Download PDF
Endoskopie heute 2003; 16(4): 176-182
DOI: 10.1055/s-2003-819983
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Endoskopische Papillotomie (EPT) - eine selektive Literaturrecherche der beiden letzten Jahre

Endoscopic Papillotomy (EPT) - A Selective Literature Research for the Last Two YearsM. Classen1 , P. Born1
  • 1II. Medizinische Klinik und Poliklinik, Klinikum r. d. Isar, Technische Universität München
Further Information

Publication History

Publication Date:
19 February 2004 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Fundamentale Veränderungen am Papillotom und an der Inzisionstechnik haben seit der Einführung der Methode im Jahr 1973 nicht stattgefunden. Die Einführung eines Führungsdrahtes hat jedoch die Anwendung des Papillotoms signifikant verbessert. Auch wurde der selektive Zugang zum Gallengang und zum Pankreasgang durch eine Modifikation der Schneidetechnik erleichtert. Wenn der selektive Zugang zum gestauten Gallengang zunächst nicht möglich erscheint, der Pankreasgang jedoch sondiert werden kann, dann kann eine Inzision vom Ductus Wirsungianus durch das Gewebe der Papille bis in den Gallengang durchgeführt werden, ohne dass die Komplikationsrate bei diesem Vorgehen ansteigt. Das Nadelmesser ist hilfreich, wenn eine enge Öffnung die selektive Einführung des Erlanger Papillotoms in einen der Gänge nicht gestattet. Dies gelingt besonders leicht und risikoarm, wenn die Papille vergrößert ist. Für eine Vielzahl von Erkrankungen von Papilla major et minor, für Veränderungen des Gallen- und des Pankreasgangssystems stellt die endoskopische Papillotomie eine maßgeschneiderte und minimalinvasive Therapie dar. Einige Fragen sind zum gegenwärtigen Zeitpunkt nicht definitiv und für alle Patienten zu beantworten, nämlich die Rolle der EPT bei akuter biliärer Pankreatitis und bei Sphinkter Oddi Dyskinesie des Pankreassphinkters. Die Einführung eines dünnkalibrigen Stents in den Pankreasgang nach EPT bei Risikopatienten verhindert die am meisten gefürchtete Komplikation, nä mlich die akute biliäre Pankreatitis bei vielen, aber nicht bei allen Patienten. Für diese und andere offene Fragestellungen werden weitere klinische Studien benötigt.

Abstract

Following the introduction of endoscopic papillotomy (EPT) in 1973 there have not been any substantial modifications neither of the papillotome itself nor of the cutting technique. Using the papillotome over a guidewire has greatly facilitated the procedure. The guidewire also enables better selective cannulation of the common bile duct; should this fail and the pancreatic duct be intubated, papillotomy in an upwards direction via the pancreatic orifice until the biliary duct is reached has been shown to be successful without an increase in complication rate. In case of failure of even pancreatic duct cannulation, the needle knife is used to gain access to the pancreatobiliary system, a successful and easy way especially in enlarged papillas. Endoscopic papillotomy has established itself as a tailored and minimal-invasive treatment modality for a variety of diseases of both papillae, as well as of the biliary tract and the pancreatic duct. Still, some questions remain unanswered even at present, e. g. the role of sphincterotomy in acute biliary pancreatitis and spincter Oddi dyskinesia of the pancreatic sphincter. Placement of a small-caliber stent into the pancreatic duct after papillotomy in patients at high risk of pancreatitis - the most feared complication of ERCP and papillotomy - has been shown to reduce this complication. Further studies are needed to clarify this and other open question.

Schlüsselwörter

Endoskopische Papillotomie - Sphinkterotomie - Pankreopathien, Erkrankungen des biliären Systems

