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Pancreatic Neoplasms: HELP
Articles by Jeanin E. van Hooft
Based on 23 articles published since 2008
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Between 2008 and 2019, J. van Hooft wrote the following 23 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. 2017

Polkowski, Marcin / Jenssen, Christian / Kaye, Philip / Carrara, Silvia / Deprez, Pierre / Gines, Angels / Fernández-Esparrach, Gloria / Eisendrath, Pierre / Aithal, Guruprasad P / Arcidiacono, Paolo / Barthet, Marc / Bastos, Pedro / Fornelli, Adele / Napoleon, Bertrand / Iglesias-Garcia, Julio / Seicean, Andrada / Larghi, Alberto / Hassan, Cesare / van Hooft, Jeanin E / Dumonceau, Jean-Marc. ·Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland. · Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland. · Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany. · Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy. · Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. · Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain. · Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium. · Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy. · Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France. · Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal. · Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy. · Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France. · Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #28898917.

ABSTRACT: For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

2 Article The Dutch Pancreas Biobank Within the Parelsnoer Institute: A Nationwide Biobank of Pancreatic and Periampullary Diseases. 2018

Strijker, Marin / Gerritsen, Arja / van Hilst, Jony / Bijlsma, Maarten F / Bonsing, Bert A / Brosens, Lodewijk A / Bruno, Marco J / van Dam, Ronald M / Dijk, Frederike / van Eijck, Casper H / Farina Sarasqueta, Arantza / Fockens, Paul / Gerhards, Michael F / Groot Koerkamp, Bas / van der Harst, Erwin / de Hingh, Ignace H / van Hooft, Jeanin E / Huysentruyt, Clément J / Kazemier, Geert / Klaase, Joost M / van Laarhoven, Cornelis J / van Laarhoven, Hanneke W / Liem, Mike S / de Meijer, Vincent E / van Rijssen, L Bengt / van Santvoort, Hjalmar C / Suker, Mustafa / Verhagen, Judith H / Verheij, Joanne / Verspaget, Hein W / Wennink, Roos A / Wilmink, Johanna W / Molenaar, I Quintus / Boermeester, Marja A / Busch, Olivier R / Besselink, Marc G / Anonymous5040939. · ·Pancreas · Pubmed #29521943.

ABSTRACT: OBJECTIVES: Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank. METHODS: The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit. RESULTS: Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples. CONCLUSIONS: Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.

3 Article The clinical benefit of hyperthermia in pancreatic cancer: a systematic review. 2018

van der Horst, Astrid / Versteijne, Eva / Besselink, Marc G H / Daams, Joost G / Bulle, Esther B / Bijlsma, Maarten F / Wilmink, Johanna W / van Delden, Otto M / van Hooft, Jeanin E / Franken, Nicolaas A P / van Laarhoven, Hanneke W M / Crezee, Johannes / van Tienhoven, Geertjan. ·a Department of Radiation Oncology and Hyperthermia , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · b Department of Surgery , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · c Medical Library , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · d Laboratory for Experimental Oncology and Radiobiology (LEXOR) , Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · e Department of Medical Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · f Department of Radiology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. · g Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. ·Int J Hyperthermia · Pubmed #29168401.

ABSTRACT: OBJECTIVE: In pancreatic cancer, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of radio(chemo)therapy. The aim of this systematic review is to investigate the validity of the hypothesis that hyperthermia added to radiotherapy and/or chemotherapy improves treatment outcome for pancreatic cancer patients. METHODS AND MATERIALS: We searched MEDLINE and Embase, supplemented by handsearching, for clinical studies involving hyperthermia in pancreatic cancer patients. The quality of studies was evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Primary outcome was treatment efficacy; we calculated overall response rate and the weighted estimate of the population median overall survival (m RESULTS: Overall, 14 studies were included, with 395 patients with locally advanced and/or metastatic pancreatic cancer of whom 248 received hyperthermia. Patients were treated with regional (n = 189), intraoperative (n = 39) or whole-body hyperthermia (n = 20), combined with chemotherapy, radiotherapy or both. Quality of the studies was low, with level of evidence 3 (five studies) and 4. The six studies including a control group showed a longer m CONCLUSIONS: Hyperthermia, when added to chemotherapy and/or radiotherapy, may positively affect treatment outcome for patients with pancreatic cancer. However, the quality of the reviewed studies was limited and future randomised controlled trials are needed to establish efficacy.

4 Article Induction Chemotherapy Followed by Resection or Irreversible Electroporation in Locally Advanced Pancreatic Cancer (IMPALA): A Prospective Cohort Study. 2017

Vogel, Jantien A / Rombouts, Steffi J / de Rooij, Thijs / van Delden, Otto M / Dijkgraaf, Marcel G / van Gulik, Thomas M / van Hooft, Jeanin E / van Laarhoven, Hanneke W / Martin, Robert C / Schoorlemmer, Annuska / Wilmink, Johanna W / van Lienden, Krijn P / Busch, Olivier R / Besselink, Marc G. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, University of Louisville, Louisville, KY, USA. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #28560601.

