[Endoscopic and surgical procedures for enteral nutrition]. / Endoskopische und chirurgische Techniken zur enteralen Ernährung.

Standardized management of oncology patients necessarily includes screening for nutritional risk. Weight loss of > 5 kg within 3 months and diminished food intake are warning signals even in overweight patients. In case oral nutrition is neither adequate nor feasible even by fortification or oral nutritional supplements, the implantation of a percutaneous endoscopic gastrostomy (PEG) or fine needle catheter jejunostomy (FNCJ) offers enteral access for long-term nutritional support. Although the indications derive from fulfilling caloric needs, endoscopic or operative measures are not considered to be an urgent or even emergency measure. The endoscopist or surgeon should be fully aware and informed of the indications and make a personal assessment of the situation. The implantation of a feeding tube requires informed consent of the patient or legal surrogates. The review summarizes recent indications, technical problems and complications.

[Dying with living donor transplantation]. / Sterbend mit Lebendspende.

A female patient with primary sclerosing cholangitis developed a cholangiocarcinoma (Klatskin tumor) at the age of 42 years. It was successfully resected by hemihepatectomy and hepaticojejunostomy. In the next 15 years she had recurrent episodes of bacterial cholangitis and had to be hospitalized several times a year for intravenous antibiotics. At the same time the sclerosing cholangitis progressed and she developed liver cirrhosis. The patient, who was never willing to give up, underwent liver transplantation by receiving the left liver lobe of her daughter (living donor). Postoperatively she suffered from severe complications including a biliary leak, sepsis, intraabdominal abscesses and cachexia. Soon after she was dismissed by the transplantation center, she was admitted to our hospital in a very poor condition. She refused any further intensive care and died, with the well functioning donated left liver lobe of the daughter dying with her.