Key words

Endoscopic papillotomy - Sphincterectomy - pancreatic/hiliary disorders

Literatur

  • 1 Abraham N S, Barkun J S, Barkun A N. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life.  Gastrointest Endosc. 2002;  56 835-841
    CrossrefPubMedSearch in Google Scholar
  • 2 Akashi R, Kiyozumi T, Tanaka T, Sakurai K, Oda Y, Sagara K. Mechanism of pancreatitis caused by ERCP.  Gastrointest Endosc. 2002;  55 50-54
    CrossrefPubMedSearch in Google Scholar
  • 3 Andriulli A, Clemente R, Solmi L, Terruzzi V, Suriani R, Sigillito A, Leandro G, Leo P, De Maio G, Perri F. Gabexate or somatostatin administration before ERCP in patients at high rsik for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial.  Gastrointest Endosc. 2002;  56 488-495
    CrossrefPubMedSearch in Google Scholar
  • 4 Battaille L, Deprez P. A new application for therapeutic EUS: main pancreatic duct drainage with a “pancreatic rendezvous technique”.  Gastrointest Endosc. 2002;  55 740-743
    CrossrefPubMedSearch in Google Scholar
  • 5 Bergmann J J, Rauws E A, Fockens P, van Berkel A M, Bossuyt P M, Tijssen J G. et al . Randomized trial of endoscopic balloon dilatation versus endoscopic sphincterotomy for removal of bile duct stones.  Lancet. 1997;  349 1124-1129
    CrossrefPubMedSearch in Google Scholar
  • 6 Born P, Sandschin W, Rösch T. Percutaneous Antegrade Sphincterotomy under Endoscopic Retrograde Control: Report of Two Cases.  Endoscopy. 2002;  34 512-513
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Brodsky J A, Marks J M, Malm J A, Bower A, Ponsky J L. Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent in resolving cystic duct leaks in a canine model.  Gastrointest Endosc. 2002;  56 849-851
    CrossrefPubMedSearch in Google Scholar
  • 8 Burmeister E, Niehaus J, Leineweber T, Huetteroth T. EUS- cholangio-drainage of the bile duct: report of 4 cases.  Gastrointest Endosc. 2003;  57 246-251
    Search in Google Scholar
  • 9 Buscarini E, Tansini P, Vallisa D, Zambelli A, Buscarini L. EUS for suspected choledocholithiasis: Do benefits outweigh costs? A prospective, controlled study.  Gastrointest Endosc. 2003;  57 510-518
    CrossrefPubMedSearch in Google Scholar
  • 10 Catalano M F, Geenen J E, Lehman G A, Siegel J H, Jacob L, Mc Kinley M J, Raijman I, Meier P, Jacobson I, Kozarek R, Al-Kawas F H, Lo S K, Dua K S, Baille J, Ginsberg G G, Parsons W, Meyerson S M, Cohen S, Nelson D B, Mc Hattie J D, Carr-Locke D L. “Tannenbaum” Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture.  Gastrointest Endosc. 2002;  55 354-358
    CrossrefPubMedSearch in Google Scholar
  • 11 Cheng J LS, Bruno M J, Bergmann J J, Rauws E A, Tytgat G N, Huibregtse K. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents.  Gastrointest Endosc. 2002;  56 33-39
    CrossrefPubMedSearch in Google Scholar
  • 12 Classen M, Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus.  Dtsch med Wschr. 1974;  99 496-497
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Costamagna G, Mutignani M, Gabrielli A. et al . Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy.  Acta Gastroenterol Belg. 1994;  57 155
    PubMedSearch in Google Scholar
  • 14 Costamagna G, Tringali A, Shah S K, Mutignani M, Zuccala G, Perri V. Long- Term Follow-Up of Patients After Endoscopic Sphincterotomy for Choledocholithiasis, and Risk Factors for Recurrence.  Endoscopy. 2002;  34 273-279
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 De Palma G D, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L, Persico G. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study.  Gastrointest Endosc. 2003;  58 50-53
    CrossrefPubMedSearch in Google Scholar
  • 16 DiSario J A. Endoscopic balloon dilatation for extraction of bile duct stones: the devil is in the details.  Gastrointest Endosc. 2003;  57 282-285
    PubMedSearch in Google Scholar
  • 17 Eickhoff A, Jakobs R, Leonhardt A, Eickhoff J C, Riemann J F. Self-expandable Metal Mesh Stents for Common Bile Duct Stenosis in Chronic Pancreatitis: Retrospective Evaluation of Long-term Follow-up and Clinical Outcome of a Pilot Study.  Z Gastroenterol. 2003;  41 649-654