ABSTRACT: BACKGROUND: Following induction chemotherapy, both resection or irreversible electroporation (IRE) may further improve survival in patients with locally advanced pancreatic cancer (LAPC). However, prospective studies combining these strategies are currently lacking, and available studies only report on subgroups that completed treatment. This study aimed to determine the applicability and outcomes of resection and IRE in patients with nonprogressive LAPC after induction chemotherapy. METHODS: This was a prospective, single-center cohort study in consecutive patients with LAPC (September 2013 to March 2015). All patients were offered 3 months of induction chemotherapy (FOLFIRINOX or gemcitabine depending on performance status), followed by exploratory laparotomy for resection or IRE in patients with Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 nonprogressive, IRE-eligible tumors. RESULTS: Of 132 patients with LAPC, 70% (n = 93) started with chemotherapy (46% [n = 61] FOLFIRINOX). After 3 months, 59 patients (64%) had nonprogressive disease, of whom 36 (27% of the entire cohort) underwent explorative laparotomy, resulting in 14 resections (11% of the entire cohort, 39% of the explored patients) and 15 IREs (11% of the entire cohort, 42% of the explored patients). After laparotomy, 44% (n = 16) of patients had Clavien-Dindo grade 3 or higher complications, and 90-day all-cause mortality was 11% (n = 4). With a median follow-up of 24 months, median overall survival after resection, IRE, and for all patients with nonprogressive disease without resection/IRE (n = 30) was 34, 16, and 15 months, respectively. The resection rate in 61 patients receiving FOLFIRINOX treatment was 20%. CONCLUSION: Induction chemotherapy followed by IRE or resection in nonprogressive LAPC led to resection or IRE in 22% of all-comers, with promising survival rates after resection but no apparent benefit of IRE, despite considerable morbidity. Registered at Netherlands Trial Register (NTR4230).

5 Article Prevalence and Progression of Pancreatic Cystic Precursor Lesions Differ Between Groups at High Risk of Developing Pancreatic Cancer. 2017

Konings, Ingrid C A W / Harinck, Femme / Poley, Jan-Werner / Aalfs, Cora M / van Rens, Anja / Krak, Nanda C / Wagner, Anja / Nio, C Yung / Sijmons, Rolf H / van Dullemen, Hendrik M / Vleggaar, Frank P / Ausems, Margreet G E M / Fockens, Paul / van Hooft, Jeanin E / Bruno, Marco J / Anonymous3550887. ·From the *Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam; †Department of Clinical Genetics, Academic Medical Center; and ‡Family Cancer Clinic Cancer Institute, Amsterdam; Departments of §Radiology and ∥Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam; ¶Department of Radiology, Academic Medical Center, Amsterdam; #Department of Genetics, University of Groningen, and **Department of Gastroenterology and Hepatology, University Medical Center, Groningen; Departments of ††Gastroenterology and Hepatology and ‡‡Clinical Genetics, University Medical Center, Utrecht; and §§Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands. ·Pancreas · Pubmed #27846136.

ABSTRACT: OBJECTIVES: The aim of this study was to compare the prevalence of cystic pancreatic lesions and their natural behavior in 2 distinct high-risk groups for developing pancreatic ductal adenocarcinoma (PDAC): (1) carriers of a mutation that predisposes to PDAC and (2) individuals without a known gene mutation but with a family history of PDAC (familial pancreatic cancer [FPC]). METHODS: Pancreatic surveillance by annual magnetic resonance imaging and endoscopic ultrasound was performed in individuals with an estimated lifetime risk of developing PDAC of 10% or greater. Progression of a lesion was defined as growth 4 mm or greater or the development of worrisome features. RESULTS: We included 186 individuals: 98 mutation carriers and 88 FPC individuals (mean follow-up, 51 months). Individuals with FPC were significantly more likely than mutation carriers to have a pancreatic cyst 10 mm or greater (16% vs 5%, P = 0.045). Pancreatic cysts detected in mutation carriers, however, were significantly more likely to progress than those in FPC individuals (16% vs 2%, P = 0.050). CONCLUSIONS: This study provides evidence that the prevalence and growth characteristics of pancreatic cysts differ between distinct high-risk groups: individuals with FPC have a higher prevalence of pancreatic cysts 10 mm or greater, whereas cysts in mutation carriers are more likely to progress. These observations may help to develop more optimally tailored surveillance strategies in specific high-risk populations.

6 Article Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome. 2017

Lekkerkerker, Selma J / Besselink, Marc G / Busch, Olivier R / Verheij, Joanne / Engelbrecht, Marc R / Rauws, Erik A / Fockens, Paul / van Hooft, Jeanin E. ·Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. ·Gastrointest Endosc · Pubmed #27693645.

