D Apel

Klinikum Ludwigshafen, Ludwigshafen, Rheinland-Pfalz, Germany

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Publications (19)44.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Today, endoscopic resection is a standard procedure for the resection of colonic polyps. Before the establishment of endoscopic techniques, the surgical approach was a clearly preferred method for removal of polyps with a size larger than three centimeters. The safety and effectiveness concerning endoscopic resections of colorectal polyps also with a size of more than 3 cm have been demonstrated in numerous studies. Data from 165 patients (age: 68 +/- 10.4 years) harboring 167 polyps with a minimum diameter of 3 cm were retrospectively evaluated. Objects of interest were macroscopic morphology and histopathology of the polyps, their localization in the colon, the modality of endoscopic resection and follow-up. In those cases with macroscopic signs of malignancy the patients were excluded. Successful endoscopic resections were obtained in 72.5 %. Therefrom, resection in the piecemeal-technique was necessary in 73.6 %. Recurrence polyps after endoscopic complete resections occurred in 26.3 % after a mean follow-up of 16 +/- 12.5 months. We registered a complication rate of 19.2 %. Relevant bleeding and perforation were registered as early complications in 18.6 %. We observed no intervention-related mortality. Endoscopic mucosal resection is a safe and efficient method even for removing giant colorectal polyps. Controls are recommended at defined intervals for detecting polyp recurrence.
    Zeitschrift für Gastroenterologie 07/2010; 48(7):741-7. · 1.41 Impact Factor
  • Zeitschrift Fur Gastroenterologie - Z GASTROENTEROL. 01/2007; 45(08).
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    ABSTRACT: Preliminary uncontrolled studies of photodynamic therapy (PDT) of bile duct cancer (BDC) have shown astonishingly good results in the reduction of cholestasis, improvement of life quality, and potential improvement of survival time. Therefore, we investigated the influence of PDT on survival time in advanced BDC in a randomized controlled study. Thirty-two patients with nonresectable BDC were randomized. In the PDT group 48 h after intravenous application of 2 mg/kg body weight of Photosan-3((R)), light activation was performed. In the control group, patients were treated with endoprostheses but no PDT. PDT group and the control group were comparable due to age, gender, performance status, bilirubin level, and BDC stage (Bismuth classification). The median survival time after randomization was 7 months for the control group and 21 months for the PDT group (p= 0.0109). In half of the initially percutaneously treated patients, we could change from percutaneous to transpapillary drainage after PDT. Four patients showed infectious complications after PDT versus one patient in the control group. PDT is minimally invasive but shows a considerable postinterventional cholangitis rate. PDT has the potential to result in a changeover of current palliative treatment of BDC.
    The American Journal of Gastroenterology 12/2005; 100(11):2426-30. · 9.21 Impact Factor
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    ABSTRACT: Premalignant duodenal polyps are considered to be rare. Recurrence after local excision is reported to be frequent, so many authors propose radical surgical treatment of these tumors. The aim of this study was to determine the long-term outcome after endoscopic resection of duodenal adenomas. Between January 1990 and April 2003 we retrospectively evaluated a group of patients who presented with nonampullary duodenal villous tumors but who did not have a polyposis syndrome. Duodenal polyps were diagnosed in 21 patients during routine endoscopy during the study period. Of these, 18 patients (6 men, 12 women; median age 67, range 50 - 81), with a total of 20 duodenal adenomas, were enrolled into the study. The median size +/- SD of the tumors was 27.5 +/- 12 mm (range 8 - 50 mm). Of these 20 tumors, 18 adenomas were tubulovillous, one was tubulous and one was villous. Nineteen polyps were treated by snare excision and one adenoma was treated with argon plasma coagulation alone. Argon plasma coagulation was applied to polyps in six patients after snare excision during this initial treatment phase. The success rate for endoscopic adenoma removal after a 3-month interval was 55 %. After a median follow-up period of 71 months (range 22 - 151 months), 12 patients remained in remission. Local recurrences of the lesion occurred in five patients (25 %) and these were re-treated. None of the patients developed carcinoma during the follow-up period. Endoscopic snare excision of duodenal adenomas is an effective mode of treatment but an endoscopic surveillance program is mandatory in order to detect and treat recurrence.
    Endoscopy 06/2005; 37(5):444-8. · 5.74 Impact Factor
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    ABSTRACT: A 52-year old female presented with a low, malignant centroblastic-centrocytic lymphoma. After splenectomy and under steroid therapy it came to the eruption of a latent Strongyloides stercoralis infection, which the patient had presumably been suffering from for several years. Due to the immunodeficient condition and under continued steroid therapy even three courses of high dose anthelmintic therapy could not eradicate the parasites. The patient died of fulminant sepsis.