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Ersoz G, Tekesin O, Ozutemiz A O, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract.  Gastrointest Endosc. 2003;  57 156-159
    CrossrefPubMedSearch in Google Scholar
  • 19 Fazel A, Quadri A, Catalano M F, Meyerson S M, Geenen J E. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study.  Gastrointest Endosc. 2003;  57 291-294
    CrossrefPubMedSearch in Google Scholar
  • 20 Freeman M L, Nelson D B, Sherman S, Haber G, Herman M E, Dorsher P J, Moore J P, Fennerty B, Ryan M E, Shaw M J, Lande J D, Pheley A M. Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
    CrossrefPubMedSearch in Google Scholar
  • 21 Fujita N, Maguchi H, Komatsu Y, Yasuda I, Hasebe O, Igarashi Y, Murakami A, Mukai H, Fujii T, Yamao K, Maeshiro K. for the JESED Study Group . Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial.  Gastrointest Endosc. 2003;  57 151-155
    CrossrefPubMedSearch in Google Scholar
  • 22 Fulcher A S. MRCP and ERCP in the diagnosis of common bile duct stones.  Gastrointest Endosc. 2002;  56 (Suppl) S 178-S 182
    PubMedSearch in Google Scholar
  • 23 Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) Antibiotic Prophylaxis for Gastrointestinal Endoscopy.  Endoscopy. 1998;  30 318-324
    PubMedSearch in Google Scholar
  • 24 Holm M, Matzen P. Stenting and Extracorporeal Shock Wave Lithotripsy in Chronic Pancreatitis.  Scand J Gastroenterol. 2003;  38 328-331
    CrossrefPubMedSearch in Google Scholar
  • 25 Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, Canard J M, Fritsch J, Rey J F, Burtin P. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study.  Gastrointest Endosc. 2003;  57 178-182
    CrossrefPubMedSearch in Google Scholar
  • 26 Kaw M, Al Antably Y, Kaw P. Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy.  Gastrointest Endosc. 2002;  56 61-65
    CrossrefPubMedSearch in Google Scholar
  • 27 Kawai K, Akasaka Y, Murakami K, Tada M, Kohli Y, Nakajima M. Endoscopic sphincterotomy of the ampulla of Vater.  Gastrointest Endosc. 1974;  20 148-151
    PubMedSearch in Google Scholar
  • 28 Keeling S P, Freeman M L. Placement of self- expanding metallic stents in the pancreatic duct for treatment of obstructive complications of pancreatic cancer.  Gastrointest Endosc. 2003;  57 756-759
    CrossrefPubMedSearch in Google Scholar
  • 29 Kim M H, Lee S K, Lee M H, Myung S J, Yoo B M, Seo D W, Min Y I. Endoscopic retrogarde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: A comparative study of the forward-viewing endoscope and the side-viewing duodenoscope.  Endoscopy. 1997;  29 82-85
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Kin H, Mochizuki T, Matsumura K, Watanabe K, Fukuzawa H, Hamamura K, Miyoshi H, Shirane N, Kondou M, Kojima K. Needle-Knife Papillotomy With Pancreatic Stent: A Prospective Evaluation Of Efficacy And Complications.  Gastrointest Endosc. 2003;  57 AB 192
    PubMedSearch in Google Scholar
  • 31 Kozarek R. Role of ERCP in acute pancreatitis.  Gastrointest Endosc. 2002;  56 (Suppl) S 231-S 236
    PubMedSearch in Google Scholar
  • 32 Lee D WH, Chan A CW, Lam Y, Ng E KW, Lau J YW, Law B KB, Lai C, Sung J JY, Chung S CS. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial.  Gastrointest Endosc. 2002;  56 361-365
    CrossrefPubMedSearch in Google Scholar
  • 33 Lehman G A. Role of ERCP and other endoscopic modalities in chronic pancreatitis.  Gastrointest Endosc. 2002;  56 (Suppl) S 237-S 240
    PubMedSearch in Google Scholar
  • 34 Manolakopoulos S, Avgerinos A, Vlachogiannakos J, Armonis A, Viazis N, Papadimitriou N, Mathou N, Stefanidis G, Rekoumis G, Vienna E, Tzourmakliotis D, Raptis A. Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis: a multicenter randomized controlled trial.  Gastrointest Endosc. 2002;  55 470-475
    CrossrefPubMedSearch in Google Scholar
