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Marin FS, Assaf A, Doumbe-Mandengue P, Abou Ali E, Belle A, Coriat R, Chaussade S. Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method. Surg Endosc 2024; 38:1600-1607. [PMID: 38242987 DOI: 10.1007/s00464-023-10654-1] [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] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Several endoscopic treatments for iatrogenic perforations are currently available, with some limitations in terms of size, location, complexity, or cost. Our aims were to introduce a novel technique for closure, using an endoloop and clips, to assess its rate of technical success and post-resection complications. METHODS For closure of large perforations (diameter ≥ 10 mm), two similar techniques were implemented, using a single-channel endoscope. An endoloop was deployed through the operating channel or towed by an endoclip alongside the endoscope. Several clips were utilized to fix it on the muscular layer of defect's margins. The defect was closed, by fastening the loop either directly or after being reattached to the mobile hook. RESULTS This analysis included eleven patients (72% women, median age 68 years). Eight colorectal, one appendiceal, and two gastric lesions were resected, with a median perforation size of 15 mm. As confirmed by computed tomography, closure of wall defects was achieved successfully in all cases, using a median of 6 clips. Pneumoperitoneum was evacuated in 4 cases. The median hospitalization duration was 4 days, prophylactic antibiotics being prescribed for a median of 7 days. One patient had a small abdominal collection, without requiring drainage, while another presented post-resection bleeding from the mucosal defect. CONCLUSION The novel techniques, utilizing a single-channel endoscope, clips, and an endoloop, ensuring an edge-to-edge suture of muscular layer, proved to be safe, reproducible, and easy to implement. They exhibit an excellent technical success rate and a minimal incidence of non-severe complications.
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Affiliation(s)
- Flavius-Stefan Marin
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| | - Antoine Assaf
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
| | - Paul Doumbe-Mandengue
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Faculty of Medicine, The University of Paris Cité, Paris, France
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Marchese U, Rebours V, Sauvanet A, Caron O, Ali EA, Perkins G, Malka D, Dohan A, Thibault LM, Perrod G, Buecher B. [Hereditary and familial forms of pancreatic adenocarcinoma: Genetic determinism, patients eligible for systematic screening, screening methods and results]. Bull Cancer 2024; 111:199-212. [PMID: 38123413 DOI: 10.1016/j.bulcan.2023.11.002] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
Systematic screening for pancreatic cancer in high risk individuals is justified by the poor prognosis of the majority of cases diagnosed at a symptomatic stage that are mostly advanced and unresectable Individual risk assessment is based on both genetic data and family history. The screening of a panel of susceptibiility genes should be offered to any affected individual when a genetic predisposition is suspected. An international consortium has proposed a definition of the at risk population, candidate for screening, and there is a consensus on the target lesions of this screening: early adenocarcinoma and benign lesions with a high potential for malignant transformation: Intraductal Papillary Mucinous Neopasm (IPMN) and Pancreatic Intraepithelial Neoplasia (PanIN) with high-grade dysplasia. Its modalities currently consist of an annual pancreatic MRI and/or endoscopic ultrasound (EUS), associated with screening for diabetes mellitus. The main limitation of screening, the effectiveness of which has not yet been demonstrated, is its lack of sensitivity, which results in a non-negligible rate of interval cancers and sometimes advanced diagnoses. Insufficient specificity is also imperfect, in particular with regard to benign lesions with a low potential for degeneration, and can lead to the proposal of unjustified surgeries. This situation makes the future integration of new imaging techniques and promising new biological approaches that are being explored highly desirable.
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Affiliation(s)
- Ugo Marchese
- AP-HP, hôpital Cochin, université de Paris, centre, service de chirurgie digestive, hépatobiliaire et endocrinienne, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Vinciane Rebours
- AP-HP, hôpital Beaujon - Clichy, université Paris-Cité, service de pancréatologie et oncologie digestive, 100, boulevard du Général Leclerc, 92110 Clichy, France
| | - Alain Sauvanet
- AP-HP, hôpital Beaujon - Clichy, université Paris-Cité, département chirurgie hépato-biliaire et pancréatique, 100, boulevard du Général Leclerc, 92110 Clichy, France
| | - Olivier Caron
- Gustave-Roussy, département de médecine oncologique, 94805 Villejuif, France
| | - Einas Abou Ali
- AP-HP, hôpital Cochin, université de Paris, centre, service de gastro-entérologie et oncologie digestive, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Géraldine Perkins
- AP-HP, hôpital européen Georges-Pompidou, Centre, université Paris-Cité, unité d'oncogénétique, 20, rue Leblanc, 75015 Paris, France
| | - David Malka
- Institut mutualiste Montsouris, département d'oncologie médicale, 42, boulevard Jourdan, 75014 Paris, France
| | - Anthony Dohan
- AP-HP, hôpital Cochin, université de Paris, centre, service de radiologie, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Louise May Thibault
- Centre François-Baclesse, service d'oncogénétique, unité de biopathologie, 3, avenue de Général Harris, 14000 Caen, France
| | - Guillaume Perrod
- AP-HP, hôpital européen Georges-Pompidou, université Paris-Cité, centre, département d'hépato-gastroentérologie et endoscopies digestives, 20, rue Leblanc, 75015 Paris, France
| | - Bruno Buecher
- PSL Research University, institut Curie, service de génétique, pôle médecine diagnostique & théranostique, 26, rue d'Ulm, 75248 Paris cédex 05, France.
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3
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Cheminel L, Lupu A, Wallenhorst T, Lepilliez V, Leblanc S, Albouys J, Abou Ali E, Barret M, Lorenzo D, De Mestier L, Burtin P, Girot P, Le Baleur Y, Gerard R, Yzet C, Tchirikhtchian K, Degand T, Culetto A, Lemmers A, Schaefer M, Chevaux JB, Zhong P, Hervieu V, Subtil F, Rivory J, Fine C, Jacques J, Walter T, Pioche M. Systematic Resection of the Visible Scar After Incomplete Endoscopic Resection of Rectal Neuroendocrine Tumors. Am J Gastroenterol 2024; 119:378-381. [PMID: 37734341 DOI: 10.14309/ajg.0000000000002516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION When initial resection of rectal neuroendocrine tumors (r-NETs) is not R0, persistence of local residue could lead to disease recurrence. This study aimed to evaluate the interest of systematic resection of non-R0 r-NET scars. METHODS Retrospective analysis of all the consecutive endoscopic revisions and resections of the scar after non-R0 resections of r-NETs. RESULTS A total of 100 patients were included. Salvage endoscopic procedure using endoscopic submucosal dissection or endoscopic full-thickness resection showed an R0 rate of near 100%. Residual r-NET was found in 43% of cases. DISCUSSION In case of non-R0 resected r-NET, systematic scar resection by endoscopic full-thickness resection or endoscopic submucosal dissection seems necessary.
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Affiliation(s)
- Loïc Cheminel
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Lupu
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Department of Endoscopy and Gastroenterology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Vincent Lepilliez
- Department of Endoscopy and Gastroenterology, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Einas Abou Ali
- Department of Endoscopy and Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Maximilien Barret
- Department of Endoscopy and Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Diane Lorenzo
- Department of Endoscopy and Gastroenterology, Beaujon Hospital, APHP, Paris, France
| | - Louis De Mestier
- Department of Endoscopy and Gastroenterology, Beaujon Hospital, APHP, Paris, France
| | - Pascal Burtin
- Digestive Endoscopy Unit, Gustave Roussy Oncology Institute, Villejuif, France
| | - Paul Girot
- Department of Oncology, Loire Vendée Océan Hospital, La Roche sur Yon, France
| | - Yann Le Baleur
- Digestive Endoscopy Unit, Department of Gastroenterology, Paris Saint-joseph Hospital, Paris, France
| | - Romain Gerard
- Department of Digestive Diseases, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Thibault Degand
- Department of Endoscopy and Gastroenterology, Dijon University Hospital, Dijon, France
| | - Adrian Culetto
- Department of Gastroenterology and Pancreatology, Rangueil University Hospital, Toulouse, France
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Brussels, Belgium
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
| | | | - Peng Zhong
- Department of Endoscopy and Gastroenterology, Besançon Regional University Hospital, Besançon, France
| | | | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Caroline Fine
- Department of Endoscopy and Gastroenterology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France ; and
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thomas Walter
- Department of Medical Oncology, Pavillon E, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Yzet C, Le Baleur Y, Albouys J, Jacques J, Doumbe-Mandengue P, Barret M, Abou Ali E, Schaefer M, Chevaux JB, Leblanc S, Lepillez V, Privat J, Degand T, Wallenhorst T, Rivory J, Chaput U, Berger A, Aziz K, Rahmi G, Coron E, Kull E, Caillo L, Vanbiervliet G, Koch S, Subtil F, Pioche M. Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study. Endoscopy 2023; 55:1002-1009. [PMID: 37500072 DOI: 10.1055/a-2116-9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. METHODS : All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. RESULTS : 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20-30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30-40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. CONCLUSION: ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.
