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THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK CONTENTS NEWS & MANAGEMENT 1-7 LABORATORY 8-13 INFECTION CONTROL 14-15 DIABETES 16-17 RADIOLOGY 18-21 ULTRASOUND 22 CARDIOLOGY 23 www.healthcare-in-europe.com V O L 2 4 I S S U E 3 / 1 5 • J U N E / J U LY 2 0 1 5 Report: Juliane Dannert For many people a cancer diagnosis means little chance of a cure and con- siderable limitations to life, as they know it. However, many patients, particularly those with gastro-intes- tinal cancers, can be helped by early detection. In the future, this will possibly also apply to Type 2 diabetics, of which there are more than seven million in Germany alone. During our interview with internationally renowned endoscopist Professor Horst Neuhaus, Senior Consultant for Internal Medicine at the Evangelical Hospital in Dusseldorf, he spoke of innova- tions in digital endoscopic imag- ing technology that are used to improve diagnosis and treatment for patients. Figures from the German Cancer Research Centre show that the coun- try’s cancer mortality rate has been decreasing over recent years. One reason for this are improvements in early detection, for instance of colon cancer. Almost one in three screen- ings reveals patient polyps, Neuhaus explained. ‘The more thoroughly a doctor examines, the more he will find and the lower the risk of the patient developing cancer, despite a colonoscopy. ‘One quality criterion for the examination procedure is the ade- noma detection rate. It quantifies the frequency with which a doctor discovers an adenoma during an endoscopic examination. For people aged 50 and over, this, as confirmed by studies, should be over 15% for women and more than 25% for men.’ Quality reflects experience Modern and innovative endoscopes, as well as the endoscopist’s expe- rience, are critical for successful intestine and therefore disconnects the duodenum, not only lose weight but also that their diabetes improves. One of the reasons for this appears early detection, Neuhaus said. ‘In my view, the quality of the endoscopist is one of the most important criteria. A high resolution endoscope is necessary but cannot compensate for a bad endoscopist.’ The adenoma detection rate is a good quality criterion to assess a doctor’s work in colon cancer prevention. ‘In other areas, such as endoscopic interventions in the oesophagus, things become more complex. In Germany, any doctor, even those who have only limited experience with therapeutic endos- copy are at liberty to do advanced procedures,’ he said. ‘It would defi- nitely be in the interest of patients and health insurers to keep a tighter rein on the quality of these interven- tions because, mostly, they represent a gentler alter- native to surgery.’ Neuhaus believes that the increasing use of the latest endo- scopic procedures clearly improves the prognosis for patients along with the quality of treatment. At the same time, however, the respective responsibilities in medicine shift. One example of this is microscopic endoscopy: ‘If you carry out an MRI scan in a 60- to 70-year-old patient you will discover cysts in the pan- creas in about 10% of the cases. Not all of these will be malignant of course, but it is not always possible to determine this with certainty in individual cases. The risk however can be assessed with modern endo- sonographic procedures, such as contrast-enhanced ultrasound, or a cyst puncture to analyse the content. In selected cases in the context of studies this latter technique involves insertion of an ultra-thin catheter into the cyst. This allows us to pro- duce endomicroscopic images with a resolution equivalent to what the pathologist sees under the micro- scope, i.e. current data indicate that we can diagnose safely and can clas- sify our findings as malignant or not. ‘However, it doesn’t always have to be endomicroscopy.’ The new, high-resolution endoscopes are helpful in the early detection of cancer of the digestive tract because we have long-standing training in the recognition of changes to the structure of mucosa and vessels; the key word here being neo-angio- genesis.’ For Neuhaus and team the endoscope offers a gentle method to complement biop- sies with interventional imaging diagnostics. ‘When the image has been produced it obviously needs to be assessed. Studies and Working Groups that classify the images, and pathology colleagues who take a look at the images, are helpful here. ‘Cooperation with colleagues is very important because, in early stages of cancer in different organs, including the oesophagus, stomach, pancreas and others, there’s always a certain percentage of patients who will have to undergo surgery. The patient benefits from the fact that we can offer everything in one location.’ Diabetes – a new area for endoscopy The teamwork also continues with diabetologists, with whom Neuhaus, in partnership with the medical technology industry and in the con- text of international multi-centre tri- als, is working on a new procedure to treat Type 2 diabetics. ‘‘Half of all diabetic patients have a raised HbA1c level. We know that patients with a gastric bypass, where the surgeon connects the remaining part of the stomach with the small Endoscopy jumps the boundaries‘Health insurers should keep a tighter rein on the quality of endoscopic interventions because, mostly, they represent a gentler alternative to surgery,’ asserts international expert Horst Neuhaus, during an EH interview with Daniela Zimmermann. LABORATORY 8-13 • New blood collection device avoids haemolysis • Developing POCTs for out-patient care • Wanted: WHO reforms and high security labs CARDIOLOGY 23 • Six international studies unani- mously endorse thrombectomy • Super-smart mobile will support implants patients Senior Consultant of the Medical Clinical at the Evangelical Hospital Dusseldorf since 1995, Professor Horst Neuhaus MD has his scientific and clinical focus set on diagnosis and treatment of particularly early cancer stages of the intestinal tract, diseases of the biliary tract and pancreas, as well as diagnostic and therapeutic endoscopy. He is involved in several inter- national studies in close cooperation with German and international centres and hospitals. He also hosts the International Endoscopy Symposium in Dusseldorf, considered one of the world’s largest and most important congresses within the discipline. Continued on page 8 V O L 24 I S S U E 3 / 15 • J U N E / J U LY 2015

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