Forschung, Kooperation & Studien

Wir nehmen an wissenschaftlichen Studien teil. Wir wollen damit unseren Beitrag zur Erweiterung des medizinischen Wissens im Bereich der sogenannten Versorgungsforschung leisten. 

Unabhängig hiervon besteht eine enge Kooperation sowohl mit den entsprechenden Fachabteilungen der Charité als auch ausgewählten Berliner Spezialkliniken. Besonders zu erwähnen ist, dass wir die bei unseren Untersuchungen entnommenen Gewebeproben in eine spezialisierte Fachabteilung für Gastropathologie versenden, wodurch eine hohe Qualität bei der Begutachtung unserer Proben sichergestellt ist.

Viele endoskopische Untersuchungen bedürfen einer technischen Ausstattung und Überwachungsmöglichkeiten, die nur in Kliniken vorhanden und sinnvoll sind. Im Besonderen zu nennen sind Untersuchungen und Eingriffe an den Gallenwegen und der Bauchspeicheldrüse (ERCP), die Beseitigung von Engstellen durch Dilatation, Bougierung oder das Einbringen sogenannter Stents, die Verödung von Krampfadern der Speiseröhre, das Legen von Ernährungssonden (PEG, PEJ), der endoskopische Ultraschall (Endosonographie) und weitere. In Kooperation mit ausgewählten Partnerkliniken führen wir, falls Sie dies wünschen, derartige Eingriffe selbst in den Kliniken durch und begleiten Sie so auch persönlich während des stationären Aufenthalts weiter.

In diesem Zusammenhang auch interessant:​

Original article

Second-generation distal attachment cuff for adenoma detection in screening colonoscopy: a randomized multicenter study

Alireza Aminalai MD Wolfgang Spitz MD Ulrich Möhler MD Frank Heller MD Rüdiger Ber ndt MD CordulaBartel-Kowalski MD Katrin Niemax MD Wolfgang Burmeister MD Guido Schachschal MD
Background and Aims

Randomized studies have demonstrated that a distal attachment cap with rubber side arms, the Endocuff Vision (ECV; Olympus America, Center Valley, Pa, USA), increased colonoscopic adenoma detection rate (ADR) in various mixed patient collectives. This is the first study to evaluate its use in a primary colonoscopic screening program.

Methods

Patients over age 55 years undergoing screening colonoscopy in 9 German private offices in Berlin and Hamburg were randomized to either the study group using ECV or the control group using high-definition colonoscopies (standard of care). The main outcome parameter was ADR, whereas secondary outcomes were detection rates of all adenomas per colonoscopy (APCs), of adenoma subgroups, and of hyperplastic polyps.

Results

Of 1416 patients (mean age, 61.1 years; 51.8% women), with a median of 41 examinations per examiner (n = 23; interquartile range, 12-81), 700 were examined with ECV and 716 without. Adjusting for the effects of the colonoscopies, ADR was 39.5% (95% confidence interval [CI], 32.6%-46.3%) in the ECV group versus 32.2% (95% CI, 25.9%-38.6%) in the control group, which resulted in an increase of 7.2% (95% CI, 2.3%-12.2%; P = .004). The increase in ADR was mainly because of small polyps, with adjusted ADRs for adenomas <10 mm of 33.3% (95% CI, 26.5%-40.2%) for study patients versus 24.0% (95% CI, 18.2%-29.8%) for control patients (P < .001). APC was also significantly increased (.57 ECV vs .51 control subjects, P = .045).

Conclusions

A distal attachment cap with side arms significantly increased the ADR in patients undergoing primary colonoscopic screening. Because of the correlation of ADR and interval cancer, its use should be encouraged, especially in this setting. (Clinical trial registration number: NCT03442738.)

Methods

Between September 2017 and November 2020, patients undergoing screening colonoscopy in 9 private practices in Berlin and Hamburg with 23 experienced examiners (>1000 lifetime examinations) were included in the study; the median number of colonoscopies per physician was 41 (interquartile range, 12-81). All persons aged >55 years and capable of giving consent who voluntarily underwent a screening colonoscopy (screening is reimbursed by health insurance funds from age 55 years) were included.

Results

A total of 1416 patients were included in the study (51.8% women; mean age, 61.1 years) (Fig. 1), and patient and colonoscopy data are shown in Table 1. Cecal intubation was very high (99.8%), and bowel cleanliness was good (excellent/good in 94.8%). For bowel preparation the following solutions were used: 2 L polyethylene glycol plus ascorbic acid (72% of cases), 1 L polyethylene glycol plus ascorbic acid (9.5%), and natrium sulfate–based solutions (18.5%). No adverse events were encountered.

Discussion

In contrast to imaging techniques, mechanical methods such as caps or balloons have been shown to improve adenoma detection during colonoscopy performed for various indications.9,10 Although simple transparent caps do not seem to consistently increase adenoma yield,39 a special cap with soft side branches that flatten colonic folds on withdrawal, the EC, yields better results. Almost all randomized trials comparing this device with control subjects included mixed patient collectives (Table 4).14

 
 

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