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Affiliation(s)
- Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Yann Le Baleur
- Endoscopy and Gastroenterology Unit, Hospital Saint Joseph, Paris, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Paul Doumbe-Mandengue
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Einas Abou Ali
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
| | | | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lepillez
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jocelyn Privat
- Endoscopy and Gastroenterology Unit, Vichy Hospital, Vichy, France
| | - Thibault Degand
- Endoscopy and Gastroenterology Unit, Dijon University Hospital, Dijon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ulriikka Chaput
- Endoscopy and Gastroenterology Unit, Saint-Antoine University Hospital, Paris, France
| | - Arthur Berger
- Endoscopy and Gastroenterology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Karim Aziz
- Endoscopy and Gastroenterology Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - Gabriel Rahmi
- Endoscopy and Gastroenterology Unit, Georges Pompidou European Hospital, Paris, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
- Digestive Diseases Institute, University Hospital Nantes, Nantes, France
| | - Eric Kull
- Endoscopy and Gastroenterology Unit, Metz Hospital, Metz, France
| | - Ludovic Caillo
- Endoscopy and Gastroenterology Unit, Nîmes University Hospital, Nîmes, France
| | | | - Stéphane Koch
- Endoscopy and Gastroenterology Unit, Besançon University Hospital, Besançon, France
| | - Fabien Subtil
- Biostatistics Unit, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, and Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Camus B, Pellat A, Rouquette A, Marchese U, Dohan A, Belle A, Abou Ali E, Chaussade S, Coriat R, Barret M. Diagnostic Yield of Repeat Endoscopic Ultrasound-Guided Fine Needle Biopsy for Solid Pancreatic Lesions. Cancers (Basel) 2023; 15:3745. [PMID: 37509406 PMCID: PMC10378084 DOI: 10.3390/cancers15143745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
PATIENTS AND METHODS we performed a retrospective case-control study, including cases with repeat EUS FNB for a solid pancreatic lesion, matched on a 1:2 ratio on age, sex, tumor location and presence of chronic pancreatitis with cases diagnosed on the first EUS FNB. RESULTS thirty-four cases and 68 controls were included in the analysis. Diagnostic accuracies were 80% and 88% in the repeat and single EUS FNB groups, respectively (p = 0.824). The second EUS FNB had a sensitivity of 80%, a specificity of 75%, a positive predictive value of 96%, and a negative predictive value of 33%. Of the 34 patients in the repeat EUS FNB group, 25 (74%) had a positive diagnosis with the second EUS FNB, 4 (12%) after surgery due to a second negative EUS FNB, 4 (12%) during clinical follow-up, and 1 (3%) after a third EUS FNB. Of the 25 patients diagnosed on the repeat EUS FNB, 17 (68%) had pancreatic adenocarcinomas, 2 (8%) neuroendocrine tumors, 2 (8%) other autoimmune pancreatitis, 2 (8%) chronic pancreatitis nodules, 1 (4%) renal cancer metastasis, and 1 (4%) other malignant diagnostic. There were no complications reported after the second EUS FNB in this study. CONCLUSION repeat EUS FNB made a diagnosis in three fourths of patients with solid pancreatic lesions and a first negative EUS FNB, with 26% of benign lesions. This supports the repetition of EUS FNB sampling in this clinical situation.
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Affiliation(s)
- Baptiste Camus
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anna Pellat
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
| | - Alexandre Rouquette
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Ugo Marchese
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, 75006 Paris, France
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6
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Karam E, Hollenbach M, Abou Ali E, Auriemma F, Anderloni A, Barbier L, Belfiori G, Caillol F, Crippa S, Del Chiaro M, De Ponthaud C, Dahel Y, Falconi M, Giovannini M, Heling D, Inoue Y, Jarnagin WR, Leung G, Lupinacci RM, Mariani A, Masaryk V, Miksch RC, Musquer N, Napoleon B, Oba A, Partelli S, Petrone MC, Prat F, Repici A, Sauvanet A, Salzmann K, Schattner MA, Schulick R, Schwarz L, Soares K, Souche FR, Truant S, Vaillant JC, Wang T, Wedi E, Werner J, Weismüller TJ, Wichmann D, Will U, Zaccari P, Gulla A, Heise C, Regner S, Gaujoux S. Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study. Neuroendocrinology 2023; 113:1024-1034. [PMID: 37369186 DOI: 10.1159/000531712] [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: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. METHODS From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. RESULTS 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. CONCLUSION Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
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Affiliation(s)
- Elias Karam
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Louise Barbier
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Stefano Crippa
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles De Ponthaud
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Yanis Dahel
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Massimo Falconi
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Dominik Heling
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Rainer Christoph Miksch
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | | | | | - Atsushi Oba
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefano Partelli
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Maria C Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Frédéric Prat
- Department of Digestive, hepatobiliary and endocrine surgery, Cochin Hospital, APHP, and Université de Paris, Paris, France
| | - Alessandro Repici
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Alain Sauvanet
- Departement of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Katrin Salzmann
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Mark A Schattner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - François R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire De Lille, Lille, France
| | - Jean C Vaillant
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Tiegong Wang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Piera Zaccari
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Aiste Gulla
- Institute of Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, MedStar Georgetown University Hospital, General Surgery, Georgetown, Washington, District of Columbia, USA
| | - Christian Heise
- Department of Medicine I - Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Department of Surgery, Sorbonne University, Paris, France
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7
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Marin FS, Abou Ali E, Belle A, Beuvon F, Coriat R, Chaussade S. "Transanal endoscopic microsurgery" with a flexible colonoscope (F-TEM): a new endoscopic treatment for suspicious deep submucosal invasion T1 rectal carcinoma. Surg Endosc 2023:10.1007/s00464-023-10141-7. [PMID: 37231174 DOI: 10.1007/s00464-023-10141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Endoscopic techniques allow resections of deep submucosal invasion rectal carcinoma, but mostly are facing issues such as costs, follow-up care or size limit. Our aim was to design a new endoscopic technique, which retains the advantages over surgical resections while eliminating the disadvantages mentioned above. PATIENTS AND METHODS We propose a technique for the resection of the superficial rectal tumours, with highly suspicious deep submucosal invasion. It combines steps of endoscopic submucosal dissection, muscular resection and edge-to-edge suture of the muscular layers, finally performing the equivalent of a "transanal endoscopic microsurgery" with a flexible colonoscope (F-TEM). RESULTS A 60-year-old patient was referred to our unit, following the discovery of a 15 mm distal rectum adenocarcinoma. The computed tomography and the endoscopic ultrasound examination revealed a T1 tumour, without secondary lesions. Considering that the initial endoscopic evaluation highlighted a depressed central part of the lesion, with several avascular zones, an F-TEM was performed, without severe complication. The histopathological examination revealed negative resection margins, without risk factors for lymph node metastasis, no adjuvant therapy being proposed. CONCLUSION F-TEM allows endoscopic resection of highly suspicious deep submucosal invasion T1 rectal carcinoma and it proves to be a feasible alternative to surgical resection or other endoscopic treatments as endoscopic submucosal dissection or intermuscular dissection.
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Affiliation(s)
- Flavius-Stefan Marin
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Beuvon
- Faculty of Medicine, Paris Cité University, Paris, France
- Department of Pathology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
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8
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Doumbe-Mandengue P, Pellat A, Belle A, Ali EA, Hallit R, Beuvon F, Terris B, Chaussade S, Coriat R, Barret M. Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma. Clin Res Hepatol Gastroenterol 2023; 47:102138. [PMID: 37169124 DOI: 10.1016/j.clinre.2023.102138] [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: 11/21/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopic resection of early esophageal adenocarcinoma. The choice between the two techniques takes into account the morphology of the lesion, and the experience of the endoscopist. The aim of this study was to compare EMR to ESD for the treatment of early esophageal adenocarcinoma. METHODS Patients who underwent an endoscopic resection for esophageal adenocarcinomas between March 2015 and December 2019 were included. ESD was compared to EMR in terms of clinical, procedural, histologic, and oncologic outcomes. RESULTS 85 patients were included: 57 ESD and 28 EMR. The median (IQR) diameter of the lesion was 20(15-25) mm in the ESD group, and 15(8-16) mm in the EMR group, p<0.01. ESD allowed en bloc resection in 100% of cases, and EMR in 39% of cases, p<0.001. The R0 and curative resection rate in the ESD group versus the EMR group were 88% and 67%, respectively, versus 21% and 11%, p<0.001. We recorded one severe adverse event, in the EMR group. After a median (IQR) follow-up of 27.5 (14.5-38.7) months, the local recurrence rate was 23% vs. 18% (p=0.63), and the overall survival 89% vs. 86% (p=0.72), in the ESD and EMR groups, respectively. CONCLUSION ESD was as safe as EMR and allowed higher en bloc, R0 and curative resection rates. Although these results did not translate into long-term outcomes, these data prompt for a broader adoption of ESD for the resection of esophageal lesions suspected of harboring early esophageal adenocarcinoma.
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Affiliation(s)
- Paul Doumbe-Mandengue
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France.
