonide, but not placebo, reduced noneosinophilic markers of inflammation, epithelial cell apoptosis, and remodeling events. Compared with control individuals, patients had significantly thickened esophageal walls, based on endosonography (3.05 vs 2.18 mm; P < .0001). Budesonide therapy was associated with a significant reduction in mucosal thickness (0.75-0.45 mm; P = .025), but epithelial thickness remained stable (261.22 vs 277.23 μm; P = .576). No serious adverse events occurred. Low-dose budesonide is more effective than placebo in maintaining EoE in histologic and clinical remission. Signs of esophageal remodeling showed a trend toward normalization. Long-term administration of topical corticosteroids was well tolerated without induction of epithelial atrophy.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2011; 9(5):400-9.e1. DOI:10.1016/j.cgh.2011.01.017 · 7.90 Impact Factor
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    ABSTRACT: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by dense tissue eosinophilia; it is refractory to proton pump inhibitor therapy. EoE affects all age groups but most frequently individuals between 20 and 50 years of age. Topical corticosteroids are effective in pediatric patients with EoE, but no controlled studies of corticosteroids have been reported in adult patients. We performed a randomized, double-blind, placebo-controlled trial to evaluate the effect of oral budesonide (1 mg twice daily for 15 days) in adolescent and adult patients with active EoE. Pretreatment and posttreatment disease activity was assessed clinically, endoscopically, and histologically. The primary end point was reduced mean numbers of eosinophils in the esophageal epithelium (number per high-power field [hpf] = esophageal eosinophil load). Esophageal biopsy and blood samples were analyzed using immunofluorescence and immunoassays, respectively, for biomarkers of inflammation and treatment response. A 15-day course of therapy significantly decreased the number of eosinophils in the esophageal epithelium in patients given budesonide (from 68.2 to 5.5 eosinophils/hpf; P < .0001) but not in the placebo group (from 62.3 to 56.5 eosinophils/hpf; P = .48). Dysphagia scores significantly improved among patients given budesonide compared with those given placebo (5.61 vs 2.22; P < .0001). White exudates and red furrows were reversed in patients given budesonide, based on endoscopy examination. Budesonide, but not placebo, also reduced apoptosis of epithelial cells and molecular remodeling events in the esophagus; no serious adverse events were observed. A 15-day course of treatment with budesonide is well tolerated and highly effective in inducing a histologic and clinical remission in adolescent and adult patients with active EoE.
    Gastroenterology 11/2010; 139(5):1526-37, 1537.e1. DOI:10.1053/j.gastro.2010.07.048 · 16.72 Impact Factor
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    ABSTRACT: Colonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions. We performed a prospective, single-center pilot study at a University Hospital. Data were obtained from November 2007 until May 2008. Patients underwent CCE on Day 1 and CSPY on Day 2. Outcomes were evaluated regarding sensitivity and specificity of polyp detection rate, with a significance level set at >5 mm. 59 individuals were included in this study, the results were evaluable in 56 patients (males 34, females 22; median age 59). CCE was complete in 36 subjects. Polyp detection rate for significant polyps was 11% on CSPY and 27% on CCE.6/56 (11%) patients had polyps on CSPY not detected on CCE (miss rate).Overall sensitivity was 79% (95% confidence interval [CI], 61 to 90), specificity was 54% (95% CI, 35 to 70), positive predictive value (PPV) was 63% and negative predictive value (NPV) was 71%. Adjusted to significance of findings, sensitivity was 50% (95% CI, 19 to 81), specificity was 76% (95% CI, 63 to 86), PPV was 20% and NPV was 93%. In comparison to the gold standard, the sensitivity of CCE for detection of relevant polyps is low, however, the high NPV supports its role as a possible screening tool. NCT00991003.
    BMC Gastroenterology 06/2010; 10(66):66. DOI:10.1186/1471-230X-10-66 · 2.37 Impact Factor
  • Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)60565-3 · 16.72 Impact Factor
  • Gastroenterology 05/2009; 136(5). DOI:10.1016/S0016-5085(09)61549-3 · 16.72 Impact Factor
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    ABSTRACT: Serum protein electrophoresis is used in clinical practice to identify patients with multiple myeloma and other serum protein disorders. It is an inexpensive and easy-to-perform screening procedure. Electrophoresis separates serum proteins based on their physical properties and identifies morphologic patterns in response to acute and chronic inflammation, various malignancies, liver or renal failure, and hereditary protein disorders. For gastroenterologists, the use of serum protein electrophoresis may be helpful in the diagnosis of both common diseases with unusual presentations and rare disorders with typical presentations. Therefore, it represents an ideal screening tool.
    Digestion 05/2009; 79(4):203-10. DOI:10.1159/000212077 · 2.10 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2009; 123(2). DOI:10.1016/j.jaci.2008.12.1037 · 11.48 Impact Factor
  • Shajan Peter · Lukas Degen
    Gastrointestinal endoscopy 08/2008; 68(1):147-8. DOI:10.1016/j.gie.2008.01.015 · 5.37 Impact Factor
  • Lukas Degen · Christoph Beglinger
    Gastroenterologie up2date 06/2008; 4(2):155-167. DOI:10.1055/s-2008-1077293
  • Gastroenterology 04/2008; 134(4). DOI:10.1016/S0016-5085(08)60488-6 · 16.72 Impact Factor
  • Gastroenterology 04/2008; 134(4). DOI:10.1016/S0016-5085(08)61410-9 · 16.72 Impact Factor