  • 35 Mark D H, Lefevre F, Flamm C R, Aronson N. Evidence- based assessment of ERCP in the treatment of pancreatitis.  Gastrointest Endosc. 2002;  56 (Suppl) S 249-S 254
    PubMedSearch in Google Scholar
  • 36 Mcintosh D, Love J, Abraham N. Endoscopic Sphincterotomy Using Pure-Cut Current Does Not Reduce The Risk Of Post-ERCP Pancreatitis: A Prospective Randomized Trial.  Gastrointest Endosc. 2003;  57 AB 189
    PubMedSearch in Google Scholar
  • 37 Minami A, Fujita R. A new technique for removal of bile duct stones with an expandable metallic stent.  Gastrointest Endosc. 2003;  57 945-948
    CrossrefPubMedSearch in Google Scholar
  • 38 Mönckemüller K E, Linder J D, Fry L C. Modified Rendezvous Technique for Biliary Cannulation.  Endoscopy. 2002;  34 936
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Mora J, Aguilera V, Sala T, Martinez F, Bastida G, Palau A, Arguello I, Pons V, Pertejo V, Berenguer J, Alapont J M. Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones.  Gastroenterol Hepatol. 2002;  25 585-588
    PubMedSearch in Google Scholar
  • 40 Moreto M, Zaballa M, Casado I, Merino O, Rueda M, Ramirez K, Urcelay R, Baranda A. Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: a randomized double-blind trial.  Gastrointest Endosc. 2003;  57 1-7
    PubMedSearch in Google Scholar
  • 41 Murray B, Carter R, Imrie C, Evans S, O'Suillebhain C. Diclofenac Reduces the Incidence of Acute Pancreatitis After Endoscopic Retrograde Cholangiopancreatography.  Gastroenterology. 2003;  124 1786-1791
    CrossrefPubMedSearch in Google Scholar
  • 42 Neuhaus H. Endoscopic and Percutaneous Treatment of Difficult Bile Duct Stones.  Endoscopy. 2003;  35 (Suppl 1) S 31-S 34
    PubMedSearch in Google Scholar
  • 43 Oviedo J A, Barrison A, Lichtenstein D R. Endoscopic argon plasma coagulation for refractory postsphincterotomy bleeding: report of two cases.  Gastrointest Endosc. 2003;  58 148-151
    PubMedSearch in Google Scholar
  • 44 Park J J, Kim S S, Kim Y K, Jung M K, Park H C, Kim J H, Kim J S, Hyun J H. Biliary drainage by endoscopic choledochoduodenal fistulotomy in patients with papillary carcinoma.  Gastrointest Endosc. 2002;  55 730-735
    CrossrefPubMedSearch in Google Scholar
  • 45 Park S H, Watkins J L, Fogel E L, Sherman S, Lazzell L, Bucksot L, Lehman G A. Long-term outcome of endoscopic dual pancreatobiliry sphincterotomy in patients with manometry-documented sphincter of Oddi dysfunction and normal pancreatogram.  Gastrointest Endosc. 2003;  57 483-491
    CrossrefPubMedSearch in Google Scholar
  • 46 Prat F, Amaris J, Ducot B, Bocquentin M, Fritsch J, Choury A D, Pelletier G, Buffet C. Nifedipin for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study.  Gastrointest Endosc. 2002;  56 202-208
    CrossrefPubMedSearch in Google Scholar
  • 47 Rabenstein T, Fischer B, Wiesner V, Schmidt H, Radespiel-Tröger M, Hochberger J, Mühldorfer S, Nusko G, Messmann H, Schölmerich J, Schulz H J, Schönekäs H, Hahn E G, Schneider H T. Low-Molecular-Weight Heparin Does Not Prevent Acute Post-ERCP Pancreatitis.  Gastrointest Endosc. 2003;  57 AB 189
    PubMedSearch in Google Scholar
  • 48 Rabenstein T, Roggenbruck S, Framke B, Martus P, Fischer B, Nusko G, Muehldorfer S, Hochberger J, Ell C, Hahn E G, Schneider T. Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP?.  Gastrointest Endosc. 2002;  55 476-483
    CrossrefPubMedSearch in Google Scholar
  • 49 Saleh M MA, Norregaard P, Jorgensen H L, Andersen P K, Matzen P. Preoperative endoscopic stent placement before pancreaticoduodenectomy: a meta-analysis of the effect on morbiditiy and mortality.  Gastrointest Endosc. 2002;  56 529-534
    CrossrefPubMedSearch in Google Scholar
  • 50 Schilling D, Rink G, Arnold J C, Benz C, Adamek H E, Jakobs R, Riemann J F. Prospective, randomized, single-center trial comparing 3 different 10F plastic stents in malignant mid and distal bile duct strictures.  Gastrointest Endosc. 2003;  58 54-58
    CrossrefPubMedSearch in Google Scholar