    Der Internist 10/2004; 45(9):1043-6. · 0.33 Impact Factor
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    ABSTRACT: Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. However, it is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis are at greater risk for colorectal neoplasia and, therefore, should routinely undergo surveillance colonoscopy. The aim of this study was to determine whether there is a correlation between non-papillary duodenal adenoma without familial adenomatous polyposis and colorectal adenoma. Twenty-five patients with non-papillary duodenal adenomas without familial adenomatous polyposis, seen from January 1990 to April 2003, were retrospectively evaluated. Non-papillary duodenal polyps were diagnosed by endoscopy in the 25 patients. Of these, 21 underwent colonoscopy and one underwent proctoscopy. The mean age of these 22 patients (12 women, 10 men) was 69 years (range 50-83 years). Sixteen of the 22 patients (72.7%) with duodenal adenomas had associated colorectal adenomas. A total of 38 adenomas and one colorectal cancer were detected. The mean size of the polyps was 6.2 mm (range 3-15 mm). The adenomas were removed by snare excision or with a biopsy forceps. Based on the results of this uncontrolled, retrospective study, the frequency of colorectal adenomas in patients with duodenal polyps without familial adenomatous polyposis appears to be increased compared with the general population. All patients with duodenal polyps should undergo surveillance colonoscopy for colorectal adenomas. A prospective study to definitively establish the frequency of colorectal adenomas in these patients is warranted.
    Gastrointestinal Endoscopy 10/2004; 60(3):397-9. · 5.21 Impact Factor
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    ABSTRACT: An unusual pancreatobiliary fistula occurred as a complication of chronic pancreatitis. Endoscopic papillotomy was performed and a plastic endoprosthesis was inserted into the main pancreatic duct. The pancreatic stenting led to the closure of the fistula and no additional surgical treatment was necessary.
    Scandinavian Journal of Gastroenterology 05/2004; 39(4):395-7. · 2.33 Impact Factor
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    ABSTRACT: Eine 52-jährige Patientin erkrankte an einem niedrig malignen zentroblastisch-zentrozytischen B-Zell-Lymphom. Nach Splenektomie und unter Steroidtherapie kam es zur klinischen Manifestation einer latenten, vermutlich bereits mehrere Jahre bestehenden Strongyloides-stercoralis-Infektion. Bei immunkomprimiertem Abwehrzustand und fortgesetzter Steroidtherapie konnte eine 3-malige hoch dosierte anthelmintische Therapie keine Parasiteneradikation erreichen. Ein septischer, fulminanter Krankheitsverlauf besiegelte das Schicksal der Patientin.
    Der Internist 01/2004; 45(9). · 0.33 Impact Factor
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2004; 59(5).
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2004; 59(5).
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    ABSTRACT: A 78-year-old woman presented at our hospital with palpitation, tachycardia and progressive dyspnea. The health history included the diagnosis of diabetes mellitus and chronic obstructive pulmonary disease. The ECG showed atrial fibrillation, later changing with sinus rhythm and low voltage. The echocardiography revealed pericardial effusion. The cytology showed signet ring cells from the stomach. Endoscopic study revealed a 3 cm tumor in the posterior wall of the upper part of the body. The histopathological examination diagnosed cancer of diffuse type according to Lauren, with signet-ring cells. After treating the atrial fibrillation a pericardial drainage was performed. The pericardiocentesis yielded 500 ml of serous fluid. In an echocardiogram after pericardial drainage, pericardial effusion was no longer present. During the clinical course the patient suffered a stroke and the chemotherapy could not be initiated. The patient died 2 months after diagnosis. Cardiac involvement with clinical manifestations and pericardial effusion may be associated with a malignant neoplasm. Echocardiography and pericardiocentesis are helpful for the diagnosis of cardiac metastases.
    DMW - Deutsche Medizinische Wochenschrift 05/2003; 128(16):870-3. · 0.65 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 04/2003; 128(16):870-873. · 0.65 Impact Factor
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    ABSTRACT: The results of preliminary studies of photodynamic therapy (PDT) for palliation of patients with bile duct cancer with hematoporphyrin derivative have been good. Rapid elimination of a photosensitizer could potentially shorten the time requirement for shielding from light. This would enhance the benefit of this form of palliative treatment. Therefore the feasibility of PDT was investigated for nonresectable bile duct cancer by using 5-aminolevulinic acid. Four patients with nonresectable bile duct cancer underwent cholangiography, cholangioscopy, and intraductal US before PDT. Light activation was performed 5 to 7 hours after oral administration of 5-aminolevulinic acid. All patients had an endoprosthesis placed in the bile duct after PDT. Cholangioscopy 72 hours after PDT revealed superficial fibrinoid necrosis. However, 4 weeks after PDT there was no significant reduction in bile duct stenoses. Two patients had infectious complications develop, but phototoxicity was not observed. Although superficial tumor necrosis was evident, PDT with 5-aminolevulinic acid failed to significantly reduce malignant bile duct obstruction. Therefore 5-aminolevulinic acid-PDT cannot be recommended for the palliative treatment of bile duct cancer.