  • Gastroenterology 04/2008; 134(4). DOI:10.1016/S0016-5085(08)61411-0 · 16.72 Impact Factor
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    ABSTRACT: More than 95% of malignant tumours of the pancreas are exocrine carcinomas. The exocrine carcinomas have to be distinguished from benign serous cystadenomas and tumours, the latter including mucinous cystic neoplasms, serous cysts, and solid pseudopapillary neoplasms. Cystic lesions have to be separated from pseudocysts, which are the most common cysts. Pseudocysts are due to extensive confluent autodigestive tissue necrosis caused by alcoholic, biliary, or traumatic acute pancreatitis. This review focuses on the classification of the different types of solid and cystic lesions based on histological criteria. The various imaging procedures are also discussed, along with their strengths and limitations.
    Baillière&#x027 s Best Practice and Research in Clinical Gastroenterology 02/2008; 22(1):91-103. DOI:10.1016/j.bpg.2007.10.022 · 3.48 Impact Factor
  • Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 12/2007; 5(11):A22. DOI:10.1016/j.cgh.2007.08.024 · 7.90 Impact Factor
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    ABSTRACT: An oral formulation of EP01572, a peptidomimetic growth hormone secretagogue, was studied. An oral delivery system would be preferable in many of the possible therapeutic indications of ghrelin agonists such as EP01572. Our objective was to establish the pharmacological profile and the GH-releasing activity of increasing oral doses of EP01572 in healthy volunteers. In addition, the pharmacokinetics and pharmacological effects of EP01572 were investigated after intraduodenal (ID) administration. This study was a single-center escalating dose study with oral and ID applications. In the first part, EP01572 was given orally to 36 male subjects; the treatment consisted of one oral dose of either EP01572 or placebo (0.005, 0.05, and 0.5 mg/kg body weight). Six subjects received two additional oral doses of EP01572: 0.125 and 0.25 mg/kg body weight. In the second part, the following treatments were performed in a randomized order: 1) administration of a bolus of saline (placebo) to the small intestine; 2) ID administration of a bolus of EP01572 at 0.2 mg/kg body weight; 3) ID perfusion of a bolus of EP01572 at 0.35 mg/kg body weight; and 4) ID perfusion of a bolus of EP01572 at 0.5 mg/kg body weight. The oral and ID administration of EP01572 induced a rapid and dose-dependent increase in plasma drug concentrations and a potent GH release in healthy male volunteers. This study showed that EP01572 was active with regard to stimulation of GH release in humans after oral and ID administration.
    Journal of Clinical Endocrinology &amp Metabolism 06/2007; 92(5):1814-20. DOI:10.1210/jc.2006-2160 · 6.21 Impact Factor
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    ABSTRACT: Cholecystokinin (CCK), peptide YY (PYY), and ghrelin have been proposed to act as satiety hormones. CCK and PYY are stimulated during meal intake by the presence of nutrients in the small intestine, especially fat, whereas ghrelin is inhibited by eating. The sequence of events (fat intake followed by fat hydrolysis and CCK release) suggests that this process is crucial for triggering the effects. The aim of this study was therefore to investigate whether CCK mediated the effect of intraduodenal (ID) fat on ghrelin secretion and PYY release via CCK-1 receptors. Thirty-six male volunteers were studied in three consecutive, randomized, double-blind, cross-over studies: 1) 12 subjects received an ID fat infusion with or without 120 mg orlistat, an irreversible inhibitor of gastrointestinal lipases, compared with vehicle; 2) 12 subjects received ID long-chain fatty acids (LCF), ID medium-chain fatty acids (MCF), or ID vehicle; and 3) 12 subjects received ID LCF with and without the CCK-1 receptor antagonist dexloxiglumide (Dexlox) or ID vehicle plus intravenous saline (placebo). ID infusions were given for 180 min. The effects of these treatments on ghrelin concentrations and PYY release were quantified. Plasma hormone concentrations were measured in regular intervals by specific RIA systems. We found the following results. 1) ID fat induced a significant inhibition in ghrelin levels (P < 0.01) and a significant increase in PYY concentrations (P < 0.004). Inhibition of fat hydrolysis by orlistat abolished both effects. 2) LCF significantly inhibited ghrelin levels (P < 0.02) and stimulated PYY release (P < 0.008), whereas MCF were ineffective compared with controls. 3) Dexlox administration abolished the effect of LCF on ghrelin and on PYY. ID fat or LCF significantly stimulated plasma CCK (P < 0.006 and P < 0.004) compared with saline. MCF did not stimulate plasma CCK release. In summary, fat hydrolysis is essential to induce effects on ghrelin and PYY through the generation of LCF, whereas MCF are ineffective. Furthermore, LCF stimulated plasma CCK release, suggesting that peripheral CCK is the mediator of these actions. The CCK-1 receptor antagonist Dexlox abolished the effect of ID LCF, on both ghrelin and PYY. Generation of LCF through hydrolysis of fat is a critical step for fat-induced inhibition of ghrelin and stimulation of PYY in humans; the signal is mediated via CCK release and CCK-1 receptors.
    AJP Regulatory Integrative and Comparative Physiology 04/2007; 292(4):R1391-9. DOI:10.1152/ajpregu.00734.2006 · 3.11 Impact Factor

Publication Stats

1k Citations
464.84 Total Impact Points


  • 2000–2014
    • Universitätsspital Basel
      • Institut für Pathologie
      Bâle, Basel-City, Switzerland
  • 2010
    • Universität Bern
      • Institute of Animal Pathology
      Berna, Bern, Switzerland
  • 1996
    • Universität Basel
      • Department of Chemistry
      Bâle, Basel-City, Switzerland