  • 51 Shah R J, Antillon M R, Springer E W, Penberthy J A, Chen Y K. A New Rotatable Papillotome (RP) In Complex Therapeutic ERCP: Indications For Use And Results.  Gastrointest Endosc. 2003;  57 AB 206
    PubMedSearch in Google Scholar
  • 52 Sherman S, Blaut U, Watkins J L, Barnett J, Freeman M, Geenen J, Ryan M, Parker H, Frakes J T, Fogel E L, Silverman W B, Dua K S, Aliperti G, Yakshe P, Uzer M, Jones W, Goff J, Earle D, Temkit M, Lehman G A. Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study.  Gastrointest Endosc. 2003;  58 23-29
    CrossrefPubMedSearch in Google Scholar
  • 53 Sherman S, Earle D, Bucksot L, Rusche M, Lehman G. Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy (ES)-induced pancreatitis? A final analysis of a prospective study.  Gastrointest Endosc. 1996;  43 413 A
    PubMedSearch in Google Scholar
  • 54 Singh P, Sivak M V, Agarwal D, Wong R, Isenberg G, Das A, Mughal T B, Singh R, Cnak A. Prophylactic Pancreatic Stenting For Prevention Of Post-ERCP Acute Pancreatitis: A Meta-Analysis Of Controlled Studies.  Gastointest Endosc. 2003;  57 AB 89
    PubMedSearch in Google Scholar
  • 55 Sivak M V. EUS for bile duct stones: How does it compare with ERCP?.  Gastrointest Endosc. 2003;  56 (Suppl) S 175-S 177
    PubMedSearch in Google Scholar
  • 56 Smithline A, Silverman W, Rogers D, Nisi R, Wiersema M, Jamidar P, Hawes R, Lehman G. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients.  Gastrointest Endosc. 1993;  39 652-657
    CrossrefPubMedSearch in Google Scholar
  • 57 Sriram P VJ, Rao G V, Nageshwar Reddy D. The Precut - When, Where and How? A Review.  Endoscopy. 2003;  35 (Suppl 1) S 24-S 30
    PubMedSearch in Google Scholar
  • 58 Stefanidis G, Karamanolis G, Viazis N, Sgouros S, Papadopoulou E, Ntatsakis K, Mantides A, Nastos H. A comparative study of postendoscopic sphincterotomy complications with various types of electrosurgical current in patients with choledocholithiasis.  Gastrointest Endosc. 2003;  57 192-197
    PubMedSearch in Google Scholar
  • 59 Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilatation.  Gastrointest Endosc. 2003;  57 531-535
    PubMedSearch in Google Scholar
  • 60 Tarnasky P, Cunningham J, Cotton P, Hoffman B, Palesch Y, Freeman J, Curry N, Hawes R. Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis.  Endoscopy. 1997;  29 252-257
    PubMedSearch in Google Scholar
  • 61 Telford J J, Farrell J J, Saltzman J R, Shields SJ, Banks P A, Lichtenstein D R, Johannes R S, Kelsey P B, Carr-Locke D L. Pancreatic stent placement for duct disruption.  Gastrointest Endosc. 2002;  56 18-24
    CrossrefPubMedSearch in Google Scholar
  • 62 Ueno N, Ozawa Y, Aizawa T. Prognostic factors for recurrence of bile duct stones after endoscopic treatment by sphincter dilation.  Gastrointest Endosc. 2003;  58 336-340
    CrossrefPubMedSearch in Google Scholar
  • 63 Van Berkel A -M, Van Westerloo D, Cahen D, Bergman J, Rauws E, Huibregtse K, Bruno M. Efficacy of Wallstents in Benign Biliary Strictures Due to Chronic Pancreatitis.  Gastrointest Endosc. 2003;  57 AB 198
    PubMedSearch in Google Scholar
  • 64 Van Lent A UG, Bartelsman J FWM, Tytgat G NJ, Speelman P, Prins J M. Duration of antibiotic therapy for cholangitis after successful endoscopic drainage of the biliary tract.  Gastrointest Endosc. 2002;  55 518-522
    CrossrefPubMedSearch in Google Scholar
  • 65 Varadarajulu S, Noone T, Hawes R H, Cotton P B. Pancreatic duct stent insertion for functional smoldering pancreatitis.  Gastrointest Endosc. 2003;  58 438-441
    CrossrefPubMedSearch in Google Scholar
  • 66 Wright B E, Cass O W, Freeman M L. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.  Gastrointest Endosc. 2002;  56 225-232
    CrossrefPubMedSearch in Google Scholar

Prof. Dr. Drs. h. c. M. Classen

II. Medizinische Klinik und Poliklinik · Klinikum r. d. Isar · Technische Universität München

Ismaninger Str. 22

81675 München

Phone: 0 89/41 40-22 57

Fax: 0 89/41 40-67 05

Email: meinhard.classen@lrz.tum.de