1
|
Fathallah N, Alam A, Rentien AL, La Greca G, Co J, Pommaret E, Barré A, Kegne S, Beaussier H, Spindler L, de Parades V. Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management. J Visc Surg 2024:S1878-7886(24)00030-4. [PMID: 38580520 DOI: 10.1016/j.jviscsurg.2024.03.005] [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] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION There are very few French studies on hemorrhoidal disease and its management. PATIENTS AND METHODS Prospective single-center study from July to December 2021 including 472 patients. RESULTS Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. CONCLUSION Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.
Collapse
Affiliation(s)
- Nadia Fathallah
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - Amine Alam
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Anne L Rentien
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Giorgio La Greca
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Joshua Co
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Elise Pommaret
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Amélie Barré
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Stéphane Kegne
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Hélène Beaussier
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Lucas Spindler
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Vincent de Parades
- Institut Léopold-Bellan, Service de Proctologie médicochirurgicale, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
2
|
Fathallah N, Akaffou M, Haouari MA, Spindler L, Alam A, Barré A, Pommaret E, Fels A, de Parades V. Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study. Tech Coloproctol 2023; 27:1201-1210. [PMID: 36811811 DOI: 10.1007/s10151-023-02765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. METHODS We prospectively studied the first patients receiving MSC injections at our center and undergoing 12 months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. RESULTS We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. CONCLUSIONS This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.
Collapse
Affiliation(s)
- N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - M Akaffou
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - M A Haouari
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Alam
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Barré
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Fels
- Clinical Research Centre, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
3
|
Fathallah N, Siproudhis L, Akaffou M, Haouari MA, Landemaine A, Pommaret E, Spindler L, Brochard C, Bouguen G, de Parades V. Allogenic stem cells for Crohn's anal fistulas: Treating early improves the deep remission rate. Colorectal Dis 2023; 25:2170-2176. [PMID: 37849054 DOI: 10.1111/codi.16782] [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: 03/05/2023] [Revised: 07/08/2023] [Accepted: 08/03/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim of this study was to evaluate the real-life clinical and radiological efficacy of darvadstrocel injection into complex perianal fistulas in Crohn's disease. Secondary endpoints were to assess symptomatic efficacy, adverse effects and factors associated with complete combined clinical-radiological response (deep remission). METHODS After marketing the product in France, all first patients treated consecutively were included. A complete clinical response was defined by a complete closure of all external openings with no discharge on pressure. A complete radiological response (MRI), evaluated at least after six months of follow-up, was defined by a completely fibrotic sequela without abscess. A deep remission was defined as the association of a complete clinical response with a complete radiological response. RESULTS A total of 43 patients were included (M/F: 22/21, median age 37 [26-45] years). The fistulas were already drained with seton(s) and were on biologic treatment. After a median follow-up of 383 (359-505) days, 28 (65%) patients showed a clinical response (22 complete and 6 partial) and 16 (37%) achieved a deep remission. The Perineal Disease Activity Index decreased significantly after treatment: 39 (91%) patients reported symptomatic improvement in terms of discharge, pain, and induration, and 28 (65%) no longer had any perineal symptoms. No severe adverse events were reported. A short history of Crohn's disease <3 years was significantly associated with deep remission (OD 4.5 [1.0-19.1], p = 0.04). CONCLUSION Darvadstrocel injection resulted in a clinical response for two thirds of patients and deep remission for one third. A shorter duration of Crohn's disease was associated with deep remission.