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9
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Barret M, Doridot L, Le Gall M, Beuvon F, Jacques S, Pellat A, Belle A, Abou Ali E, Dhooge M, Leblanc S, Camus M, Nicco C, Coriat R, Chaussade S, Batteux F, Prat F. Mechanisms of esophageal stricture after extensive endoscopic resection: a transcriptomic analysis. Endosc Int Open 2023; 11:E149-E156. [PMID: 36741340 PMCID: PMC9894697 DOI: 10.1055/a-2000-8801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Esophageal stricture is the most frequent adverse event after endoscopic resection for early esophageal neoplasia. Currently available treatments for the prevention of esophageal stricture are poorly effective and associated with major adverse events. Our aim was to identify transcripts specifically overexpressed or repressed in patients who have developed a post-endoscopic esophageal stricture, as potential targets for stricture prevention. Patients and methods We conducted a prospective single-center study in a tertiary endoscopy center. Patients scheduled for an endoscopic resection and considered at risk of esophageal stricture were offered inclusion in the study. The healthy mucosa and resection bed were biopsied on Days 0, 14, and 90. A transcriptomic analysis by microarray was performed, and the differences in transcriptomic profile compared between patients with and without esophageal strictures. Results Eight patients, four with esophageal stricture and four without, were analyzed. The mean ± SD circumferential extension of the mucosal defect was 85 ± 11 %. The transcriptomic analysis in the resection bed at day 14 found an activation of the interleukin (IL)-1 group (Z score = 2.159, P = 0.0137), while interferon-gamma (INFγ) and NUPR1 were inhibited (Z score = -2.375, P = 0.0022 and Z score = -2.333, P = 0.00131) in the stricture group. None of the activated or inhibited transcripts were still significantly so in any of the groups on Day 90. Conclusions Our data suggest that IL-1 inhibition or INFγ supplementation could constitute promising targets for post-endoscopic esophageal stricture prevention.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Ludivine Doridot
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France,Department of Immunology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Morgane Le Gall
- 3P5 Proteom’IC facility, Université de Paris, Institut Cochin, INSERM, CNRS, F-75014, France
| | - Frédéric Beuvon
- Genomʼic CNRS UMR8104, Paris, France,Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Marion Dhooge
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Marine Camus
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Department of Gastroenterology, St Antoine Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Carole Nicco
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France
| | - Frédéric Batteux
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France,Department of Immunology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
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10
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Berger A, Perrod G, Pioche M, Barret M, Cesbron-Métivier E, Lépilliez V, Hupé M, Perez-Cuadrado-Robles E, Cholet F, Daubigny A, Texier C, Ali EA, Chabrun E, Jacques J, Wallenhorst T, Chevaux JB, Schaefer M, Cellier C, Rahmi G. Efficacy of Organ Preservation Strategy by Adjuvant Chemoradiotherapy after Non-Curative Endoscopic Resection for Superficial SCC: A Multicenter Western Study. Cancers (Basel) 2023; 15:cancers15030590. [PMID: 36765546 PMCID: PMC9913357 DOI: 10.3390/cancers15030590] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In case of high risk of lymph node invasion after endoscopic resection (ER) of superficial esophageal squamous cell carcinoma (SCC), adjuvant chemoradiotherapy (CRT) can be an alternative to surgery. We assessed long-term clinical outcomes of adjuvant therapy by CRT after non-curative ER for superficial SCC. METHODS We performed a retrospective multicenter study. From April 1999 to April 2018, all consecutive patients who underwent ER for SCC with tumor infiltration beyond the muscularis mucosae were included. RESULTS A total of 137 ER were analyzed. The overall nodal or metastatic recurrence-free survival rate at 5 years was 88% and specific recurrence-free survival rates at 5 years with and without adjuvant therapy were, respectively, 97.9% and 79.1% (p = 0.011). Independent factors for nodal and/or distal metastatic recurrence were age (HR = 1.075, p = 0.031), Sm infiltration depth > 200 µm (HR = 4.129, p = 0.040), and the absence of adjuvant CRT or surgery (HR = 11.322, p = 0.029). CONCLUSION In this study, adjuvant therapy is associated with a higher recurrence-free survival rate at 5 years after non-curative ER. This result suggests this approach may be considered as an alternative to surgery in selected patients.
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Affiliation(s)
- Arthur Berger
- CHU Bordeaux, Department of Gastroenterology and Digestive Endoscopy, Univ. Bordeaux, 33000 Bordeaux, France
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Paris-Cité University, 75015 Paris, France
- Correspondence: ; Tel.: +33-0-5-57-65-64-09
| | - Guillaume Perrod
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Paris-Cité University, 75015 Paris, France
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon 1 University Claude Bernard, 69003 Lyon, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Endoscopy, Cochin University Hospital, University of Paris, 75014 Paris, France
| | - Elodie Cesbron-Métivier
- Department of Hepatology and Gastroenterology, Angers Teaching Hospital, Angers University, 49000 Angers, France
| | - Vincent Lépilliez
- Department of Hepatogastroenterology, Jean Mermoz Private Hospital, Ramsay Santé, 69008 Lyon, France
| | - Marianne Hupé
- CHU Bordeaux, Department of Gastroenterology and Digestive Endoscopy, Univ. Bordeaux, 33000 Bordeaux, France
| | - Enrique Perez-Cuadrado-Robles
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Paris-Cité University, 75015 Paris, France
| | - Franck Cholet
- Department of Hepatology and Gastroenterology, Brest Teaching Hospital, Brest University, 29200 Brest, France
| | - Augustin Daubigny
- Department of Hepatology and Gastroenterology, Brest Teaching Hospital, Brest University, 29200 Brest, France
| | - Charles Texier
- Department of Hepatology and Gastroenterology, Angers Teaching Hospital, Angers University, 49000 Angers, France
- Department of Hepatology and Gastroenterology, Brest Teaching Hospital, Brest University, 29200 Brest, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Endoscopy, Cochin University Hospital, University of Paris, 75014 Paris, France
| | - Edouard Chabrun
- CHU Bordeaux, Department of Gastroenterology and Digestive Endoscopy, Univ. Bordeaux, 33000 Bordeaux, France
| | - Jérémie Jacques
- Department of Hepatology and Gastroenterology, Limoges Teaching Hospital, Limoges University, 87000 Limoges, France
| | - Timothee Wallenhorst
- Department of Hepatology and Gastroenterology, Rennes Teaching Hospital, Rennes University, 35033 Rennes, France
| | - Jean Baptiste Chevaux
- Department of Endoscopy and Hepatogastroenterology, Nancy Teaching Hospital, Nancy University, 54000 Nancy, France
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Nancy Teaching Hospital, Nancy University, 54000 Nancy, France
| | - Christophe Cellier
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Paris-Cité University, 75015 Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Paris-Cité University, 75015 Paris, France
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11
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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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12
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Weiss S, Pellat A, Corre F, Abou Ali E, Belle A, Terris B, Leconte M, Dohan A, Chaussade S, Coriat R, Barret M. Predictive factors of radiofrequency ablation failure in the treatment of dysplastic Barrett's esophagus. Clin Res Hepatol Gastroenterol 2023; 47:102065. [PMID: 36494071 DOI: 10.1016/j.clinre.2022.102065] [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: 10/02/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) has become the recommended endoscopic treatment for flat dysplastic Barrett's esophagus. However, the outcomes of this treatment are variable across European countries. Our aim was to report the results of a French high-volume center, and to investigate factors associated with treatment failure. METHODS We conducted a single-center retrospective study from a prospectively collected database from 2011 to 2020, including all consecutive patients treated with RFA for flat dysplastic Barrett's esophagus. The primary endpoint was the failure rate of esophageal radiofrequency treatment, defined as either persistence of intestinal metaplasia at the end of treatment, or neoplastic progression during RFA. RESULTS 96 patients treated with a median of four RFA sessions for a mean C5M6 Barrett's esophagus were included in the analysis. Complete eradication of intestinal metaplasia and dysplasia were achieved in 59% and 79% of patients, respectively, resulting in a treatment failure rate of 41%. Ten patients experienced neoplastic progression during treatment. We recorded 14% of post-RFA esophageal strictures, all successfully treated by endoscopic dilatation. Univariate analysis identified the length of Barrett's esophagus and the absence of hiatal hernia as predictive factors for treatment failure, however not confirmed in multivariate analysis. CONCLUSION In our experience, RFA of flat dysplastic Barrett's esophagus had a 41% treatment failure rate. The length of the Barrett's segment might be associated with treatment failure. Although our results confirm a role for RFA in the management of dysplastic Barrett's esophagus, the treatment failure rate was higher than expected. This suggest that endoscopists, even in high-volume centers, should receive specific training in RFA.
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Affiliation(s)
- Simon Weiss
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France
| | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Felix Corre
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; Université de Paris Cité, France.
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13
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Chaussade S, Pellat A, Corre F, Hallit R, Abou Ali E, Belle A, Barret M, Chaussade P, Coriat R. A new system to prevent SARS-CoV-2 and microorganism air transmission through the air circulation system of endoscopes. Endosc Int Open 2022; 10:E1589-E1594. [PMID: 36531679 PMCID: PMC9754862 DOI: 10.1055/a-1907-3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Evidence for the modes of transmission of SARS-CoV-2 remains controversial. Recently, the potential for airborne spread of SARS-CoV-2 has been stressed. Air circulation in gastrointestinal light source boxes and endoscopes could be implicated in airborne transmission of microorganisms. Methods The ENDOBOX SC is a 600 × 600 mm cube designed to contain any type of machine used during gastrointestinal endoscopy. It allows for a 100-mm space between a machine and the walls of the ENDOBOX SC. To use the ENDOBOX SC, it is connected to the medical air system and it provides positive flow from the box to the endoscopy room. The ENDOBOX SC uses medical air to inflate the digestive tract and to decrease the temperature induced by the microprocessors or by the lamp. ENDOBOX SC has been investigated in different environments. Results An endoscopic procedure performed without ventilation was interrupted after 40 minutes to prevent computer damage. During the first 30 minutes, the temperature increased from 18 °C to 31 °C with a LED system. The procedure with fans identified variations in temperature inside the ENDOBOX SC from 21 to 26 °C (± 5 °C) 1 hour after the start of the procedure. The temperature was stable for the next 3 hours. Conclusions ENDOBOX SC prevents the increase in temperature induced by lamps and processors, allows access to all necessary connections into the endoscopic columns, and creates a sterile and positive pressure volume, which prevents potential contamination from microorganisms.