ABSTRACT: BACKGROUND AND AIMS: Currently, 3 guidelines are available for the management of pancreatic cysts. These guidelines vary in their indication for resection of high-risk cysts. We retrospectively compared the final pathologic outcome of surgically removed pancreatic cysts with the indications for resection according to 3 different guidelines. METHODS: Patients who underwent pancreatic resection were extracted from our prospective pancreatic cyst database (2006-present). The final histopathologic diagnosis was compared with the initial indication for surgery stated by the guidelines of the International Association of Pancreatology (IAP), European Study Group on Cystic tumors of the Pancreas and American Gastroenterological Association (AGA). We considered surgery in retrospect justified for malignancy, high-grade dysplasia, solid pseudopapillary neoplasms, neuroendocrine tumors or symptom improvement. Furthermore, we evaluated the patients with suspected intraductal papillary mucinous neoplasm (IPMN) separately. RESULTS: Overall, 115 patients underwent pancreatic resection. The preoperative diagnosis was correct in 83 of 115 patients (72%) and differentiation between benign and premalignant in 99 of 115 patients (86%). In retrospect, surgery was justified according to the aforementioned criteria in 52 of 115 patients (45%). For patients with suspected IPMN (n = 75) resection was justified in 36 of 67 (54%), 36 of 68 (53%), and 32 of 54 (59%) of patients who would have had surgery based on the IAP, European, or AGA guidelines, respectively. The AGA guideline would have avoided resection in 21 of 75 (28%) patients, versus 8 of 75 (11%) and 7 of 75 (9%) when the IAP or European guideline would have been applied strictly. Nevertheless, 4 of 33 patients (12%) with high-grade dysplasia or malignancy would have been missed with the AGA guidelines, compared with none with the IAP or European guidelines. CONCLUSION: Although fewer patients undergo unnecessary surgery based on the AGA guidelines, the risk of missing malignancy or high-grade dysplasia with this guideline seems considerably high.

7 Article Factors associated with cancer worries in individuals participating in annual pancreatic cancer surveillance. 2017

Konings, Ingrid C A W / Harinck, Femme / Kuenen, Marianne A / Sidharta, Grace N / Kieffer, Jacobien M / Aalfs, Cora M / Poley, Jan-Werner / Smets, Ellen M A / Wagner, Anja / van Rens, Anja / Vleggaar, Frank P / Ausems, Margreet G E M / Fockens, Paul / van Hooft, Jeanin E / Bruno, Marco J / Bleiker, Eveline M A / Anonymous2720881. ·Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands. · Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands. · Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Clinical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, Amsterdam, The Netherlands. e.bleiker@nki.nl. · Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands. e.bleiker@nki.nl. ·Fam Cancer · Pubmed #27629874.

ABSTRACT: It is important to adequately and timely identify individuals with cancer worries amongst participants in a pancreatic ductal adenocarcinoma (PDAC) surveillance program, because they could benefit from psychosocial support to decrease distress. Therefore, the aim of this study was to assess both psychosocial and clinical factors associated with cancer worries. High-risk individuals participating in PDAC-surveillance were invited to annually complete a cancer worry scale (CWS) questionnaire which was sent after counseling by the clinical geneticist (T0), after intake for participation in PDAC-surveillance (T1), and then annually after every MRI and endoscopic ultrasonography (EUS) (T2 and further). Analyses were performed to identify factors associated with cancer worries in the second year of surveillance (T3). We found a significant intra-individual decrease in cancer worries (β = -0.84, P < 0.001), nevertheless, 33 % of individuals had a CWS-score ≥14 at T3. We found one factor significantly associated with cancer worries at T3: having a family member affected by PDAC <50 years of age (β = 0.22, P = 0.03). The detection of a cystic lesion, a shortened surveillance interval, or undergoing pancreatic surgery did not lead to more cancer worries (P = 0.163, P = 0.33, and P = 0.53, respectively). In conclusion, this study identified 'a family history of PDAC <50 years of age' as the only predictor of cancer worries experienced after 2 years of surveillance in individuals at high risk of developing PDAC. This knowledge could help clinicians to timely identify individuals 'at risk' for high levels of cancer worries who would likely benefit from psychosocial support.

8 Article Long-term follow-up of neoplastic pancreatic cysts without high-risk stigmata: how often do we change treatment strategy because of malignant transformation? 2016

Lekkerkerker, Selma J / Besselink, Marc G / Busch, Olivier R / Dijk, Frederike / Engelbrecht, Marc R / Rauws, Erik A / Fockens, Paul / van Hooft, Jeanin E. ·a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ; · b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands ; · c Department of Pathology , Academic Medical Center , Amsterdam , The Netherlands ; · d Department of Radiology , Academic Medical Center , Amsterdam , The Netherlands. ·Scand J Gastroenterol · Pubmed #27175891.