Collapse
Affiliation(s)
- Nadia Fathallah
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Laurent Siproudhis
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
| | - Mélissa Akaffou
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Amandine Landemaine
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elise Pommaret
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Lucas Spindler
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Charlène Brochard
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
- Physiology Unit, CHU-Ponchaillou, Rennes, France
| | - Guillaume Bouguen
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
| | - Vincent de Parades
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| |
Collapse
|
4
|
Fathallah N, Fels A, Benfredj P, Pommaret E, Beaussier H, de Parades V. Long-Term Efficacy of Artery Ligation with Mucopexy in Hemorrhoidal Disease: High Recurrence Rates but Most Patients Satisfied. J Gastrointest Surg 2023; 27:1936-1938. [PMID: 36988783 DOI: 10.1007/s11605-023-05667-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Nadia Fathallah
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Paul Benfredj
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Hélène Beaussier
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent de Parades
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
5
|
De Parades V, Haouari MA, Fathallah N, Spindler L, Barré A, Pommaret E, Benfredj P. [Anal fistulas: Sparing the sphincter]. Rev Prat 2023; 73:274-278. [PMID: 37289115] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ANAL FISTULAS SPARING THE SPHINCTER. Fistulotomy is the most used treatment for anal fistula. It is very effective with a cure rate of over 95% but carries a risk of incontinence. This has led to the development of various sphincter sparing techniques. The injection of biological glue or paste and the insertion of a plug have disappointing results and are expensive. The rectal advancement flap is still practised because of its cure rate of around 75% but it may result in some incontinence. Intersphincteric ligation of the fistula track and laser treatment are widely practised in France with cure rates between 60 and 70%. Video-assisted anal fistula treatment as well as injections of adipose tissue, stromal vascular fraction, platelet-enriched plasma and/or mesenchymal stem cells are emerging techniques for which even better results are expected.
Collapse
Affiliation(s)
- Vincent De Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | | | - Nadia Fathallah
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Amélie Barré
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Paul Benfredj
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
6
|
Draullette M, Spindler L, Fathallah N, Pommaret E, Alam A, de Parades V. Sinus laser therapy-A video vignette. Colorectal Dis 2023; 25:164. [PMID: 35916641 DOI: 10.1111/codi.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Mélanie Draullette
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Nadia Fathallah
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Amine Alam
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent de Parades
- Department of Medico Surgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
7
|
Fathallah N, Alam A, Pommaret E, Spindler L, Rentien AL, de Parades V. Injection of mesenchymal stem cells (darvadstrocel) into Crohn's perianal fistula - A video vignette. Colorectal Dis 2022; 24:1097. [PMID: 35384229 DOI: 10.1111/codi.16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/10/2021] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Nadia Fathallah
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Amine Alam
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Anne-Laure Rentien
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent de Parades
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
8
|
Alam A, Fathallah N, Spindler L, El Mituialy A, Pommaret E, Benfredj P, Rentien AL, Aubert M, Safa Far E, Fellous K, Abbes L, Beaussier H, de Parades V. Hemorrhoidal surgery in patients with IBD: caution is the parent of safety. Tech Coloproctol 2021; 25:1319-1321. [PMID: 34609635 DOI: 10.1007/s10151-021-02531-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the outcome of hemorrhoidal surgery in patients with inflammatory bowel disease (IBD) undergoing surgery at our center. METHODS All adult patients with IBD undergoing hemorrhoidal surgery in our department between November 1, 2013 and July 7, 2020 were included in the study. At the time of surgery, the patients' IBD was in clinical, biological and endoscopic remission, and none of the patients had specific primary anoperineal lesions. RESULTS We included 25 patients (48% female) with a mean age 48 years (± 13.1 years). There were 13 cases of CD (52%) and 12 of ulcerative colitis (UC). Pharmacological and instrumental hemorrhoidal treatment had failed in all patients. The CD lesions were exclusively ileal (77%) or ileocolic (23%). The surgical procedures performed for CD were mono-hemorrhoidectomy in three patients (21.4%), tripedicular hemorrhoidectomy in six patients (42.9%), and artery ligations with mucopexy in five patients (35.7%). UC was rectal (16.7%), rectosigmoid (66.7%), or pancolic (16.6%). The surgical procedures performed for UC were a tripedicular hemorrhoidectomy in ten patients (83.3%) and artery ligations with mucopexy in two patients (16.7%). The mean duration of postoperative follow-up was 15.1 months. None of the patients was lost to follow-up. The mean time to wound healing after resection was 71.1 days (± 21 days) for patients with CD and 56.9 days (± 6.7 days) for patients with UC (p = 0.05). Postoperative complications were reported for four patients with CD (28.8%) and two patients with UC (16.7%). There was no suppuration, stenosis, or anal incontinence sequelae. CONCLUSIONS Hemorrhoidal surgery resulted in a non-negligible frequency of complications in our series of IBD patients, especially in those with CD. Caution is, therefore, still necessary in this patient population.