    Gastrointestinal Endoscopy 01/2002; 54(6):763-6. · 5.21 Impact Factor
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    ABSTRACT: A 32-year-old man developed acute pancreatitis with a main duct stricture resulting from blunt abdominal trauma sustained during a car accident 11 weeks before admission. No interventions were performed and unusually, after 3 months' follow-up, the pancreatic main duct stricture resolved and the patient remained asymptomatic. There are no other reports in the literature demonstrating resolution of pancreatic main duct stricture without any endoscopic or surgical treatment subsequent to a blunt abdominal trauma.
    European Journal of Gastroenterology & Hepatology 09/2001; 13(8):997-1000. · 1.92 Impact Factor
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    ABSTRACT: Preliminary results of photodynamic therapy (PDT) of bile duct cancer have shown astonishingly good results in the reduction of cholestasis, improvement of quality of life, and even prolongation of the survival time. Unfortunately, the existing dye laser systems are large and costly, and their maintenance is expensive. Therefore, we investigated the feasibility of a diode laser system for PDT of nonresectable bile duct cancer. Eight patients with nonresectable bile duct cancer were treated. Forty-eight hours after i. v. application of 2 mg/kg body weight of Photosan-3, light activation was performed by a transpapillary (four patients) or percutaneus (four patients) access. We used a cylindrical diffusor tip and illuminated using a wavelength of 633+/-3 nm and a total energy of 200 J/cm2. All patients were additionally provided with bile duct endoprostheses after PDT. Four weeks after initial PDT all patients showed a marked reduction of bile duct stenosis. The median serum bilirubin value declined from 5.8 mg/dl (2.0-10.1) to 1.0 mg/dl (0.8-4.4). The median survival time at the time of writing is 119 days (52-443). Five patients are still alive. In four patients we could change from percutaneous to transpapillary drainage after PDT, two patients showed infectious complications. PDT with the diode laser system seems to be effective in reducing malignant bile duct stenosis. This treatment is minimally invasive and has a low specific complication rate. Randomized, controlled studies comparing PDT with the insertion of endoprostheses and long term follow-up of results are needed to confirm the promising short term results.
    The American Journal of Gastroenterology 08/2001; 96(7):2093-7. · 9.21 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) of dysplasia and early cancer of the esophagus could show good results in the potential of ablation. Unfortunately, the existing expensive and temperamental dye laser systems foiled a broad clinical use. In this pilot study, we investigated the feasibility of an inexpensive and maintenance-free diode laser system for PDT of dysplasia and early cancer in Barrett's esophagus. Eight patients with Barrett's esophagus and/or early cancer were treated. As light source we used a diode laser system with a maximum power output of 2 W and a wavelength of 633 +/- 3 nm. One patient was treated initially with Photosan-3, seven patients received 5-aminolevulinic acid. In all patients we could achieve reduction in length and/or histologically proven downgrading. In three quarters of the patients, complete eradication of adenocarcinoma could be attained. Columnar-lined metaplastic epithelium could also be completely eradicated. PDT using a diode laser system is comparably effective in Barrett's esophagus/early cancer as PDT with dye laser systems. PDT is a gentle and effective technique with little side effects.