ABSTRACT: OBJECTIVE: Patients with potentially premalignant neoplastic pancreatic cysts without high-risk stigmata usually enter a surveillance program. Data on outcomes of such surveillance programs are scarce. We aimed to evaluate the resection rate and malignancy rate during follow-up. MATERIAL AND METHODS: From our prospective database (2006-2015) of patients with pancreatic cysts, we analyzed patients with pancreatic cysts without high-risk stigmata with at least six months follow-up. RESULTS: In total, 146 patients were followed for a median of 29 months (IQR 13.5-50 months). In 124 patients (84.9%), no changes in clinical or imaging characteristics occurred during follow-up. Thirteen patients (8.9%) developed an indication for surgery after a median follow-up of 25 months (IQR 12-42 months). Two patients did not undergo surgery because of comorbidity, 11 patients (7.5%) underwent resection. Indications for surgery were symptoms (n = 2), development of a pancreatic mass (n = 1), a new nodule (n = 2), thickened cyst wall (n = 1), pancreatic duct dilation (n = 3), and/or suspicion of mucinous cystic neoplasm (MCN) (n = 3). Postoperative histology showed one pancreatic malignancy not originating from the cyst, three mixed type-intraductal papillary mucinous neoplasm (IPMN), one side branch-IPMN, two MCN, one neuroendocrine tumor, one serous cystadenoma, one inflammatory cyst, and one lymphangioma. The highest grade of cyst dysplasia was borderline dysplasia. CONCLUSIONS: Most neoplastic pancreatic cysts without high-risk stigmata at initial presentation show no substantial change during 1-4-year follow-up. Only 7.5% of patients underwent surgery and less than 1% of patients developed pancreatic malignancy. This indicates that additional markers are needed to tailor treatment of pancreatic cysts.

9 Article Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. 2016

Lekkerkerker, Selma J / Nio, Chung Y / Issa, Yama / Fockens, Paul / Verheij, Joanne / Busch, Olivier R / van Gulik, Thomas M / Rauws, Erik A / Boermeester, Marja A / van Hooft, Jeanin E / Besselink, Marc G. ·Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·J Gastroenterol Hepatol · Pubmed #26997497.

ABSTRACT: BACKGROUND AND AIM: Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY: Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS: From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS: Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.

10 Article Repeated participation in pancreatic cancer surveillance by high-risk individuals imposes low psychological burden. 2016

Konings, Ingrid C A W / Sidharta, Grace N / Harinck, Femme / Aalfs, Cora M / Poley, Jan-Werner / Kieffer, Jacobien M / Kuenen, Marianne A / Smets, Ellen M A / Wagner, Anja / van Hooft, Jeanin E / van Rens, Anja / Fockens, Paul / Bruno, Marco J / Bleiker, Eveline M A. ·Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. · Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands. · Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands. ·Psychooncology · Pubmed #26632416.

ABSTRACT: BACKGROUND: When assessing the feasibility of surveillance for pancreatic cancer (PC), it is important to address its psychological burden. The aim of this ongoing study is to evaluate the psychological burden of annual pancreatic surveillance for individuals at high risk to develop PC. METHODS: This is a multicenter prospective study. High-risk individuals who undergo annual pancreatic surveillance with magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) were invited to complete questionnaires to assess motivations for participating in surveillance, experiences with participation, perceived PC risk, topics of concern, and psychological distress. Questionnaires were sent after intake for participation (T1), after the first MRI and EUS (T2), and after the MRI and EUS 1 (T3), 2 (T4), and 3 years (T5) after first surveillance. RESULTS: In total, 140 out of 152 individuals returned one or more of the questionnaires (response 92%); 477 questionnaires were analyzed. The most frequently reported motivation for participating in surveillance was the possible early detection of (a precursor stage of) cancer (95-100%). Only a minority of respondents experienced MRI and EUS as uncomfortable (10% and 11%, respectively), and respondents dreaded their next EUS investigation less as surveillance progressed. Respondents' cancer worries decreased significantly over time, and both their anxiety and depression scores remained stable and low over the 3-year period of follow-up. CONCLUSIONS: The psychological burden of pancreatic surveillance is low at all assessments. Therefore, from a psychological point of view, participation of high-risk individuals in an annual pancreatic surveillance program is feasible.Copyright © 2015 John Wiley & Sons, Ltd.

11 Article Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. 2016

Tol, J A M G / van Hooft, J E / Timmer, R / Kubben, F J G M / van der Harst, E / de Hingh, I H J T / Vleggaar, F P / Molenaar, I Q / Keulemans, Y C A / Boerma, D / Bruno, M J / Schoon, E J / van der Gaag, N A / Besselink, M G H / Fockens, P / van Gulik, T M / Rauws, E A J / Busch, O R C / Gouma, D J. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. · Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands. ·Gut · Pubmed #26306760.

ABSTRACT: INTRODUCTION: In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. METHODS: A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. RESULTS: 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. CONCLUSIONS: For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. TRIAL REGISTRATION NUMBER: Dutch Trial Registry (NTR3142).

12 Article A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. 2016

Harinck, F / Konings, I C A W / Kluijt, I / Poley, J W / van Hooft, J E / van Dullemen, H M / Nio, C Y / Krak, N C / Hermans, J J / Aalfs, C M / Wagner, A / Sijmons, R H / Biermann, K / van Eijck, C H / Gouma, D J / Dijkgraaf, M G W / Fockens, P / Bruno, M J / Anonymous4380830. · ·Gut · Pubmed #25986944.