Collapse
Affiliation(s)
- A Alam
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France.
| | - N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - A El Mituialy
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - P Benfredj
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - A L Rentien
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - M Aubert
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - E Safa Far
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - K Fellous
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - L Abbes
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| | - H Beaussier
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France
| |
Collapse
|
9
|
Alam A, Pommaret E, Fathallah N, Spindler L, Aubert M, de Parades V. Fistula closure by laser - a video vignette. Colorectal Dis 2021; 23:1596. [PMID: 33721387 DOI: 10.1111/codi.15627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Amine Alam
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Nadia Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Manuel Aubert
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
10
|
Boukris Toledano A, Blanchard P, Zaleski A, Benfredj P, Fathallah N, Sultan S, Pommaret E, de Parades V. Lessons from the first 70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology. Journal of Coloproctology 2021. [DOI: 10.1016/j.jcol.2017.12.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Doppler-guided haemorrhoidal artery ligation with mucopexy is a minimal-invasive surgical technique. It is both effective and less painful than conventional haemorrhoidectomy.
Methods We gathered records on all patients operated on between November 2012 and June 2014. Pre- and postoperative scores were calculated during consultation and then by phone. Unsuccessful surgical treatment was defined by persistent haemorrhoid symptoms within three months following the procedure and relapse defined by recurrent symptoms after the third postoperative month.
Results During the period analysed, 70 patients underwent consecutive surgical procedures for haemorrhoid prolapse (52%), bleeding (29%), or both (17%). Hospitalisation was outpatient or overnight for 87% of patients. There were no complications in 92.7% of cases. The average period away from work was 11 days (± 6.5). The time between the procedure and last postoperative consultation, followed by telephone contact, was respectively 2.7 months (± 5.8) and 16.5 months (± 4.9). At the time of the postoperative telephone call, the Thaha et al. score decreased by 5.6 (p < 0.001), while the quality of life score decreased by 2 (p < 0.001). The Wexner score remained the same or improved for all patients except one. Treatment was unsuccessful for 6/67 patients (9%) and 10/61 patients (16.4%) experienced a subsequent recurrence in haemorrhoid symptoms. Only those over 51 years old were statistically associated with more frequent recurrences (p = 0.044).
Conclusion Doppler-guided haemorrhoidal artery ligation with mucopexy is an effective technique in the medium-term. Good tolerance in makes this treatment an attractive alternative to conventional haemorrhoidectomy.
Collapse
Affiliation(s)
- Alexia Boukris Toledano
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Pierre Blanchard
- Institut Gustave Roussy, Epidemiology and Biostatistics, Villejuif, France
| | | | - Paul Benfredj
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
- Clinique du Louvre, Paris, France
| | - Nadia Fathallah
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Samy Sultan
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Elise Pommaret
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Vincent de Parades
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| |
Collapse
|
11
|
de Bonnechose G, Lefevre JH, Aubert M, Lemarchand N, Fathallah N, Pommaret E, Soudan D, Soudan D, Spindler L, de Parades V. Laser ablation of fistula tract (LAFT) and complex fistula-in-ano: "the ideal indication" is becoming clearer…. Tech Coloproctol 2020; 24:695-701. [PMID: 32333136 DOI: 10.1007/s10151-020-02203-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND An initial study enabled us to achieve 60% healing of high transsphincteric fistula-in-ano with laser ablation of fistula tract (LAFT) The purpose of this new study was to investigate other predictors of the success of this technique in the treatment of complex anoperineal fistulas. METHODS All patients treated with LAFT in our department between May 2017 and October 2018 were included prospectively. LAFT was used for patients with complex anoperineal fistulas who were at high risk of anal incontinence after fistulotomy. The fistula was considered healed when the internal and external openings were closed and the patient experienced no pain or leakage. RESULTS A total of 100 consecutive patients (65 males) with a median age of 43 years (range 22-88 years) were included in the study. Eight patients were lost to follow-up. The fistulas were low (8%) or high (79%) transsphincteric, and suprasphincteric (13%). After a median follow-up of 13.6 months (range 6-23 months), fistula healing was observed in 41 patients (44.6%). On univariate analysis, an anterior location, a narrow internal orifice and administration of less than 400 J of energy were significantly associated with healing. On multivariate analysis, a narrow internal orifice and low energy administration remained significant predictive factors of success [OR 5.08 (1.03-25.03), p = 0.046; OR 2.59 (1.08-6.17), p = 0.032]. No new cases of anal incontinence or any worsening of pre-existing anal incontinence was observed during follow up. CONCLUSIONS This study indicates that complex anoperineal fistulas with a narrow internal orifice can be successfully treated with less than 400 J and are ideal for LAFT.