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Affiliation(s)
- Stanislas Chaussade
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Anna Pellat
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Felix Corre
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Rachel Hallit
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Paul Chaussade
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Endoscopy Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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14
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Amoyel M, Belle A, Dhooge M, Ali EA, Pellat A, Hallit R, Terris B, Prat F, Chaussade S, Coriat R, Barret M. Outcomes of endoscopic mucosal resection for large superficial non-ampullary duodenal adenomas. Sci Rep 2022; 12:14592. [PMID: 36028514 PMCID: PMC9418143 DOI: 10.1038/s41598-022-18528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Endoscopic mucosal resection (EMR) is the recommended treatment for superficial non-ampullary duodenal epithelial tumors larger than 6 mm. This endoscopic technique carries a high risk of adverse events. Our aim was to identify the risk factors for adverse events following EMR for non-ampullary duodenal adenomatous lesions. We retrospectively analyzed a prospectively collected database of consecutive endoscopic resections for duodenal lesions at a tertiary referral center for therapeutic endoscopy. We analyzed patients with non-ampullary duodenal adenomatous lesions ≥ 10 mm resected by EMR, and searched for factors associated with adverse events after EMR. 167 duodenal adenomatous lesions, with a median size of 25 (25–40) mm, were resected by EMR between January 2015 and December 2020. Adverse events occurred in 37/167 (22.2%) after endoscopic resection, with 29/167 (17.4%) delayed bleeding, 4/167 (2.4%) immediate perforation and 4/167 (2.4%) delayed perforation. In logistic regression, the size of the lesion was the only associated risk factor of adverse events (OR = 2.81, 95% CI [1.27; 6.47], p = 0.012). Adverse events increased mean hospitalization time (7.7 ± 9 vs. 1.9 ± 1 days, p < 0.01). None of the currently recommended preventive methods, particularly clips, affected the adverse event rate. EMR of centimetric and supracentimetric duodenal adenomatous lesions carries a high risk of adverse events, increasing with the size of the lesion and with no benefit from any preventive method. These results suggest that these procedures should be performed in expert centers, and underline the need for novel endoscopic tools to limit the rate of adverse events.
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Affiliation(s)
- Maxime Amoyel
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Arthur Belle
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Marion Dhooge
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Einas Abou Ali
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris Cité, Paris, France
| | - Anna Pellat
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris Cité, Paris, France
| | - Rachel Hallit
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Benoit Terris
- Université de Paris Cité, Paris, France.,Pathology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France.,Université de Paris Cité, Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris Cité, Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris Cité, Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris Cité, Paris, France
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15
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Assaf A, Terris B, Palmieri LJ, Rouquette A, Beuvon F, Pellat A, Ali EA, Ginestet C, Belle A, Dhooge DM, Brezault DC, Hallit R, Dohan A, Chaussade S, Coriat R, Barret M. Endoscopic ultrasound guided fine needle biopsy in patients with suspected gastric linitis plastica. Clin Res Hepatol Gastroenterol 2022; 46:101903. [PMID: 35301155 DOI: 10.1016/j.clinre.2022.101903] [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: 01/27/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastric linitis plastica (GLP) is a diffuse infiltrating type of gastric adenocarcinoma. It is associated with a poor prognosis and a five-year survival of 3-10%. The infiltrating profile of this tumor explains the low yield of the superficial mucosal biospies. The objective of this study was to investigate the role of endoscopic ultrasound-fine needle biopsy (EUS-FNB) in the diagnosis of GLP. METHODS We performed a retrospective analysis including all patients who had an EUS-FNB, at a tertiary referral center, over the last 3 years. The primary outcome was the sensitivity of EUS-FNB in patients with suspected GLP. RESULTS Between January 2017 and December 2020, 34 patients had an EUS-FNB for suspected GLP. Ten patients had a diagnostic of GLP. This diagnosis was obtained by EUS-FNB in 90% (9/10) of the cases. Eight patients had at least one previous esophagogastroduodenoscopy (EGD) with negative mucosal biopsies. Gastric EUS-FNB helped diagnose other serious conditions in 47% (16/34) of cases with inconclusive mucosal biopsies. CONCLUSION Gastric EUS-FNB in patients with suspected GLP and normal endoscopic mucosal biopsies may lead to a positive diagnosis of GLP in 90% of cases without notable adverse events. This technique should be considered as a second step in the setting of suspicion of GLP after inconclusive mucosal biopsies.
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Affiliation(s)
- Antoine Assaf
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France.
| | - Benoit Terris
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Alexandre Rouquette
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Frédéric Beuvon
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Claire Ginestet
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Dr Marion Dhooge
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Dr Catherine Brezault
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
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16
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Chaussade S, Hallit R, Abou Ali E, Belle A, Barret M, Coriat R. SARS-CoV-2 in endoscopy: a potential way of microorganisms' air transmission. Gut 2022; 71:656-657. [PMID: 33952605 DOI: 10.1136/gutjnl-2021-324934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Stanislas Chaussade
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
| | - Rachel Hallit
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
| | - Arthur Belle
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Department - Université de Paris-GH APHP Centre, Hospital Cochin, Paris, Île-de-France, France
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17
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Hallit R, Barret M, Belle A, Abou Ali E, Dhooge M, Coriat R, Chaussade S. Appendoscopy in patients with serrated polyposis syndrome. Gut 2022; 71:653-654. [PMID: 33833068 DOI: 10.1136/gutjnl-2021-324679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/08/2022]
Affiliation(s)
- Rachel Hallit
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Marion Dhooge
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology Department, Hopital Cochin - GH APHP Centre - Université de Paris, Paris, France
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18
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Marchese U, Gaillard M, Pellat A, Tzedakis S, Abou Ali E, Dohan A, Barat M, Soyer P, Fuks D, Coriat R. Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors. Cancers (Basel) 2022; 14:433. [PMID: 35053593 PMCID: PMC8773540 DOI: 10.3390/cancers14020433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.
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Affiliation(s)
- Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Anthony Dohan
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Maxime Barat
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Philippe Soyer
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
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19
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Amoyel M, Belle A, Dhooge M, Ali EA, Hallit R, Prat F, Dohan A, Terris B, Chaussade S, Coriat R, Barret M. Endoscopic management of non-ampullary duodenal adenomas. Endosc Int Open 2022; 10:E96-E108. [PMID: 35047339 PMCID: PMC8759941 DOI: 10.1055/a-1723-2847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Duodenal polyps are found in 0.1 % to 0.8 % of all upper endoscopies. Duodenal adenomas account for 10 % to 20 % of these lesions. They can be sporadic or occur in the setting of a hereditary predisposition syndrome, mainly familial adenomatous polyposis. Endoscopy is the cornerstone of management of duodenal adenomas, allowing for diagnosis and treatment, primarily by endoscopic mucosal resection. The endoscopic treatment of duodenal adenomas has a high morbidity, reaching 15 % in a prospective study, consisting of bleeding and perforations, and should therefore be performed in expert centers. The local recurrence rate ranges from 9 % to 37 %, and is maximal for piecemeal resections of lesions > 20 mm. Surgical resection of the duodenum is flawed with major morbidity and considered a rescue procedure in cases of endoscopic treatment failures or severe endoscopic complications such as duodenal perforations. In this paper, we review the existing evidence on endoscopic diagnosis and treatment of non-ampullary duodenal adenomas.
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Affiliation(s)
- Maxime Amoyel
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Arthur Belle
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Marion Dhooge
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Einas Abou Ali
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,University of Paris, France.
| | - Rachel Hallit
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,University of Paris, France.
| | - Frederic Prat
- Gastroenterology Department, Beaujon Hospital, Assistance Publique – Hôpitaux de Paris, France,University of Paris, France.
| | - Anthony Dohan
- University of Paris, France.,Radiology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Benoit Terris
- University of Paris, France.,Pathology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,University of Paris, France.
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Gastroenterology Department, Beaujon Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Gastroenterology Department, Beaujon Hospital, Assistance Publique – Hôpitaux de Paris, France
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20
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de Carbonnières A, Challine A, Cottereau AS, Coriat R, Soyer P, Abou Ali E, Prat F, Terris B, Bertherat J, Dousset B, Gaujoux S. Surgical management of insulinoma over three decades. HPB (Oxford) 2021; 23:1799-1806. [PMID: 33975801 DOI: 10.1016/j.hpb.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma. METHODS A retrospective monocentric cohort study was performed from January 1989 to July 2019, including all the patients who had been operated on for pancreatic insulinoma. The preoperative work-up, surgical management, and postoperative outcome were analyzed. RESULTS Eighty patients underwent surgery for sporadic pancreatic insulinoma, 50 of which were female (62%), with a median age of 50 (36-70) years. Preoperatively, the tumors were localized in 76 patients (95%). Computed tomography (CT) and magnetic resonance imaging allowed exact preoperative tumor localization in 76% of the patients (64-85 and 58-88 patients, respectively), increasing to 96% when endoscopic ultrasonography was performed. Forty-one parenchyma-sparing pancreatectomies (PSP) (including enucleation, caudal pancreatectomy, and uncinate process resection) and 39 pancreatic resections were performed. The mortality rate was 6% (n = 5), with a morbidity rate of 72%, including 24 severe complications (30%) and 35 pancreatic fistulas (44%). No differences were found between formal pancreatectomy and PSP in terms of postoperative outcome procedures. The surgery was curative in all the patients. CONCLUSION CT used in combination with endoscopic ultrasonography allows accurate localization of insulinomas in almost all patients. When possible, a parenchyma-sparing pancreatectomy should be proposed as the first-line surgical strategy.
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Affiliation(s)
- Anne de Carbonnières
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Alexandre Challine
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Anne Ségolène Cottereau
- Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Cochin Hospital, APHP, 75014 Paris, France
| | - Romain Coriat
- Université de Paris, 75006 Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, 75014 Paris, France
| | - Philippe Soyer
- Université de Paris, 75006 Paris, France; Department of Radiology, Cochin Hospital, APHP, 75014 Paris, France
| | - Einas Abou Ali
- Université de Paris, 75006 Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, 75014 Paris, France
| | - Frédéric Prat
- Université de Paris, 75006 Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, 75014 Paris, France
| | - Benoit Terris
- Université de Paris, 75006 Paris, France; Department of Pathology, Cochin Hospital, APHP, 75014 Paris, France
| | - Jérôme Bertherat
- Université de Paris, 75006 Paris, France; Department of Endocrinology, Cochin Hospital, APHP, 75014 Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
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21
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Belle A, Lorut C, Lefebvre A, Ali EA, Hallit R, Leblanc S, Bordacahar B, Coriat R, Roche N, Chaussade S, Barret M. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9:E1350-E1354. [PMID: 34466358 PMCID: PMC8367450 DOI: 10.1055/a-1490-9001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.
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Affiliation(s)
- Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Lorut
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Lefebvre
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France
| | - Benoit Bordacahar
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Nicolas Roche
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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22
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Chartier M, Barat M, Dohan A, Belle A, Oudjit A, Abou Ali E, Hallit R, Leandri C, Scialom S, Coriat R, Chaussade S, Soyer P, Barret M. Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders. Endosc Int Open 2021; 9:E1355-E1360. [PMID: 34466359 PMCID: PMC8367446 DOI: 10.1055/a-1512-9638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background and study aims Per oral endoscopic myotomy (POEM) of the lower esophageal sphincter has become a major treatment for esophageal motility disorders, especially achalasia. POEM can result in esophageal bleeding or perforation and pleural and mediastinal effusion. Early routine computed tomography (CT) esophagogram is frequently performed to assess these adverse events (AEs) before resuming oral food intake. We sought to evaluate the value of routine CT esophagogram on postoperative day (POD) 1 after POEM. Patients and methods This single-center retrospective study was performed in a tertiary referral center for interventional digestive endoscopy. We included consecutive patients with POEM and routine CT esophagogram on POD 1 between July 2018 and July 2019. Results Fifty-eight patients were included in the study, 79 % of whom had achalasia. Twenty patients (34 %) presented post-endoscopic AEs, including two patients with severe AEs requiring intensive care admission (one compressive pneumothorax and one mediastinitis); no deaths occurred. Of the 58 CT esophagograms performed, only one was normal. The 57 others (98 %) showed at least one abnormal finding: pneumoperitoneum or retroperitoneal air (91 %), pneumomediastinum (78 %), pleural effusion (34 %), pneumothorax (14 %), pneumonia (7 %), pericardial effusion (2 %), and mediastinal collection (2 %). CT esophagograms revealed AEs and modified therapeutic management in eight patients of 58 (14 %), all of whom had clinical symptoms prior to CT. Conclusions POD 1 CT esophagogram after POEM for esophageal motility disorders diagnosed clinically meaningful AEs in 14 % of patients, all associated with persistent clinical symptoms. Routine use of CT esophagogram after POEM in asymptomatic patients is questionable.
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Affiliation(s)
- Marion Chartier
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Barat
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ammar Oudjit
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chloé Leandri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Scialom
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Philippe Soyer
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
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Doumbe-Mandengue P, Beuvon F, Belle A, Dermine S, Palmieri LJ, Abou Ali E, Hallit R, Leconte M, Dohan A, Bibault JE, Terris B, Chaussade S, Coriat R, Barret M. Outcomes of endoscopic submucosal dissection for early esophageal and gastric cardia adenocarcinomas. Clin Res Hepatol Gastroenterol 2021; 45:101700. [PMID: 33848673 DOI: 10.1016/j.clinre.2021.101700] [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: 12/05/2020] [Revised: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Adenocarcinomas of the esophagus and of the gastric cardia are regarded as a same clinical entity in oncology. For endoscopic resection however, endoscopic mucosal resection is recommended for esophageal adenocarcinoma, while endoscopic submucosal dissection (ESD) is advocated for gastric adenocarcinomas. Our aim was to compare the outcomes of ESD in both types of esophagogastric junction adenocarcinomas. METHODS Between March 2015 and December 2019, we included all patients who underwent an ESD for early adenocarcinoma of the esophagogastric junction at a French tertiary referral center. Esophageal and gastric cardia adenocarcinomas were compared in terms of clinical, procedural and histological outcomes. RESULTS 57 esophageal and 19 gastric cardia adenocarcinomas were included in the analysis, for a total of 76 patients. The median (IQR) size of the resections was 40 (40-57.5) and 50 (35-55)mm, p=0.96, respectively. En bloc resection was achieved in 100% and 89% for adenocarcinomas of the esophagus and the gastric cardia, p=0.06. Late adverse events occurred in 14% and 5.3%, respectively, p=0.44, with no severe adverse event. Curative resection rates were 67% and 63% for adenocarcinomas of the esophagus and the gastric cardia, respectively, p=0.89. CONCLUSION ESD is a safe treatment for T1 adenocarcinomas of the esophagogastric junction, curative in two thirds of the patients, in tumors arising from the esophagus or from the stomach. ESD should be considered for the routine resection of esophageal adenocarcinomas.
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Affiliation(s)
- Paul Doumbe-Mandengue
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Solène Dermine
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Jean-Emmanuel Bibault
- Department of Radiotherapy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, France.
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24
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Chaussade S, Ali EA, Hallit R, Belle A, Barret M, Coriat R. Air circulation in a gastrointestinal light source box and endoscope in the era of SARS-CoV-2 and airborne transmission of microorganisms. Endosc Int Open 2021; 9:E482-E486. [PMID: 33655053 PMCID: PMC7899790 DOI: 10.1055/a-1336-3280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/05/2020] [Indexed: 12/30/2022] Open
Abstract
Background and study aims The role that air circulation through a gastrointestinal endoscopy system plays in airborne transmission of microorganisms has never been investigated. The aim of this study was to explore the potential risk of transmission and potential improvements in the system. Methods We investigated and described air circulation into gastrointestinal endoscopes from Fujifilm, Olympus, and Pentax. Results The light source box contains a lamp, either Xenon or LED. The temperature of the light is high and is regulated by a forced-air cooling system to maintain a stable temperature in the middle of the box. The air used by the forced-air cooling system is sucked from the closed environment of the patient through an aeration port, located close to the light source and evacuated out of the box by one or two ventilators. No filter exists to avoid dispersion of particles outside the processor box. The light source box also contains an insufflation air pump. The air is sucked from the light source box through one or two holes in the air pump and pushed from the air pump into the air pipe of the endoscope through a plastic tube. Because the air pump does not have a dedicated HEPA filter, transmission of microorganisms cannot be excluded. Conclusions Changes are necessary to prevent airborne transmission. Exclusive use of an external CO 2 pump and wrapping the endoscope platform with a plastic film will limit scatter of microorganisms. In the era of pandemic virus with airborne transmission, improvements in gastrointestinal ventilation systems are necessary to avoid contamination of patients and health care workers.
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Affiliation(s)
- Stanislas Chaussade
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France,French Society for Digestive Endoscopy (SFED)
| | - Einas Abou Ali
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France,French Society for Digestive Endoscopy (SFED)
| | - Rachel Hallit
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France,French Society for Digestive Endoscopy (SFED)
| | - Arthur Belle
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France,French Society for Digestive Endoscopy (SFED)
| | - Maximilien Barret
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France,French Society for Digestive Endoscopy (SFED)
| | - Romain Coriat
- Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France
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Abou Ali E, Belle A, Hallit R, Terris B, Beuvon F, Leconte M, Dohan A, Leblanc S, Dermine S, Palmieri LJ, Coriat R, Chaussade S, Barret M. Management of esophageal strictures after endoscopic resection for early neoplasia. Therap Adv Gastroenterol 2021; 14:1756284820985298. [PMID: 33519974 PMCID: PMC7816530 DOI: 10.1177/1756284820985298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. METHODS We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. RESULTS Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett's neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0-4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2-7); range 1-17; p = 0.02], and in the case of circumferential resection [4.0 (3.0-7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. CONCLUSION Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.
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Affiliation(s)
- Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris France,University of Paris, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Solène Dermine
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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26
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Heise C, Abou Ali E, Hasenclever D, Auriemma F, Gulla A, Regner S, Gaujoux S, Hollenbach M. Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions. J Clin Med 2020; 9:jcm9113622. [PMID: 33182806 PMCID: PMC7696506 DOI: 10.3390/jcm9113622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I2 = 91.38%) for EA, 96.4% (93.6–99.2%, I2 = 37.8%) for SA and 98.9% (98.0–99.7%, I2 = 0%) for PD. AEs were 24.7% (19.8–29.6%, I2 = 86.4%), 28.3% (19.0–37.7%, I2 = 76.8%) and 44.7% (37.9–51.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I2 = 91.3%), 9.4% (4.8–14%, I2 = 57.3%) and 14.2% (9.5–18.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.
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Affiliation(s)
- Christian Heise
- Department of Medicine I—Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, 06097 Halle, Germany;
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, 75014 Paris, France;
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, 04103 Leipzig, Germany;
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Aiste Gulla
- Department of Abdominal Surgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 01513 Vilnius, Lithuania;
- General Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Sara Regner
- Department of Clinical Sciences Malmö, Section for Surgery, Lund University, 221 00 Lund, Sweden;
| | - Sébastien Gaujoux
- Department of Pancreatic and Endocrine Surgery, Pitié-Salpetriere Hospital, Médecine Sorbonne Université, 75000 Paris, France;
| | - Marcus Hollenbach
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-34-1971-2362
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Palmieri LJ, Dermine S, Abou Ali E, Lavolé J, Belle A, Beuvon F, Terris B, Chaussade S, Coriat R, Barret M. Early esophageal signet ring cell carcinoma: A contraindication to endoscopic resection? Clin Res Hepatol Gastroenterol 2020; 44:e98-e102. [PMID: 32033926 DOI: 10.1016/j.clinre.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/15/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Endoscopic resection is a standard-of-care for early esophageal neoplasia. Early gastric signet ring cell carcinoma (SRCC) can be safely managed by endoscopic resection, if the early SRCC is limited to the mucosa and less than 15mm, with a low lymph node metastasis rate. It is not known if esophageal signet ring cell carcinoma is amenable to endoscopic resection. METHODS We retrospectively collected demographic, procedural, oncologic and follow-up data from all patients with esophageal SRCC resected endoscopically at our institution, and compared them to those of patients with endoscopically resected poorly differentiated esophageal adenocarcinomas. RESULTS Between 2016 and 2018, 170 endoscopic resections were performed for esophageal neoplasms, among which 7 patients with SRCC and 6 patients with poorly differentiated early adenocarcinomas were identified. The histologically complete (R0) resection rate was 28.6% (2/7) for SRCC vs. 100% for poorly differentiated adenocarcinomas (P=0.04). The presence of lymphovascular invasion or deep submucosal invasion led to curative resection rates of 14.2% (1/7) and 66.6% (4/6) for SRCC and poorly differentiated adenocarcinomas, respectively (P=0.1). CONCLUSION Endoscopic resection of early esophageal SRCC is neither histologically complete, nor curative in the majority of cases. These data argue against upfront endoscopic resection when SRCC is evidenced on esophageal biopsies.
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Affiliation(s)
- Lola-Jade Palmieri
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France.
| | - Solène Dermine
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France
| | - Julie Lavolé
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France
| | | | - Benoît Terris
- University of Paris, Paris, France; Pathology Department, Cochin Hospital, 75014 Paris, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France
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Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regnér S, Gaujoux S. Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm-A Pancreas2000/EPC Study. Front Med (Lausanne) 2020; 7:152. [PMID: 32435644 PMCID: PMC7218136 DOI: 10.3389/fmed.2020.00152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Lesions of the Ampulla of Vater are a rare condition and represent <10% of peri-ampullary neoplasms. Nevertheless, ampullary adenomas have the potential for malignant transformation to ampullary carcinomas by an adenoma-to-carcinoma sequence. Thus, adequate patient selection and complete resection (R0) of non-invasive ampullary lesions either by endoscopic papillectomy (EP), surgical ampullectomy (SA), or pancreaticoduodenectomy (PD) is essential. Although PD was traditionally performed, recent studies reported considerable efficacy and fewer complications following EP and SA. Since consistent comparative data are lacking, the Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodectomy (ESAP) study will provide evidence for a therapeutic standard and post procedure morbidity in ampullary lesions. Methods: International multicenter retrospective study. Adult patients (>18 years of age) who underwent SA or PD for ampullary neoplasm between 2004 and 2018 or EP between 2007 and 2018 will be evaluated. Main inclusion criteria are ampullary lesions strictly located to the ampulla. This includes adenoma, adenocarcinoma (T1 and T2), neuroendocrine tumors, gastrointestinal stroma tumors and other rare conditions. Exclusion criteria are peri-ampullary lesions, e.g., from the duodenal wall or the head of the pancreas, and interventions for tumor stages higher than T2. The main objective of this study is to analyze rates of complete resection (R0), recurrence and necessity for complementary interventions following EP, SA, and PD. Treatment-quality for each procedure will be defined by morbidity, mortality and complication rates and will be compared between EP, SA, and PD. Secondary objectives include outcome for patients with incomplete resection or initially understated tumors, lesions of the minor papilla, hereditary syndromes, neuroendocrine tumors, mesenchymal lesions, and other rare conditions. Additionally, we will analyze therapy by argon plasma coagulation and radiofrequency ablation. Furthermore, outcome in curative and palliative interventions can be distinguished. Conclusion: The ESAP study will provide evidence for therapeutic algorithms and data for the implementation of guidelines in the treatment of different types of ampullary tumors, including recurrent, or incomplete resected lesions.
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Affiliation(s)
- Marcus Hollenbach
- Medical Department II—Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center of Abdominal Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Department of Surgery, Georgetown University University Hospital, Washington, DC, United States
| | - Christian Heise
- Department of Medicine I—Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Sara Regnér
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Skane University Hospital, Malmö, Sweden
| | - Sébastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
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Bresteau C, Barret M, Guillaumot MA, Abou Ali E, Belle A, Leblanc S, Oudjit A, Dohan A, Coriat R, Chaussade S. Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum? J Gastroenterol Hepatol 2020; 35:630-633. [PMID: 31693762 DOI: 10.1111/jgh.14923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/27/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Zenker's diverticulum (ZD) is the most common type of diverticulum in the esophagus. The endoscopic septotomy of the diverticular wall has become a widely accepted treatment modality, but the recurrence rate is unclear. Our aim was to assess short-term and long-term success rates after flexible endoscopic septotomy for the treatment of ZD. METHODS All consecutive patients treated at our department for a ZD between November 2014 and September 2018 were included. Endoscopic septotomy was conducted using a diverticuloscope or a distal attachment cap. Data were retrospectively analyzed from a prospectively collected database. We collected data concerning patients, endoscopic procedures, and short-term clinical outcomes. All patients were reached by phone between October and December 2018 to assess long-term results. RESULTS Seventy-seven patients were referred to our department for a ZD. Sixty patients were treated using a diverticuloscope and 17 patients with a distal attachment cap. For all 77 patients, the myotomy was technically successful. Three patients treated with a diverticuloscope reported complications. Initial treatment success was 93%. After a mean (±SEM) follow up of 23 ± 2 months, 66% of patients had persistent clinical remission. The rate of long-term treatment success was 72% in treatment-naïve and 50% in previously treated patients (P = 0.13). Treatment success was 68% in patients treated with the diverticuloscope versus 60% in the group treated with a cap (P = 0.75). CONCLUSION The flexible endoscopic septotomy for the treatment of ZD is a safe and effective treatment of ZD, with or without a diverticuloscope.
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Affiliation(s)
- Clément Bresteau
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Marie-Anne Guillaumot
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ammar Oudjit
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
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Dermine S, Palmieri LJ, Lavolé J, Barré A, Dohan A, Abou Ali E, Cottereau AS, Gaujoux S, Brezault C, Chaussade S, Coriat R. Non-Pharmacological Therapeutic Options for Liver Metastases in Advanced Neuroendocrine Tumors. J Clin Med 2019; 8:jcm8111907. [PMID: 31703375 PMCID: PMC6912565 DOI: 10.3390/jcm8111907] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
Abstract
The incidence of liver metastasis in digestive neuroendocrine tumors is high. Their presence appears as an important prognostic factor in terms of quality of life and survival. These tumors may be symptomatic because of the tumor burden itself and/or the hormonal hyper-secretion induced by the tumor. Surgery is the treatment of choice for resectable tumors and metastasis. Nevertheless, surgery is only possible in a small number of cases. The management of non-resectable liver metastasis is a challenge. The literature is rich but consists predominantly in small retrospective series with a low level of proof. Thus, the choice of one technique over another could be difficult. Local ablative techniques (radiofrequency) or trans-catheter intra-arterial liver-directed treatments (hepatic artery embolization, chemo-embolization, and radio-embolization) are frequently considered for liver metastasis. In the present review, we focus on these different therapeutic approaches in advanced neuroendocrine tumors, results (clinical and radiological), and overall efficacy, and summarize recommendations to help physicians in their clinical practice.
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Affiliation(s)
- Solène Dermine
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
- Correspondence: (S.D.); (R.C.); Tel.: +33-(1)58411952 (R.C.); Fax: +33-(1)58411965 (R.C.)
| | - Lola-Jade Palmieri
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
| | - Julie Lavolé
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
| | - Amélie Barré
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
| | - Antony Dohan
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
| | - Anne-Ségolène Cottereau
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
- Department of Nuclear Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Sébastien Gaujoux
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
- Digestive Surgery Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Catherine Brezault
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
| | - Romain Coriat
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.-J.P.); (J.L.); (A.B.); (E.A.A.); (C.B.); (S.C.)
- Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France; (A.D.); (A.-S.C.); (S.G.)
- Correspondence: (S.D.); (R.C.); Tel.: +33-(1)58411952 (R.C.); Fax: +33-(1)58411965 (R.C.)
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Haas M, Abou Ali E, Rouquette A, Coriat R, Chaussade S. Management of arterial bleeding after endoscopic resection of a neuroendocrine gastric tumor. VideoGIE 2019; 4:505-507. [PMID: 31709343 PMCID: PMC6835008 DOI: 10.1016/j.vgie.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Manon Haas
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology, Cochin Hospital, Paris, France
- Paris Descartes University, Université de Paris, Paris, France
| | - Alexandre Rouquette
- Paris Descartes University, Université de Paris, Paris, France
- Department of Pathology, Cochin Hospital, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin Hospital, Paris, France
- Paris Descartes University, Université de Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Paris, France
- Paris Descartes University, Université de Paris, Paris, France
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Affiliation(s)
- Einas Abou Ali
- Digestive disease and endoscopic departement, Cochin Hospital, Paris, France
| | - Maximilien Barret
- Digestive disease and endoscopic departement, Cochin Hospital, Paris, France
- Paris Descartes University, Université de Paris, Paris, France
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Oumrani S, Histace A, Abou Ali E, Pietri O, Becq A, Houist G, Nion-Larmurier I, Camus M, Florent C, Dray X. Multi-criterion, automated, high-performance, rapid tool for assessing mucosal visualization quality of still images in small bowel capsule endoscopy. Endosc Int Open 2019; 7:E944-E948. [PMID: 31367673 PMCID: PMC6656550 DOI: 10.1055/a-0918-5883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background and study aims Capsule endoscopy (CE) is the preferred method for small bowel (SB) exploration. Its diagnostic yield can be reduced by poor mucosal visualization. We aimed to evaluate three electronic parameters - colorimetry, abundance of bubbles, and brightness - to assess the adequacy of mucosal visualization of SB-CE images. Patients and methods Six-hundred still images were randomly extracted from 30 complete and normal SB-CEs. Three experts independently evaluated these images according to a 10-point assessment grid. Any frame with a mean score above seven was considered adequately cleansed. Each image was analyzed electronically according to the three preset parameters, individually and then combined, with the experts' score as reference. A random forests methodology was used for machine learning and testing. Results The combination of the three electronic parameters achieved better discrimination of adequately from inadequately cleansed frames as compared to each individual parameter taken separately (sensitivity 90.0 % [95 %C. I. 84.1 - 95.9], specificity 87.7 % [95 %C. I. 81.3 - 94.2]). Conclusion This multi-criterion score constitutes a comprehensive, reproducible, reliable, automated and rapid cleansing score for SB-CE frames. A patent is pending at the European patent office.
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Affiliation(s)
- Sarra Oumrani
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France
| | - Aymeric Histace
- ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, 95014 Cergy-Pontoise Cedex, France
| | - Einas Abou Ali
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France
| | - Olivia Pietri
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France
| | - Aymeric Becq
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France,Sorbonne University, Paris, France
| | - Guy Houist
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France
| | - Isabelle Nion-Larmurier
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France
| | - Marine Camus
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France,Sorbonne University, Paris, France
| | - Christian Florent
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France,Sorbonne University, Paris, France
| | - Xavier Dray
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Hepatology and Gastroenterology, Saint Antoine Hospital, Paris, France,Sorbonne University, Paris, France,ETIS, Université de Cergy-Pontoise, ENSEA, CNRS, 95014 Cergy-Pontoise Cedex, France,Corresponding author Xavier Dray, MD, PhD Endoscopy UnitSorbonne University & APHP Saint Antoine Hospital184 rue du Faubourg Saint Antoine75012 ParisFrance+0033-149-282970
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Ribiere S, Guillaumot MA, Barré A, Abou Ali E, Barret M, Chaussade S, Coriat R. Quel est le VRAI risque au long cours des inhibiteurs de la pompe à protons ? Presse Med 2019; 48:503-510. [DOI: 10.1016/j.lpm.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022] Open
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Abou Ali E, Bordacahar B, Mestas JL, Batteux F, Lafon C, Camus M, Prat F. Ultrasonic cavitation induces necrosis and impairs growth in three-dimensional models of pancreatic ductal adenocarcinoma. PLoS One 2018; 13:e0209094. [PMID: 30596678 PMCID: PMC6312319 DOI: 10.1371/journal.pone.0209094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/28/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma (PDAC) is a rapidly increasing cause of mortality whose dismal prognosis is mainly due to overwhelming chemoresistance. New therapeutic approaches include physical agents such as ultrasonic cavitation, but clinical applications require further insights in the mechanisms of cytotoxicity. 3-D in vitro culture models such as spheroids exploit realistic spatial, biochemical and cellular heterogeneity that may bridge some of the experimental gap between conventional in vitro and in vivo experiments. PURPOSE To assess the feasibility and efficiency of inertial cavitation associated or not with chemotherapy, in a spheroid model of PDAC. METHODS We used DT66066 cells, derived from a genetically-engineered murine PDAC, isolated from KPC-transgenic mice (LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx-1- Cre). Spheroids were obtained by either a standard centrifugation-based method, or by using a magnetic nano-shuttle method allowing the formation of spheroids within 24 hours and facilitating their handling. The spheroids were exposed to ultrasonic inertial cavitation in a specially designed setup. Eight or nine spheroids were analyzed for each of 4 conditions: control, gemcitabine alone, US cavitation alone, US cavitation + gemcitabine. Five US inertial cavitation indexes, corresponding to increased US intensities, were evaluated. The effectiveness of treatment was assessed after 24 hours with the following criteria: spheroid size (growth), ratio of phase S-entered cells (proliferation), proportion of cells in apoptosis or necrosis (mortality). These parameters were assessed by quantitative immunofluorescence techniques. RESULTS The 3D culture model presented excellent reproducibility. Cavitation induced a significant decrease in the size of spheroids, an effect significantly correlated to an increasing cavitation index (p < 0.0001). The treatment induced cell death whose predominant mechanism was necrosis (p < 0.0001). There was a tendency to a synergistic effect of US cavitation and gemcitabine at 5μM concentration, however significant in only one of the cavitation indexes used (p = 0. 013). CONCLUSION Ultrasonic inertial cavitation induced a significant reduction of tumor growth in a spheroid model of PDAC., with necrosis rather than apoptosis as a Cell dominant mechanism of cell death. More investigations are needed to understand the potential role of inertial cavitation in overcoming chemoresistance.
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MESH Headings
- Animals
- Antimetabolites, Antineoplastic/pharmacology
- Apoptosis/drug effects
- Carcinoma, Pancreatic Ductal/metabolism
- Carcinoma, Pancreatic Ductal/pathology
- Cell Culture Techniques
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/pharmacology
- Mice
- Mice, Transgenic
- Microscopy, Fluorescence
- Models, Biological
- Necrosis
- Oxidative Stress/drug effects
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/pathology
- Sonication
- Spheroids, Cellular/cytology
- Spheroids, Cellular/drug effects
- Spheroids, Cellular/metabolism
- Gemcitabine
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Affiliation(s)
- Einas Abou Ali
- Cochin Hospital, Gastroenterology and Endoscopy Department, Paris, France
- Cochin Institute, Paris, France
| | - Benoit Bordacahar
- Cochin Hospital, Gastroenterology and Endoscopy Department, Paris, France
- Cochin Institute, Paris, France
| | - Jean-Louis Mestas
- Inserm, U1032, LabTau, Lyon, France; Université de Lyon, Lyon, France
| | - Frederic Batteux
- Cochin Institute, Paris, France
- Paris Descartes University, Paris, France
| | - Cyril Lafon
- Inserm, U1032, LabTau, Lyon, France; Université de Lyon, Lyon, France
| | - Marine Camus
- Cochin Hospital, Gastroenterology and Endoscopy Department, Paris, France
- Cochin Institute, Paris, France
- Paris Descartes University, Paris, France
| | - Frederic Prat
- Cochin Hospital, Gastroenterology and Endoscopy Department, Paris, France
- Cochin Institute, Paris, France
- Paris Descartes University, Paris, France
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Becq A, Histace A, Camus M, Nion-Larmurier I, Abou Ali E, Pietri O, Romain O, Chaput U, Li C, Marteau P, Florent C, Dray X. Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy. Endosc Int Open 2018; 6:E844-E850. [PMID: 29978004 PMCID: PMC6031442 DOI: 10.1055/a-0577-2897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate "adequately cleansed" from "inadequately cleansed" CCE still frames. PATIENTS AND METHODS Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R + G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment. RESULTS Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5 % and a specificity of 77.7 %. Regarding the R/(R + G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5 % and a specificity of 62.9 %. CONCLUSION The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between "adequately cleansed" and "inadequately cleansed" CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.
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Affiliation(s)
- Aymeric Becq
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Aymeric Histace
- ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
| | - Marine Camus
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Isabelle Nion-Larmurier
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Einas Abou Ali
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Olivia Pietri
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Olivier Romain
- ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
| | - Ulriikka Chaput
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Cynthia Li
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,College of Arts and Sciences, Drexel University,
Philadelphia, Pennsylvania, United States
| | - Philippe Marteau
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Christian Florent
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Xavier Dray
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France,ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France,Corresponding author Xavier Dray, MD, PhD Department of Digestive DiseasesSaint-Antoine Hospital – APHP184 rue du Faubourg Saint-Antoine75571 Paris cedex 12France+0033-1-49-28-29-70
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Abou Ali E, Histace A, Camus M, Gerometta R, Becq A, Pietri O, Nion-Larmurier I, Li C, Chaput U, Marteau P, Florent C, Dray X. Development and validation of a computed assessment of cleansing score for evaluation of quality of small-bowel visualization in capsule endoscopy. Endosc Int Open 2018; 6:E646-E651. [PMID: 29868628 PMCID: PMC5979189 DOI: 10.1055/a-0581-8758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/25/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND STUDY AIMS An objective and reliable scoring system is needed to assess quality of visualization in small bowel (SB) capsule endoscopy (CE), for both clinical practice and research purposes. The aim of this study was to establish and to validate a SB-computed assessment of cleansing (SB-CAC) score. PATIENTS AND METHODS Thirty-three SB-CE were selected. A CAC score, defined as the ratio of the red over green pixels (R/G ratio), was calculated for each frame. Intervals were then determined, ranging from the lowest to the highest ratio among the extracted frames. Twelve frames were randomly selected in each of these intervals. Two hundred eighty-eight frames were shuffled and analyzed twice in random order by two experienced CE readers who were blinded to the CAC scores. Once an "adequately cleansed" or "inadequately cleansed" qualification was allotted to every still frame, a receiver operating characteristic (ROC) curve was created. In case of discrepancy between the two readers, the still frames were excluded. A second dataset of 288 different SB still frames was generated and read twice in random order by two other experienced SB-CE readers, using the same methodology. RESULTS A SB-CAC score threshold of 1.6 best achieved discrimination of adequately from inadequately cleansed frames, with a sensitivity of 92.7 % (95 %CI [89.7 - 95.8]) and a specificity of 92.9 % (95 %CI [89.9 - 95.9]). This threshold was validated using the second dataset, yielding the following performances: sensitivity 91.3 % (95 %CI [87.9 - 94.6]), specificity 94.7 % (95 %CI [92.1 - 97.3]). CONCLUSION An SB-CAC score of 1.6 has the highest sensitivity and specificity to discriminate "adequately cleansed" from "inadequately cleansed" SB-CE still frames. This constitutes an objective, reproducible, reliable, and automated cleansing score for SB-CE.
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Affiliation(s)
- Einas Abou Ali
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Aymeric Histace
- ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
| | - Marine Camus
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,Sorbonne University, Paris, France
| | | | - Aymeric Becq
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,Sorbonne University, Paris, France
| | - Olivia Pietri
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,Sorbonne University, Paris, France
| | - Isabelle Nion-Larmurier
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Cynthia Li
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania, United States
| | - Ulriikka Chaput
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Philippe Marteau
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,Sorbonne University, Paris, France
| | - Christian Florent
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,Sorbonne University, Paris, France
| | - Xavier Dray
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012, Paris, France,ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France,Sorbonne University, Paris, France,Corresponding author Xavier Dray, MD, PhD Endoscopy UnitSorbonne University & APHP Saint Antoine Hospital184 rue du Faubourg Saint Antoine75012 Paris, France+0033-1-49-28-29-70
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Pietri O, Rezgui G, Histace A, Camus M, Nion-Larmurier I, Li C, Becq A, Abou Ali E, Romain O, Chaput U, Marteau P, Florent C, Dray X. Development and validation of an automated algorithm to evaluate the abundance of bubbles in small bowel capsule endoscopy. Endosc Int Open 2018; 6:E462-E469. [PMID: 29616238 PMCID: PMC5880035 DOI: 10.1055/a-0573-1044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Bubbles can impair visualization of the small bowel (SB) mucosa during capsule endoscopy (CE). We aimed to develop and validate a computed algorithm that would allow evaluation of the abundance of bubbles in SB-CE still frames. PATIENTS AND METHODS Two sets of 200 SB-CE normal still frames were created. Two experienced SB-CE readers analyzed both sets of images twice, in a random order. Each still frame was categorized as presenting with < 10 % or ≥ 10 % of bubbles. Reproducibility (κ), sensitivity (Se), specificity (Sp), receiver operating characteristic curve, and calculation time were measured for different algorithms (Grey-level of co-occurrence matrix [GLCM], fractal dimension, Hough transform, and speeded-up robust features [SURF]) using the experts' analysis as reference. Algorithms with highest reproducibility, Se and Sp were then selected for a validation step on the second set of frames. Criteria for validation were κ = 1, Se ≥ 90 %, Sp ≥ 85 %, and a calculation time < 1 second. RESULTS Both SURF and GLCM algorithms had high operating points (Se and Sp over 90 %) and a perfect reproducibility (κ = 1). The validation step showed the GLCM detector strategy had the best diagnostic performances, with a Se of 95.79 %, a Sp of 95.19 %, and a calculation time of 0.037 seconds per frame. CONCLUSION A computed algorithm based on a GLCM detector strategy had high diagnostic performance allowing assessment of the abundance of bubbles in SB-CE still frames. This algorithm could be of interest for clinical use (quality reporting) and for research purposes (objective comparison tool of different preparations).
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Affiliation(s)
- Olivia Pietri
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France
| | - Gada Rezgui
- ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France
| | - Aymeric Histace
- ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France
| | - Marine Camus
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France,Sorbonne University, Paris, France
| | | | - Cynthia Li
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France,College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania, United States
| | - Aymeric Becq
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France
| | - Einas Abou Ali
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France
| | - Olivier Romain
- ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France
| | - Ulriikka Chaput
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France
| | - Philippe Marteau
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France,ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France
| | - Christian Florent
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France,ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France
| | - Xavier Dray
- APHP Saint Antoine Hospital, Department of Hepatogastroenterology, Paris, France,ETIS, ENSEA, Cergy-Pontoise University, Cergy-Pontoise, France,Sorbonne University, Paris, France,Corresponding author Xavier Dray Paris 6 University & APHPHôpital Saint Antoine – Digestive Diseases184 rue du Faubourg Saint AntoineParis 75012France(+33)149282970
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Shallaly GEHE, Ali EA, Ahmad NO. Development and Use of Checklists for Assessment of Medical Students in Clinical Examinations on Real Patients: A preliminary study. Sud Jnl Med Sci 2009. [DOI: 10.4314/sjms.v4i1.44870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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El Shallaly GEHA, Ali EA, Sahil S. Emergency Operations for Bleeding Duodenal Ulcer:A simple option to consider: Case Report. Sud Jnl Med Sci 2009. [DOI: 10.4314/sjms.v3i4.38556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Oral cancer accounts for around 1% of all new cancers diagnosed in the United Kingdom every year. Mortality rates remain relatively high and prognosis is worst in cases of more advanced disease at time of diagnosis. Early identification of malignant lesions and speedy referral to a specialist for treatment are therefore important. The reasons and extent of the delays at the different stages between a patient first noticing an oral lesion and attending a health care professional and then being referred for specialist care have previously been studied and consistently found to be longer than desired. The National Oral Cancer Awareness Week (NOCAW), first run in 1995, aimed to increase the awareness of oral cancer amongst health care professionals and the public. It has since been repeated and is now an annual event. Alongside publications by the British Dental Association and guidelines circulated by the Department of Health on oral cancer diagnosis and referral, it is hoped this will lead to a decrease in the delay between the onset of oral cancer and patients receiving appropriate treatment. We looked at the previously published data on referral delay in oral cancer both in the United Kingdom and overseas and then identified delays in referral of oral cancer patients in a region that had been studied before NOCAW was introduced, to see if this was having any effect on referral delays. We found that despite the great publicity raised by NOCAW and the other publications and courses on oral cancer since the original audit, patient delay and referral delay have not improved. We conclude that more needs to be done to transfer guidelines to everyday practice.
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Affiliation(s)
- N M H McLeod
- Department of Oral and Maxillofacial Surgery, Cheltenham General Hospital, Oxford, UK.
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Abstract
Lung abscesses in children often respond to conservative treatment. This is unlikely in children less than 7 years of age and in these surgery is associated with significant morbidity and mortality. We report a neonate and a 2.5 year old child successfully treated with percutaneous computed tomography guided aspiration of lung abscesses.
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Affiliation(s)
- A H Al-Salem
- Division of Pediatric Surgery, Department of Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
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Ali EA. Damage to plants due to industrial pollution and their use as bioindicators in Egypt. Environ Pollut 1993; 81:251-255. [PMID: 15091810 DOI: 10.1016/0269-7491(93)90207-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/1991] [Accepted: 06/12/1992] [Indexed: 05/24/2023]
Abstract
Effects of industrial air pollution on growth parameters of clover and Egyptian mallow were examined at three locations in the industrial area of Shoubra Elkheima, north of Cairo. Symptoms of plant damage appeared in the form of chlorosis and necrotic patterns. The decrease in chlorophyll reached more than 60% in plants cultivated in the industrial region. Plant growth and dry weights were reduced by more than 50%. The reduction in chlorophyll and growth parameters was correlated with the concentrations of air pollutants measured in the atmosphere of the locations examined. Moreover, clover and Egyptian mallow plants cultivated in the region of Shoubra Elkheima accumulated lead and cadmium, which can pass into the human food chain. It is concluded that these plants can be used as biomonitors for industrial air pollution.
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Affiliation(s)
- E A Ali
- Air Pollution Department, National Research Centre, Dokki, Cairo, Egypt
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Abstract
A total of 495 calves in 16 batches were examined (117 calves in 4 batches in 1979 and 378 in 12 batches in 1982). They were purchased in markets, transported by road to a farm in Somerset and reared on a milk substitute diet for a period of up to five weeks. Salmonella typhimurium phage type DT 193 was endemic in 1979 and phage type DT 204c in 1982. The mortality rates in the two years were 9.4% and 1.9% respectively. The causes of death were not investigated although the majority were probably due to salmonellosis. The rate of isolation of S. typhimurium from the rectal faeces of calves in all groups was either zero or relatively low on arrival. It rose to a peak (which was higher in 1979) in the second or third weeks before declining to low levels by the end of the fourth week of residence on the farm. Data from 162 calves, examined twice weekly for four weeks in 1982, indicated that the distribution of infected calves, based on the number of times that S. typhimurium was isolated from each, was not random. The calves could be assigned to two main categories; those from which the organism was never isolated and those from which it was isolated at least twice. This suggested that salmonella infected calves actively excreted the organism. The association between salmonella excretion and medication of sick animals with antibacterial drugs was strongest during the second week. Over the four-week period nearly 40% of the calves found to be excreting S. typhimurium were not treated, indicating a high incidence of subclinical infection. Salmonella excretion by the calves followed a regular pattern and infection was self-limiting within five weeks. The peak in the salmonella excretion rate and the mortality rate were higher in 1979 when phage type DT 193 was the endemic strain. However, in 1982 the calves received 100 p.p.m. furazolidone in their milk ration during the first week of their stay on the farm, and this may have contributed to the differences noted between the two years.
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