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Leideck P, Nkontchou G, Elkrief L, Erard D, d'Alteroche L, Radenne S, Billioud C, Meszaros M, Regnault D, Pageaux GP, Hilleret MN, Tripon S, Guillaud O, Ollivier-Hourmand I, Ganne-Carrié N, Dumortier J. The role and evolution of partial splenic embolization over three decades: A multicentric retrospective single cohort study of 90 patients from French nationwide experience. Clin Res Hepatol Gastroenterol 2024; 48:102355. [PMID: 38679291 DOI: 10.1016/j.clinre.2024.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Partial splenic embolization (PSE) has been proposed to treat the consequences of hypersplenism in the context of portal hypertension, especially thrombocytopenia. However, a high morbidity/mortality rate has made this technique unpopular. We conducted a multicenter retrospective nationwide French study to reevaluate efficacy and tolerance. METHODS All consecutive patients who underwent PSE for hypersplenism and portal hypertension in 7 tertiary liver centers between 1998 and 2023 were included. RESULTS The study population consisted of 91 procedures in 90 patients, with a median age of 55.5 years [range 18-83]. The main cause of portal hypertension was cirrhosis (84.6 %). The main indications for PSE were (1) an indication of medical treatment or radiological/surgical procedure in the context a severe thrombocytopenia (59.3 %), (2) a chronic hemorrhagic disorder associated with a severe thrombocytopenia (18.7 %), and (3) a chronic pain associated with a major splenomegaly (9.9 %). PSE was associated with a transjugular intrahepatic portosystemic shunt in 20 cases. Median follow-up after PSE was 41.9 months [0.5-270.5]. Platelet count increased from a median of 48.0 G/L [IQR 37.0; 60.0] to 100.0 G/L [75.0; 148]. Forty-eight patients (52.7 %) had complications after PSE; 25 cases were considered severe (including 7 deaths). A Child-Pugh B-C score (p < 0.02) was significantly associated with all complications, a history of portal vein thrombosis (p < 0.01), and the absence of prophylactic antibiotherapy (p < 0.05) with severe complications. CONCLUSION Our results strongly confirm that PSE is very effective, for a long time, although a quarter of the patients experienced severe complications. Improved patient selection (exclusion of patients with portal vein thrombosis and decompensated cirrhosis) and systematic prophylactic antibiotherapy could reduce morbidity and early mortality in the future.
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Affiliation(s)
- Paul Leideck
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France
| | - Gisèle Nkontchou
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Laure Elkrief
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Domitille Erard
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Louis d'Alteroche
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Claire Billioud
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Magdalena Meszaros
- CHU Saint Eloi, Département d'Hépatologie et Transplantation Hépatique, Montpellier, France
| | - David Regnault
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | | | | | - Simona Tripon
- CHRU Hautepierre, Service d'Hépato-Gastroentérologie, Strasbourg, France
| | - Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France; Clinique de la Sauvegarde, Ramsay Générale de Santé, Lyon, France
| | | | - Nathalie Ganne-Carrié
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France.
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Masson E, Ewers M, Paliwal S, Kume K, Scotet V, Cooper DN, Rebours V, Buscail L, Rouault K, Abrantes A, Aguilera Munoz L, Albouys J, Alric L, Amiot X, Archambeaud I, Audiau S, Bastide L, Baudon J, Bellaiche G, Bellon S, Bertrand V, Bideau K, Billiemaz K, Billioud C, Bonnefoy S, Borderon C, Bournet B, Breton E, Brugel M, Buscail L, Cadiot G, Camus M, Carpentier-Pourquier M, Chamouard P, Chaput U, Chen JM, Cholet F, Ciocan DM, Clavel C, Coffin B, Coimet-Berger L, Cosconea S, Creveaux I, Culetto A, Daboussi O, De Mestier L, Degand T, D'engremont C, Denis B, Dermine S, Drouet D'Aubigny A, Enaud R, Fabre A, Férec C, Gargot D, Gelsi E, Gentilcore E, Gincul R, Ginglinger-Favre E, Giovannini M, Gomercic C, Gondran H, Grainville T, Grandval P, Grasset D, Grimaldi S, Grimbert S, Hagege H, Heissat S, Hentic O, Herber-Mayne A, Hervouet M, Hoibian S, Jacques J, Jais B, Kaassis M, Koch S, Lacaze E, Lacroute J, Lamireau T, Laurent L, Le Guillou X, Le Rhun M, Leblanc S, Levy P, Lievre A, Lorenzo D, Maire F, Marcel K, Masson E, Mauillon J, Morgant S, Moussata D, Muller N, Nambot S, Napoleon B, Olivier A, Pagenault M, Pelletier AL, Pennec O, Pinard F, Pioche M, Prost B, Queneherve L, Rebours V, Reboux N, Rekik S, Riachi G, Rohmer B, Roquelaure B, Rosa Hezode I, Rostain F, Saurin JC, Servais L, Stan-Iuga R, Subtil C, Tanneche J, Texier C, Thomassin L, Tougeron D, Vuitton L, Wallenhorst T, Wangerme M, Zanaldi H, Zerbib F, Bhaskar S, Kikuta K, Rao GV, Hamada S, Reddy DN, Masamune A, Chandak GR, Witt H, Férec C, Chen JM. The PRSS3P2 and TRY7 deletion copy number variant modifies risk for chronic pancreatitis. Pancreatology 2023; 23:48-56. [PMID: 36517351 DOI: 10.1016/j.pan.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND PRSS1 and PRSS2 constitute the only functional copies of a tandemly-arranged five-trypsinogen-gene cluster (i.e., PRSS1, PRSS3P1, PRSS3P2, TRY7 and PRSS2) on chromosome 7q35. Variants in PRSS1 and PRSS2, including missense and copy number variants (CNVs), have been reported to predispose to or protect against chronic pancreatitis (CP). We wondered whether a common trypsinogen pseudogene deletion CNV (that removes two of the three trypsinogen pseudogenes, PRSS3P2 and TRY7) might be associated with CP causation/predisposition. METHODS We analyzed the common PRSS3P2 and TRY7 deletion CNV in a total of 1536 CP patients and 3506 controls from France, Germany, India and Japan by means of quantitative fluorescent multiplex polymerase chain reaction. RESULTS We demonstrated that the deletion CNV variant was associated with a protective effect against CP in the French, German and Japanese cohorts whilst a trend toward the same association was noted in the Indian cohort. Meta-analysis under a dominant model yielded a pooled odds ratio (OR) of 0.68 (95% confidence interval (CI) 0.52-0.89; p = 0.005) whereas an allele-based meta-analysis yielded a pooled OR of 0.84 (95% CI 0.77-0.92; p = 0.0001). This protective effect is explicable by reference to the recent finding that the still functional PRSS3P2/TRY7 pseudogene enhancers upregulate pancreatic PRSS2 expression. CONCLUSIONS The common PRSS3P2 and TRY7 deletion CNV was associated with a reduced risk for CP. This finding provides additional support for the emerging view that dysregulated PRSS2 expression represents a discrete mechanism underlying CP predisposition or protection.
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Affiliation(s)
- Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Maren Ewers
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Sumit Paliwal
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Virginie Scotet
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, CHU Rangueil and University of Toulouse, Toulouse, France
| | - Karen Rouault
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Hervouet
- Hôpital d'instruction des Armées Percy, Clamart, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seema Bhaskar
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Heiko Witt
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France.
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Lesne A, Rouquette O, Touzet S, Petit-Laurent F, Tourlonias G, Pasquion A, Rivory J, Aguero Garcete G, Scanzi J, Chalumeau S, Chambon-Augoyard C, Moussata D, Leger-Nguyen F, Degeorges S, Chauvenet M, Fontanges T, Baubet S, Brulet P, Billioud C, Thimonier E, Stroeymeyt-Martin K, Hamel B, Graillot E, Cruiziat C, Scalone O, O'Brien M, Péré-Vergé D, Souquet JC, Phelip JM, Poincloux L, Poupon-Bourdy S, Denis A, Magaud L, Ponchon T, Pioche M. Adenoma detection with blue-water infusion colonoscopy: a randomized trial. Endoscopy 2017; 49:765-775. [PMID: 28399611 DOI: 10.1055/s-0043-105073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Background and aims Colonoscopy is currently the reference method to detect colorectal neoplasia, yet some adenomas remain undetected. The water infusion technique and dying with indigo carmine has shown interesting results for reducing this miss rate. The aim of this study was to compare the adenoma detection rate (adenoma and adenocarcinoma; ADR) and the mean number of adenomas per patient (MAP) for blue-water infusion colonoscopy (BWIC) versus standard colonoscopy. Methods We performed a multicenter, randomized controlled trial in eight units, including patients with a validated indication for colonoscopy (symptoms, familial or personal history, fecal occult blood test positive). Consenting patients were randomized 1:1 to BWIC or standard colonoscopy. All colonoscopies were performed by experienced colonoscopists. All colonoscopy quality indicators were prospectively recorded. Results Among the 1065 patients included, colonoscopies were performed completely for 983 patients (514 men; mean age 59.1). The ADR was not significantly different between the groups; 40.4 % in the BWIC group versus 37.5 % in the standard colonoscopy group (odds ratio [OR] 1.13; 95 % confidence interval [CI] 0.87 - 1.48; P = 0.35). MAP was significantly greater in the BWIC group (0.79) than in the standard colonoscopy group (0.64; P = 0.005). For advanced adenomas, the results were 50 (10.2 %) and 36 (7.3 %), respectively (P = 0.10). The cecal intubation rate was not different but the time to cecal intubation was significantly longer in BWIC group (9.9 versus 6.2 minutes; P < 0.001). Conclusion Despite the higher MAP with BWIC, the routine use of BWIC does not translate to a higher ADR. Whether increased detection ultimately results in a lower rate of interval carcinoma is not yet known. CLINICAL TRIALS REGISTRATION EudraCT 2012-A00548 - 35; NCT01937429.
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Affiliation(s)
- Adriane Lesne
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France
| | - Olivier Rouquette
- Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France
| | - Sandrine Touzet
- Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France
| | - Fabien Petit-Laurent
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | - Gwenaelle Tourlonias
- Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France
| | - Audrey Pasquion
- Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France.,Hepatogastroenterology Department, St Joseph St Luc Hospital, Lyon, France
| | - Jérôme Rivory
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France
| | | | - Julien Scanzi
- Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France
| | - Sylvaine Chalumeau
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | | | - Driffa Moussata
- Hepatogastroenterology Department, University Hospital Lyon Sud, Pierre-Bénite, France
| | - Florence Leger-Nguyen
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | - Stéphane Degeorges
- Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France
| | - Marion Chauvenet
- Hepatogastroenterology Department, University Hospital Lyon Sud, Pierre-Bénite, France
| | - Thierry Fontanges
- Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France
| | - Sandrine Baubet
- Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France
| | - Philippe Brulet
- Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France
| | - Claire Billioud
- Hepatogastroenterology Department, University Hospital Croix Rousse, Lyon, France
| | - Elsa Thimonier
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | | | - Benjamin Hamel
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | - Emmanuelle Graillot
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Claire Cruiziat
- Hepatogastroenterology Department, Public Hospital Bourgoin-Jallieu, France
| | - Olivia Scalone
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | - Marc O'Brien
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Denis Péré-Vergé
- Hepatogastroenterology Department, St Joseph St Luc Hospital, Lyon, France
| | | | - Jean-Marc Phelip
- Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France
| | - Laurent Poincloux
- Hepatogastroenterology Department, University Hospital d'Estaing, Clermont-Ferrand, France
| | - Stéphanie Poupon-Bourdy
- Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France
| | - Angélique Denis
- Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France
| | - Laurent Magaud
- Hospices Civils de Lyon, pôle Information médicale Evaluation Recherche, and Université de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon, France
| | - Thierry Ponchon
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTau, Lyon, France
| | - Mathieu Pioche
- Hepatogastroenterology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTau, Lyon, France
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