Collapse
Affiliation(s)
- G de Bonnechose
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Sorbonne Université, APHP, Hôpital Saint Antoine, Paris, France
| | - M Aubert
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - N Lemarchand
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - D Soudan
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - D Soudan
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| |
Collapse
|
12
|
Marref I, Spindler L, Aubert M, Lemarchand N, Fathallah N, Pommaret E, Soudan D, Pillant-le Moult H, Safa Far E, Fellous K, Crochet E, Mory B, Benfredj P, de Parades V. The optimal indication for FiLaC ® is high trans-sphincteric fistula-in-ano: a prospective cohort of 69 consecutive patients. Tech Coloproctol 2019; 23:893-897. [PMID: 31559547 DOI: 10.1007/s10151-019-02077-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/25/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of our study was to prospectively evaluate the effectiveness of the Fistula Laser Closure (FiLaC®) technique in patients at high risk of anal incontinence and to determine the predictors of success and the impact of the procedure on anal continence. METHODS A prospective study was conducted on all patients treated with FiLaC® in our department in May 2016-April 2017, because they were at high risk of anal incontinence after fistulotomy, The fistula was considered healed when the internal and external openings were closed and the patient experienced was no pain or leakage. RESULTS A total of 69 consecutive patients (34 males) with a median age of 40 years (33-53 years) were included in the study. One patient was lost to follow up. The fistulas were intersphincteric (3%), low (15%) or high (66%) trans-sphincteric, and suprasphincteric (16%). After a median follow-up period of 6.3 months (4.2-9.3), fistula healing was observed in 31 patients (45.6%). In univariate analysis, high trans-sphincteric fistulas (p = 0.007) and age over 50 years (p = 0.034) were significantly associated with healing. In multivariate analysis, only high trans-sphincteric fistulas were a predictive factor of significant success. No new cases of anal incontinence or any worsening in case of pre-existing anal incontinence were observed during follow-up. CONCLUSIONS FiLaC® is particularly effective in cases of high trans-sphincteric fistulas (60% cure). This technique seems to be the most promising sphincter-saving technique available for this indication.
Collapse
Affiliation(s)
- I Marref
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - M Aubert
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - N Lemarchand
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - D Soudan
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - H Pillant-le Moult
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - E Safa Far
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - K Fellous
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - E Crochet
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - B Mory
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - P Benfredj
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| |
Collapse
|
13
|
Geffrier C, de Parades V, Abramowitz L, Benfredj P, Bonnaud G, Bord C, Bouchard D, Bouguen G, Devulder F, Didelot JM, Fathallah N, Higuero T, Lesage X, Nouts A, Petit P, Pigot F, Pommaret E, Roumeguere P, Siproudhis L, Staumont G, Zeitoun JD, Marteau P. Online training on how to diagnose anoperineal lesions of Crohn's disease: Do pictures matter? A nationwide randomized study. Clin Res Hepatol Gastroenterol 2019; 43:483-496. [PMID: 30935906 DOI: 10.1016/j.clinre.2018.12.003] [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: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Abstract
UNLABELLED Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees. METHOD Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion. RESULTS Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS). CONCLUSION There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes.
Collapse
Affiliation(s)
- C Geffrier
- Department of digestive diseases, CHU de Louis-Mourier, AP-HP, 92700 Colombes, France
| | - V de Parades
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - L Abramowitz
- Department of proctology and digestive diseases, CHU de Bichat, AP-HP, Paris, France
| | - P Benfredj
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - G Bonnaud
- Department of digestive diseases, clinique des Cèdres, 31700 Cornebarrieu, France
| | - C Bord
- Department of proctology, clinique Beau Soleil, 34070 Montpellier, France
| | - D Bouchard
- Department of proctology, hôpital Bagatelle, 33401 Talence, France
| | - G Bouguen
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - F Devulder
- Department of digestive diseases and proctology, polyclinique de Courlancy, 51100 Reims, France
| | - J M Didelot
- Department of proctology, Clinique Clementville, 34070 Montpellier, France
| | - N Fathallah
- Department of proctology, Clinique St Antoine, 06004 Nice, France
| | - T Higuero
- Department of proctology, 59280 Armentieres, France
| | - X Lesage
- Department of proctology, 94120 Fontenay-sous-Bois, France
| | - A Nouts
- Department of proctology, clinique Saint Augustin, 44000 Nantes, France
| | - P Petit
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - F Pigot
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - E Pommaret
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - P Roumeguere
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - L Siproudhis
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - G Staumont
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - J D Zeitoun
- Department of digestive diseases and proctology, CHU de Saint Antoine, AP-HP, 75012 Paris, France
| | - P Marteau
- Philippe-Marteau, université Paris Sorbonne, AP-HP, pole digestif, hôpital Saint Antoine 75012 Paris, France.