ABSTRACT: OBJECTIVE: Endoscopic ultrasonography (EUS) and MRI are promising tests to detect precursors and early-stage pancreatic ductal adenocarcinoma (PDAC) in high-risk individuals (HRIs). It is unclear which screening technique is to be preferred. We aimed to compare the efficacy of EUS and MRI in their ability to detect clinically relevant lesions in HRI. DESIGN: Multicentre prospective study. The results of 139 asymptomatic HRI (>10-fold increased risk) undergoing first-time screening by EUS and MRI are described. Clinically relevant lesions were defined as solid lesions, main duct intraductal papillary mucinous neoplasms and cysts ≥10 mm. Results were compared in a blinded, independent fashion. RESULTS: Two solid lesions (mean size 9 mm) and nine cysts ≥10 mm (mean size 17 mm) were detected in nine HRI (6%). Both solid lesions were detected by EUS only and proved to be a stage I PDAC and a multifocal pancreatic intraepithelial neoplasia 2. Of the nine cysts ≥10 mm, six were detected by both imaging techniques and three were detected by MRI only. The agreement between EUS and MRI for the detection of clinically relevant lesions was 55%. Of these clinically relevant lesions detected by both techniques, there was a good agreement for location and size. CONCLUSIONS: EUS and/or MRI detected clinically relevant pancreatic lesions in 6% of HRI. Both imaging techniques were complementary rather than interchangeable: contrary to EUS, MRI was found to be very sensitive for the detection of cystic lesions of any size; MRI, however, might have some important limitations with regard to the timely detection of solid lesions.

13 Article Visibility and artifacts of gold fiducial markers used for image guided radiation therapy of pancreatic cancer on MRI. 2015

Gurney-Champion, Oliver J / Lens, Eelco / van der Horst, Astrid / Houweling, Antonetta C / Klaassen, Remy / van Hooft, Jeanin E / Stoker, Jaap / van Tienhoven, Geertjan / Nederveen, Aart J / Bel, Arjan. ·Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands and Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands and Laboratory for Experimental Oncology and Radiobiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Gastroenterology & Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. ·Med Phys · Pubmed #25979055.

ABSTRACT: PURPOSE: In radiation therapy of pancreatic cancer, tumor alignment prior to each treatment fraction is improved when intratumoral gold fiducial markers (from here onwards: markers), which are visible on computed tomography (CT) and cone beam CT, are used. Visibility of these markers on magnetic resonance imaging (MRI) might improve image registration between CT and magnetic resonance (MR) images for tumor delineation purposes. However, concomitant image artifacts induced by markers are undesirable. The extent of visibility and artifact size depend on MRI-sequence parameters. The authors' goal was to determine for various markers their potential to be visible and to generate artifacts, using measures that are independent of the MRI-sequence parameters. METHODS: The authors selected ten different markers suitable for endoscopic placement in the pancreas and placed them into a phantom. The markers varied in diameter (0.28-0.6 mm), shape, and iron content (0%-0.5%). For each marker, the authors calculated T2 (∗)-maps and ΔB0-maps using MRI measurements. A decrease in relaxation time T2 (∗) can cause signal voids, associated with visibility, while a change in the magnetic field B0 can cause signal shifts, which are associated with artifacts. These shifts inhibit accurate tumor delineation. As a measure for potential visibility, the authors used the volume of low T2 (∗), i.e., the volume for which T2 (∗) differed from the background by >15 ms. As a measure for potential artifacts, the authors used the volume for which |ΔB0| > 9.4 × 10(-8) T (4 Hz). To test whether there is a correlation between visibility and artifact size, the authors calculated the Spearman's correlation coefficient (Rs) between the volume of low T2 (∗) and the volume of high |ΔB0|. The authors compared the maps with images obtained using a clinical MR-sequence. Finally, for the best visible marker as well as the marker that showed the smallest artifact, the authors compared the phantom data with in vivo MR-images in four pancreatic cancer patients. RESULTS: The authors found a strong correlation (Rs = 1.00, p < 0.01) between the volume of low T2 (∗) and the volume with high |ΔB0|. Visibility in clinical MR-images increased with lower T2 (∗). Signal shift artifacts became worse for markers with high |ΔB0|. The marker that was best visible in the phantom, a folded marker with 0.5% iron content, was also visible in vivo, but showed artifacts on diffusion weighted images. The marker with the smallest artifact in the phantom, a small, stretched, ironless marker, was indiscernible on in vivo MR-images. CONCLUSIONS: Changes in T2 (∗) and ΔB0 are sequence-independent measures for potential visibility and artifact size, respectively. Improved visibility of markers correlates strongly to signal shift artifacts; therefore, marker choice will depend on the clinical purpose. When visibility of the markers is most important, markers that contain iron are optimal, preferably in a folded configuration. For artifact sensitive imaging, small ironless markers are best, preferably in a stretched configuration.

14 Article Limited role for biliary stent as surrogate fiducial marker in pancreatic cancer: stent and intratumoral fiducials compared. 2014

van der Horst, Astrid / Lens, Eelco / Wognum, Silvia / de Jong, Rianne / van Hooft, Jeanin E / van Tienhoven, Geertjan / Bel, Arjan. ·Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: a.vanderhorst@amc.uva.nl. · Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·Int J Radiat Oncol Biol Phys · Pubmed #24803041.

ABSTRACT: PURPOSE: Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. METHODS AND MATERIALS: Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). RESULTS: The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, -2.6 to 4.2 mm). CONCLUSIONS: For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including patients with a biliary stent.

15 Article Differences in respiratory-induced pancreatic tumor motion between 4D treatment planning CT and daily cone beam CT, measured using intratumoral fiducials. 2014

Lens, Eelco / van der Horst, Astrid / Kroon, Petra S / van Hooft, Jeanin E / Dávila Fajardo, Raquel / Fockens, Paul / van Tienhoven, Geertjan / Bel, Arjan. ·Department of Radiation Oncology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands. ·Acta Oncol · Pubmed #24758251.

ABSTRACT: BACKGROUND: In radiotherapy, the magnitude of respiratory-induced tumor motion is often measured using a single four-dimensional computed tomography (4DCT). This magnitude is required to determine the internal target volume. The aim of this study was to compare the magnitude of respiratory-induced motion of pancreatic tumors on a single 4DCT with the motion on daily cone beam CT (CBCT) scans during a 3-5-week fractionated radiotherapy scheme. In addition, we investigated changes in the respiratory motion during the treatment course. MATERIAL AND METHODS: The mean peak-to-peak motion (i.e. magnitude of motion) of pancreatic tumors was measured for 18 patients using intratumoral gold fiducials visible on CBCT scans made prior to each treatment fraction (10-27 CBCTs per patient; 401 CBCTs in total). For each patient, these magnitudes were compared to the magnitude measured on 4DCT. Possible time trends were investigated by applying linear fits to the tumor motion determined from daily CBCTs as a function of treatment day. RESULTS: We found a significant (p ≤ 0.01) difference between motion magnitude on 4DCT and on CBCT in superior-inferior, anterior-posterior and left-right direction, in 13, 9 and 12 of 18 patients, respectively. In the anterior- posterior and left-right direction no fractions had a difference ≥ 5 mm. In the superior-inferior direction the difference was ≥ 5 mm for 17% of the 401 fractions. In this direction, a significant (p ≤ 0.05) time trend in tumor motion was observed in 4 of 18 patients, but all trends were small (- 0.17-0.10 mm/day) and did not explain the large differences in motion magnitude between 4DCT and CBCT. CONCLUSION: A single measurement of the respiratory-induced motion magnitude of pancreatic tumors using 4DCT is often not representative for the magnitude during daily treatment over a 3-5-week radiotherapy scheme. For this patient group it may be beneficial to introduce breath-hold to eliminate respiratory-induced tumor motion.

16 Article EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. 2014

Dávila Fajardo, Raquel / Lekkerkerker, Selma J / van der Horst, Astrid / Lens, Eelco / Bergman, Jacques J / Fockens, Paul / Bel, Arjan / van Hooft, Jeanin E. ·Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·Gastrointest Endosc · Pubmed #24518121.

ABSTRACT: -- No abstract --

17 Article Interfractional position variation of pancreatic tumors quantified using intratumoral fiducial markers and daily cone beam computed tomography. 2013

van der Horst, Astrid / Wognum, Silvia / Dávila Fajardo, Raquel / de Jong, Rianne / van Hooft, Jeanin E / Fockens, Paul / van Tienhoven, Geertjan / Bel, Arjan. ·Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.vanderhorst@amc.uva.nl ·Int J Radiat Oncol Biol Phys · Pubmed #23790774.

ABSTRACT: PURPOSE: The aim of this study was to quantify interfractional pancreatic position variation using fiducial markers visible on daily cone beam computed tomography (CBCT) scans. In addition, we analyzed possible migration of the markers to investigate their suitability for tumor localization. METHODS AND MATERIALS: For 13 pancreatic cancer patients with implanted Visicoil markers, CBCT scans were obtained before 17 to 25 fractions (300 CBCTs in total). Image registration with the reference CT was used to determine the displacement of the 2 to 3 markers relative to bony anatomy and to each other. We analyzed the distance between marker pairs as a function of time to identify marker registration error (SD of linear fit residuals) and possible marker migration. For each patient, we determined the mean displacement of markers relative to the reference CT (systematic position error) and the spread in displacements (random position error). From this, we calculated the group systematic error, Σ, and group random error, σ. RESULTS: Marker pair distances showed slight trends with time (range, -0.14 to 0.14 mm/day), possibly due to tissue deformation, but no shifts that would indicate marker migration. The mean SD of the fit residuals was 0.8 mm. We found large interfractional position variations, with for 116 of 300 (39%) fractions a 3-dimensional vector displacement of >10 mm. The spread in displacement varied significantly (P<.01) between patients, from a vector range of 9.1 mm to one of 24.6 mm. For the patient group, Σ was 3.8, 6.6, and 3.5 mm; and σ was 3.6, 4.7 and 2.5 mm, in left-right, superior-inferior, and anterior-posterior directions, respectively. CONCLUSIONS: We found large systematic displacements of the fiducial markers relative to bony anatomy, in addition to wide distributions of displacement. These results for interfractional position variation confirm the potential benefit of using fiducial markers rather than bony anatomy for daily online position verification for pancreatic cancer patients.