    Medizinische Klinik 05/2001; 96(4):212-6. · 0.34 Impact Factor
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    ABSTRACT: Zusammenfassung Hintergrund: Die photodynamische Therapie (PDT) von Dysplasien und Frühkarzinomen des Ösophagus konnte in ersten Studien gute Ergebnisse bezüglich ihres Ablationspotentials zeigen. Die bislang verwendeten teuren und wartungsaufwendigen Farbstofflaser verhinderten einen breiten klinischen Einsatz. Ziel der Pilotstudie war es, die Eignung der neuen preisgünstigen und wartungsfreien Diodenlaser zur PDT von Dysplasien und Frühkarzinomen der Barrett-Schleimhaut zu prüfen. Patienten und Methodik: Acht Patienten mit Barrett-Ösophagus und/oder Frühkarzinomen wurden behandelt. Als Lichtquelle diente ein Diodenlasersystem mit 2 W Leistung und einer Wellenlänge von 633- 3 nm. Ein Patient wurde primär mit Photosan-3® behandelt, sieben Patienten erhielten initial 5Aminolävulinsäure. Ergebnisse: In allen Fällen ließen sich eine Längenreduktion und/oder ein histologisches Down-Grading erzielen. Bei drei Viertel der Patienten gelang die komplette histologische Eradikation eines Adenokarzinoms. Metaplastisches Zylinderepithel des Barrett-Ösophagus ließ sich ebenfalls komplett eradizieren. Schlussfolgerung: Die PDT mit Diodenlasersystemen bei Barrett-Ösophagus/Adenokarzinom weist eine vergleichbare Effektivität wie die PDT mit Farbstofflasersystemen auf. Es handelt sich dabei um ein wirkungsvolles und schonendes Verfahren mit geringem Nebenwirkungsspektrum. Abstract Background: Photodynamic therapy (PDT) of dysplasia and early cancer of the esophagus could show good results in the potential of ablation. Unfortunately, the existing expensive and temperamental dye laser systems foiled a broad clinical use. In this pilot study, we investigated the feasibility of an inexpensive and maintenance-free diode laser system for PDT of dysplasia and early cancer in Barrett's esophagus. Patients and Methods: Eight patients with Barrett's esophagus and/or early cancer were treated. As light source we used a diode laser system with a maximum power output of 2 W and a wavelength of 633Dž nm. One patient was treated initially with Photosan-3®, seven patients received 5-aminolevulinic acid. Results: In all patients we could achieve reduction in length and/or histologically proven downgrading. In three quarters of the patients, complete eradication of adenocarcinoma could be attained. Columnar-lined metaplastic epithelium could also be completely eradicated. Conclusion: PDT using a diode laser system is comparably effective in Barrett's esophagus/early cancer as PDT with dye laser systems. PDT is a gentle and effective technique wit little side effects.
    Medizinische Klinik 01/2001; 96(4):212-216. · 0.34 Impact Factor
  • D Apel, J F Riemann
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    ABSTRACT: The need for emergency endoscopy is a matter of debate. The time interval for emergency procedures remains to be defined. Most authors propose a time span of 24 h as emergency time, while some define a period of 72 h (especially in acute pancreatitis). Several studies have shown a possible benefit for a select group of patients. Four main indications are established for emergency endoscopy: acute gastrointestinal bleeding (variceal and nonvariceal), acute biliary pancreatitis and acute cholangitis. In the case of upper gastrointestinal bleeding, emergency endoscopy enables exact diagnosis and appropriate therapy, and provides important prognostic information. There is some evidence that emergent endoscopic injection therapy improves clinical outcome and reduces mortality in patients with acute ulcer bleeding. Patients do not benefit if endoscopy is performed only as a diagnostic procedure. Controversial results were published recently for emergency endoscopy in acute biliary pancreatitis. There is good evidence that emergency endoscopic retrograde cholangiopancreatography is helpful in patients with severe pancreatitis and stone impaction if performed within the first 24 h after onset of symptoms. However, emergency endoscopic retrograde cholangiopancreatography is not beneficial for patients with mild pancreatitis if performed later than 72 h (or 24 h) after onset of symptoms. There is a limited number of well established evidence-based indications for emergency endoscopy. Some other indications are still a matter of debate, and controversial opinions have been published.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 04/2000; 14(3):199-203. · 1.53 Impact Factor
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    ABSTRACT: A 75-year-old man with right upper quadrant abdominal pain was diagnosed by gastroscopy to have an impacted gallstone in the duodenal bulb. Using the polypectomy loop, the stone was extracted from the bulbus and mobilized into the stomach. After failure to remove the stone from the stomach as well as fragmentation by mechanical lithotripsy, electrohydraulic lithotripsy was used to break up the stone, parts of which passed spontaneously through the bowel. Thus, it was unnecessary to proceed with surgical enterolithotomy to remove, from the duodenal bulb, the impacted gallstone responsible for the gastric outlet obstruction.
    Italian journal of gastroenterology and hepatology 01/2000; 31(9):876-9.

Publication Stats

276 Citations
44.41 Total Impact Points

Institutions

  • 2000–2005
    • Klinikum Ludwigshafen
      Ludwigshafen, Rheinland-Pfalz, Germany
  • 2004
    • Johannes Gutenberg-Universität Mainz
      • III. Department of Medicine
      Mayence, Rheinland-Pfalz, Germany