| |
Collapse
|
14
|
Spindler L, Pommaret E, Moyal Barracco M, Fathallah N, Plantier F, Duchatelle V, de Parades V. [Anal and vulvar hidradenoma papilliferum are similar: A study of 14 cases]. Ann Dermatol Venereol 2019; 146:537-541. [PMID: 31196616 DOI: 10.1016/j.annder.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/20/2018] [Revised: 01/26/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hidradenoma papilliferum (HP) is an adenomatous proliferation of mammary-like glands. These glands are located preferentially on the vaginal labia, the perineum and the anal skin. About ninety percent of HP occur on the vulva, with anal localization being much less common. AIM OF THE STUDY To analyze the clinical and histological characteristics of anal HP and compare them to those seen on the vulva based on the literature. METHOD A monocentric retrospective analysis (in the medical and surgical proctology department of the Saint-Joseph Hospital Group, Paris) of patients for whom a diagnosis of anal HP was made based on pathological analysis of a resected sample. RESULTS A total of 14 female patients were included between 2012 and 2018. The mean age was 48.2 years (22-70). The tumor, single in all cases, was asymptomatic with very slow progression. It was located on the anal skin in all patients. It generally consisted of a round nodule measuring under 1cm that was barely prominent, translucent, depressible and mobile. In 15% of patients the tumor was ulcerated. Histologically, the tumor displayed the usual characteristics of HP. Only one relapse was seen, six years after resection. CONCLUSION The clinical and histological aspects of anal HP are the same as those of the vulva, which are better documented, namely a small, rounded, pink, translucent or bluish, and mobile tumor, with a smooth surface, and more rarely ulceration or budding, and in most cases asymptomatic. All HP were diagnosed in women and were located at the anal margin. Histopathological examination of an excised sample confirms the diagnosis and rules out a malignant tumor. The frequency of anal HP may be underestimated.
Collapse
Affiliation(s)
- L Spindler
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - E Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Moyal Barracco
- Service de dermatologie, université Paris Descartes, hôpital Cochin, Assistance publique-hôpitaux de Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - N Fathallah
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - F Plantier
- Service d'anatomo-pathologie, université Paris Descartes, hôpital Cochin, Assistance publique-hôpitaux de Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - V Duchatelle
- Service d'anatomo-pathologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V de Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
| |
Collapse
|
15
|
Puia I, Pommaret E, Spindler L, Fathallah N, de Parades V. [Massive rectal bleeding after enemas for constipation]. Presse Med 2019; 48:578-580. [PMID: 30926205 DOI: 10.1016/j.lpm.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Iulia Puia
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Elise Pommaret
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Lucas Spindler
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Nadia Fathallah
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Vincent de Parades
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France.
| |
Collapse
|
16
|
Abstract
Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of postoperative incontinence. Different methods have been proposed to overcome the need for dividing part or all of the sphincter, so-called "sphincter saving techniques" (SST), such as flap advancement, intrafistular injection of glue, or the insertion of a bio-prosthesis (collagen plug). However, the success rate of SSTs is lower than that of fistulotomy. Ligation of the Intersphincteric Fistula Tract (LIFT) is one of the most recent SSTs. It aims to ligate and transect the fistula by an approach through the intersphincteric space. The methodological quality of most published studies has been only average, but several studies have reported attractive success rates of 70 to 95% without postoperative incontinence. Other techniques such as endo-anal clip or injection of autologous stem cells are still anecdotal.
Collapse
Affiliation(s)
- E Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - P Benfredj
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - D Soudan
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V de Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
17
|
Pommaret E, Vienne A, Lefevre JH, Sogni P, Florent C, Desaint B, Parc Y. Prevalence and risk factors for adenomas in the ileal pouch and the afferent loop after restorative proctocolectomy for patients with familial adenomatous polyposis. Surg Endosc 2013; 27:3816-22. [PMID: 23636532 DOI: 10.1007/s00464-013-2980-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 04/16/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the treatment of choice in familial adenomatous polyposis (FAP) to prevent the risk of colorectal cancer. However, it currently is recognized that adenomas may develop in the ileal pouch. The risk of adenoma occurring in the afferent ileal loop above the pouch is less clearly identified. This study aimed to evaluate the difference in prevalence of adenomas between the ileal pouch and the afferent ileum after IPAA in FAP. METHODS The study analyzed 442 endoscopies performed between 2003 and 2008 for 139 FAP patients. The patients had undergone an IPAA in 118 cases, an ileorectal anastomosis in 13 cases, or an ileostomy in 8 cases. RESULTS Among the 118 IPAA patients, 57 (48.3 %) had pouch adenomas a median of 15 years after surgery. The risk factors for pouch adenomas were delay since pouch construction [odds ratio (OR), 1.11; p = 0.016] and presence of advanced duodenal adenomas (OR, 4.35; p = 0.011). Seven patients had pouch adenomas with high-grade dysplasia. Only nine patients had afferent ileal loop adenomas (6.5 %). The only significant risk factor for ileal adenomas was the presence of pouch adenomas (OR, 2.16; p = 0.007). CONCLUSION After restorative proctocolectomy in FAP, adenoma recurrence is frequent in the pouch, with a higher risk for patients with advanced duodenal adenomas and an increasing risk over time, whereas adenomas are rarely found in the afferent ileal loop. This finding may help to propose redo ileal pouch anal anastomosis if required.
Collapse
Affiliation(s)
- Elise Pommaret
- Gastroenterology Department, Cochin Hospital, Paris, France
| | | | | | | | | | | | | |
Collapse
|
18
|
Abbes L, Coriat R, Pommaret E, Abitbol V, Brezault C, Massault PP, Chaussade S. Liver nodules in Crohn's ileitis. Inflamm Bowel Dis 2013; 19:E1. [PMID: 22081541 DOI: 10.1002/ibd.21924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
19
|
Camus M, Coriat R, Leblanc S, Brezault C, Terris B, Pommaret E, Gaudric M, Chryssostalis A, Prat F, Chaussade S. Helpfulness of the combination of acetic acid and FICE in the detection of Barrett's epithelium and Barrett's associated neoplasias. World J Gastroenterol 2012; 18:1921-5. [PMID: 22563172 PMCID: PMC3337567 DOI: 10.3748/wjg.v18.i16.1921] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/27/2011] [Accepted: 07/04/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the mucosal morphology in Barrett’s oesophagus by chromo and magnifying endoscopy.
METHODS: A prospective pilot study at a tertiary medical centre was conducted to evaluate the use of acetic acid pulverisation combined with virtual chromoendoscopy using Fujinon intelligent chromoendoscopy (FICE) for semiological characterization of the mucosal morphology in Barrett’s oesophagus and its neoplastic complications. Upper endoscopy using high definition white light, 2% acid acetic pulverisation and FICE with high definition videoendoscopy were performed in 20 patients including 18 patients who presented with aspects of Barrett’s oesophagus at endoscopy examination. Two patients used as controls had normal endoscopy and histological results. Prospectively, videos were watched blind from histological results by three trained FICE technique endoscopists.
RESULTS: The videos of patients with high-grade dysplasia showed an irregular mucosal pattern in 14% using high definition white light endoscopy and in 100% using acid acetic-FICE combined. Videos did not identify irregular vascular patterns using high definition white light endoscopy, while acid acetic-FICE combined visualised one in 86% of cases.
CONCLUSION: Combined acetic acid and FICE is a promising method for screening high-grade dysplasia and early cancer in Barrett’s oesophagus.
Collapse
|
20
|
Coriat R, Leblanc S, Pommaret E, Berretta O, Prat F, Chaussade S. Endoscopic management of endoscopic submucosal dissection perforations: a new over-the-scope clip device. Gastrointest Endosc 2011; 73:1067-9. [PMID: 21521573 DOI: 10.1016/j.gie.2010.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 10/25/2010] [Indexed: 02/08/2023]
|
21
|
Leblanc S, Pommaret E, Coriat R, