Treatment of pancreatic cancer with stenosis via ERCP and bougienage in University Hospital of Ludwig Maximilian University of Munich

About the department

The Department of Gastroenterology and Hepatology at the University Hospital of the Ludwig Maximilian University of Munich offers a comprehensive range of medical services in its areas of specialization. The department's physicians provide preventive care, diagnostic services, and treatment for diseases of the digestive system, including liver, gallbladder, biliary tract, esophageal, and pancreatic conditions. An important focus for the department's medical team is the treatment of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. The specialists develop long-term, individualized treatment plans aimed at controlling inflammatory activity, alleviating symptoms, and preventing complications. The department also specializes in the diagnosis and management of gastrointestinal and liver tumors. Patients have access to a state-of-the-art Endoscopy Unit offering a wide range of diagnostic and therapeutic procedures: gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, enteroscopy, and endoscopic ultrasonography. The department is certified by the German Cancer Society (DKG) and is part of the Comprehensive Cancer Center Munich, which includes specialized centers for colorectal, pancreatic, gastric, and liver cancers. The Endoscopy Unit performs more than 12,000 procedures of varying complexity each year. Many of the department’s services are provided on an outpatient basis. When needed, inpatient care is provided in the department's 92 beds. Treatment options range from modern drug therapies to advanced endoscopic procedures, which often help patients avoid the need for surgery. Patient care is based on an interdisciplinary approach and personalized treatment tailored to each patient’s individual needs. The department is headed by Prof. Dr. med. Julia Mayerle.

The diagnosis and treatment of stomach diseases are among the department’s primary focuses. Patients with gastritis, gastric ulcers, and benign or malignant stomach tumors often receive medical care here. Since the symptoms of these diseases are usually non-specific – pain in the upper abdomen, loss of appetite, and nausea – the department's specialists take a thorough approach when examining patients to ensure accurate diagnoses. Gastritis and stomach ulcers are treated with acid-suppressing medication and, if Helicobacter pylori is detected, eradication therapy, supported by dietary adjustments. In rare cases, chronic gastritis can lead to precancerous lesions or malignancies. When detected early, these conditions can be treated effectively with endoscopic mucosal resection, endoscopic submucosal dissection, argon plasma coagulation, or radiofrequency ablation. All of these procedures are available in the department's state-of-the-art Endoscopy Unit. However, gastric cancer can be difficult to detect in the early stages due to its non-specific symptoms, which ultimately complicates the treatment process. The treatment strategy for advanced gastric malignancies includes a combination of surgery with pre- and postoperative chemotherapy, depending on the depth of invasion and potential lymph node involvement. If the tumor has metastasized, chemotherapy with palliative intent is employed. Additional measures for symptom relief, such as radiation therapy or stent placement, are provided in collaboration with various medical specialties when necessary.

The department's physicians also specialize in the treatment of esophageal diseases. Doctors have all the necessary resources to effectively treat gastroesophageal reflux disease, non-reflux esophagitis, esophageal motility disorders, esophageal varices, and esophageal tumors. Gastroesophageal reflux disease (GERD) is a chronic, recurrent condition caused by the backflow of acidic stomach contents into the esophagus. Gastroenterologists in the department thoroughly review the patient's medical history and perform an endoscopic assessment. Some patients additionally require functional diagnostic testing, including 24-hour pH-impedance testing and esophageal manometry. The severity of the pathology is the decisive factor in selecting a treatment strategy for gastroesophageal reflux disease. The primary goals of therapy are to alleviate symptoms and prevent complications. In the vast majority of cases, drug therapy alone is sufficient. Endoscopic procedures can be used to treat esophageal strictures and Barrett's esophagus (complications of GERD). In complex cases of gastroesophageal reflux disease, patients require surgery, which is performed in cooperation with abdominal surgeons. The department's doctors are highly experienced in treating esophageal varices, which develop as a result of portal hypertension, most often due to liver cirrhosis. The disease is dangerous because of the possibility of internal bleeding, which can be fatal. Because of this, patients need timely treatment. The first line of therapy involves taking individually prescribed medication. If this fails, the department's doctors often use endoscopic variceal ligation. It is important to note that this procedure often needs to be repeated several times at intervals of a few weeks.