18 Article Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. 2012

de Jong, Koen / van Hooft, Jeanin E / Nio, C Yung / Gouma, Dirk J / Dijkgraaf, Marcel G W / Bruno, Marco J / Fockens, Paul. ·Department of Gastroenterology & Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ·Scand J Gastroenterol · Pubmed #22571417.

ABSTRACT: BACKGROUND: Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are considered useful techniques in the evaluation of pancreatic cysts. Aim of this study was to prospectively compare the diagnostic value of these techniques. METHODS: This study included consecutive patients who underwent MRI, EUS, and EUS-FNA for a pancreatic cyst that was eventually resected surgically. Observers scored for cyst characteristics, a distinction between mucinous and non-mucinous cysts and a suspicion of malignancy. The interobserver agreement between MRI and EUS was calculated. RESULTS: A total of 32 patients were included. Sensitivity for diagnosing a mucinous cyst was 78% for EUS versus 91% for MRI. Sensitivity for detecting malignancy was 25% (1/4) and 50% (2/4) for EUS and MRI respectively. Sensitivity of EUS-FNA for diagnosing a mucinous cyst (positive cytology and/or CEA >192 ng/ml) was 61%. Sensitivity for detecting malignancy (positive cytology) was 1/4 (25%). Interobserver agreement between MRI and EUS for the features was poor to fair. CONCLUSION: MRI and EUS are comparable techniques for the morphological characterization of pancreatic cysts. Combined sensitivity of EUS and MRI was higher than the sensitivity of one of the techniques alone. For diagnosing a mucinous cyst, FNA findings showed a low sensitivity, but a high specificity.

19 Article Feasibility of a pancreatic cancer surveillance program from a psychological point of view. 2011

Harinck, Femme / Nagtegaal, Tanja / Kluijt, Irma / Aalfs, Cora / Smets, Ellen / Poley, Jan-Werner / Wagner, Anja / van Hooft, Jeanin / Fockens, Paul / Bruno, Marco / Bleiker, Eveline M A. ·Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam. ·Genet Med · Pubmed #21857231.

ABSTRACT: PURPOSE: : The success of any surveillance program depends not solely on its technological aspects but also on the commitment of participants to adhere to follow-up investigations, which is influenced by the psychological impact of surveillance. This study investigates the psychological impact of participating in a pancreatic cancer surveillance program. METHODS: : High-risk individuals participating in an endoscopic ultrasonography-magnetic resonance imaging-based pancreatic cancer surveillance program received a questionnaire assessing experiences with endoscopic ultrasonography and magnetic resonance imaging, reasons to participate, psychological distress, and benefits and barriers of surveillance. High-risk individuals were individuals with a strong family history of pancreatic cancer or carriers of pancreatic cancer-prone gene mutations. RESULTS: : Sixty-nine participants (85%) completed the questionnaire. Surveillance was reported as "very to extremely uncomfortable" by 15% for magnetic resonance imaging and 14% for endoscopic ultrasonography. Most reported reason to participate was that pancreatic cancer might be detected in a curable stage. Abnormalities were detected in 27 respondents, resulting in surgical resection in one individual and a shorter follow-up interval in five individuals. Surveillance outcomes did not influence cancer worries. Overall, 29% was "often" or "almost always" concerned about developing cancer. Six respondents (9%) had clinical levels of depression and/or anxiety. According to 88% of respondents, advantages of surveillance outweighed disadvantages. CONCLUSIONS: : Although endoscopic ultrasonography is more invasive than magnetic resonance imaging, endoscopic ultrasonography was not perceived as more burdensome. Despite one third of respondents worrying frequently about cancer, this was not related to the surveillance outcomes. Anxiety and depression levels were comparable with the general population norms. Advantages of participation outweighed disadvantages according to the majority of respondents. From a psychological point of view, pancreatic cancer surveillance in high-risk individuals is feasible and justified.

20 Article Predictors of survival in patients with malignant gastric outlet obstruction: a patient-oriented decision approach for palliative treatment. 2011

Jeurnink, Suzanne M / Steyerberg, Ewout W / Vleggaar, Frank P / van Eijck, Casper H J / van Hooft, Jeanin E / Schwartz, Matthijs P / Kuipers, Ernst J / Siersema, Peter D / Anonymous5130688. ·Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. s.m.jeurnink@students.uu.nl ·Dig Liver Dis · Pubmed #21376680.

ABSTRACT: BACKGROUND: Gastrojejunostomy and stentplacement are the most commonly used treatments for malignant gastric outlet obstruction (GOO). The preference for either treatment largely depends on the expected survival. Our objective was to investigate predictors of survival in patients with malignant GOO and to develop a model that could aid in the decision for either gastrojejunostomy or stentplacement. METHODS: Prognostic factors for survival were collected from a literature search and evaluated in our patient population, which included 95 retrospectively and 56 prospectively followed cases. All 151 patients were treated with gastrojejunostomy or stentplacement. RESULTS: A higher WHO performance score was the only significant prognostic factor for survival in our multivariable analysis (HR 2.2 95%CI 1.7-2.9), whereas treatment for obstructive jaundice, gender, age, metastases, weight loss, level of obstruction and pancreatic cancer were not. A prognostic model that includes the WHO score was able to distinguish patients with a poor survival (WHO score 3-4, median survival: 31 days) from those with a relatively intermediate or good survival (WHO score 2, median survival: 69 and WHO score 0-1, median survival: 139 days, respectively). CONCLUSIONS: Only the WHO score is a significant predictor of survival in patients with malignant GOO. A simple prognostic model is able to guide the palliative treatment decision for either gastrojejunostomy (WHO score 0-1) or stentplacement (WHO 3-4) in patients with malignant GOO.

21 Article Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. 2010

van Hooft, Jeanin E / Vleggaar, Frank P / Le Moine, Olivier / Bizzotto, Alessandra / Voermans, Rogier P / Costamagna, Guido / Devière, Jacques / Siersema, Peter D / Fockens, Paul. ·Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. j.e.vanhooft@amc.nl ·Gastrointest Endosc · Pubmed #20656288.

ABSTRACT: BACKGROUND: Palliation of malignant gastric outlet obstruction remains challenging. Although there are 2 established treatment options, ie, surgical gastrojejunostomy and endoscopic duodenal stent insertion, there is an ongoing search for a technique that would combine the safety and rapid effect of duodenal stent placement with the long-term efficacy and low reintervention rate of a surgical gastrojejunostomy. OBJECTIVE: To investigate the safety and success rate of endoscopic creation of a gastroenteric anastomosis formed by magnetic compression and stent placement. DESIGN: Prospective, multicenter cohort study. SETTING: Four referral centers. PATIENTS: The expected number of patients with symptomatic malignant gastric outlet obstruction to be included at the participating hospitals during a year was 40. Because of a serious adverse device event, the study was terminated after inclusion of 18 patients. INTERVENTION: Creation of an endoscopic gastroenteric anastomosis by using the Cook Magnetic Anastomosis Device with transanastomotic deployment of a self-expandable stent. MAIN OUTCOME MEASUREMENTS: Primary endpoints were safety and success rate associated with the creation of an endoscopic gastrojejunostomy by using a magnetic anastomotic device with transanastomotic deployment of a self-expandable stent. RESULTS: Because of a serious adverse event, the study was terminated prematurely. A success rate of 66.7% (12 of 18 patients) was achieved; 1 serious adverse event (stent perforation) occurred leading to the death of the patient. Three patients (25%) experienced an adverse device effect (stent migration). LIMITATIONS: Small sample size, lack of a control group. CONCLUSION: Endoscopic creation of a gastroenteric anastomosis by magnetic compression is feasible and safe; however, the necessity of a stent led to serious morbidity and even mortality in this study. The current system can therefore not be recommended for clinical use.

22 Article Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. 2009

van Hooft, Jeanin E / Uitdehaag, Madeleen J / Bruno, Marco J / Timmer, Robin / Siersema, Peter D / Dijkgraaf, Marcel G W / Fockens, Paul. ·Academic Medical Center, Amsterdam, Netherlands. j.e.vanhooft@amc.nl ·Gastrointest Endosc · Pubmed #19152912.

ABSTRACT: BACKGROUND: Gastric outlet obstruction (GOO) is most commonly a complication of advanced distal gastric, periampullary, or duodenal malignancy. Palliation of obstruction is the primary aim of treatment in most of these patients. Self-expandable metal stents have emerged as an effective treatment option. OBJECTIVE: Our purpose was to investigate the efficacy and safety of a newly developed enteral metal stent (WallFlex). DESIGN: Prospective multicenter cohort study. SETTING: Three tertiary referral centers (2 academic). PATIENTS: Fifty-one consecutive patients with symptomatic malignant GOO from January 2005 to February 2006. INTERVENTION: Placement of a self-expandable metallic stent (WallFlex). MAIN OUTCOME MEASUREMENTS: The primary end point was defined as improvement of the GOO scoring system for the remainder of the patients' lives. Secondary end points focused on efficacy and safety and global quality of life. RESULTS: The Gastric Outlet Obstruction Scoring System score improved (P < .001), the body mass index decreased (P < .001), and the World Health Organization performance score improved (P = .002) when the score before stenting was compared with the mean score until death. Global quality of life did not improve. Technical and clinical success was achieved in 98% and 84% of the patients. Median survival was 62 days (75% alive at 35 days, 25% alive at 156 days). Median stent patency was 307 days (75% functional at 135 days, 25% functional at 470 days). Stent dysfunction was proved in 7 patients (14%), migration in 1 (2%), and tumor overgrowth or ingrowth in 6 (12%). LIMITATIONS: Lack of a control group. CONCLUSION: Placement of a WallFlex enteral stent in patients with nonresectable malignant GOO is safe and provides a statistically significant and clinically relevant relief of obstructive symptoms with a low need for reintervention.

23 Minor Response:. 2014

Lekkerkerker, Selma J / van der Horst, Astrid / Lens, Eelco / Fajardo, Raquel Dávila / van Hooft, Jeanin E. ·Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·Gastrointest Endosc · Pubmed #25127953.

ABSTRACT: -- No abstract --