Another important focus in the department's clinical work is the treatment of inflammatory bowel diseases. The two most common are Crohn's disease and ulcerative colitis. It is worth noting that ulcerative colitis is characterized by inflammation limited to the colon, while Crohn's disease can affect any part of the digestive tract. These conditions can manifest at any age – from early childhood to late adulthood. They cause a wide range of symptoms, such as bloody diarrhea, abdominal pain, weight loss, fatigue, and fever. The department's physicians develop personalized treatment plans for each patient, considering the specifics of their disease progression. This is because the inflammatory process can range from mild to extremely severe. Patients with mild cases mostly receive only pharmacological therapy during temporary exacerbations of the inflammatory process. Severe cases require long-term drug therapy combined with nutritional support to suppress the inflammation and control the disease. In cases of complications, doctors also perform endoscopic and surgical procedures. The treatment aims to control inflammation, alleviate symptoms, preserve bowel function, and prevent complications.

The department also has extensive experience in the treatment of liver diseases, the most common of which are hepatitis, cirrhosis, alcoholic liver disease, autoimmune liver diseases, liver failure, and liver cancer. The department's hepatologists also offer medical care for patients with bile duct diseases, such as primary sclerosing cholangitis, primary biliary cholangitis, and others. Liver diseases are mostly treated with a variety of medications. In cases of liver failure, liver transplantation may be the only effective method. This treatment option is provided in cooperation with the Department of Surgery, which specializes in organ transplant surgery. Patients with gallstones or bile duct strictures can benefit from endoscopic treatment, which may include mechanical or electrohydraulic lithotripsy, extracorporeal shock wave lithotripsy, bougienage, and balloon dilation. Inoperable bile duct strictures developing due to cancer can be treated with photodynamic therapy or radiofrequency ablation.

The department specializes in the diagnosis and treatment of the following diseases:

• Gastroenterology
  • Stomach diseases
    • Gastritis
    • Gastric ulcers
    • Gastric polyps
    • Gastric lipomas
    • Gastric leiomyomas
    • Gastric cancer
    • Gastric MALT lymphoma
    • Gastrointestinal stromal tumors (GIST)
  • Esophageal diseases
    • Gastroesophageal reflux disease (GERD)
    • Non-reflux esophagitis
    • Esophageal motility disorders
    • Esophageal varices
    • Benign and malignant tumors of the esophagus
  • Pancreatic diseases
    • Acute and chronic pancreatitis
    • Autoimmune pancreatitis
    • Pancreatic cysts
    • Pancreatic cancer
  • Bowel diseases
    • Inflammatory bowel diseases: Crohn's disease and ulcerative colitis
    • Celiac disease
    • Short bowel syndrome
  • Infectious gastrointestinal diseases
• Hepatology
  • Liver diseases
    • Cirrhosis
    • Portal hypertension
    • Acute and chronic viral hepatitis
    • Autoimmune hepatitis
    • Liver cancer
    • Hemochromatosis
    • Wilson's disease
    • Metabolic liver disease
    • Cryptogenic liver disease
  • Bile duct diseases
    • Gallstone disease
    • Jaundice
    • Primary sclerosing cholangitis
    • Primary biliary cholangitis
• Other diseases and pathological conditions

The department's range of medical services includes:

• Diagnostic options
  • Functional diagnosis
    • Esophageal manometry
    • 24-hour pH monitoring
    • 24-hour pH-impedance testing
    • Small bowel manometry
    • ¹³C-octanoic acid breath test
    • ¹³C-urea breath test for the diagnosis of Helicobacter pylori infection
    • Hydrogen breath test
  • Endoscopic examinations
    • Fluorescence-guided diagnostic procedures
    • High-resolution video endoscopy with magnification
    • Gastroscopy (esophagogastroduodenoscopy)
    • Endoscopic retrograde cholangiopancreatography
    • Cholangioscopy
    • Proctoscopy
    • Rectoscopy
    • Colonoscopy
    • Ileoscopy
    • Capsule endoscopy
    • Double-balloon enteroscopy
    • Endosonography
• Therapeutic options
  • Drug therapy
  • Endoscopic procedures
    • Hemostasis procedures
      • Hemostasis with fibrin glue
      • Clipping
      • Argon plasma coagulation
      • Rubber band ligation for esophageal varices
    • Endoscopic mucosal resection (EMR)
    • Endoscopic submucosal dissection (ESD)
    • Radiofrequency ablation
    • Bile duct bougienage, dilation, and stent implantation
    • Photodynamic therapy for bile duct cancer
    • Mechanical and electrohydraulic lithotripsy, as well as extracorporeal shock wave lithotripsy for gallstone disease
    • Percutaneous endoscopic gastrostomy
• Other diagnostic and therapeutic options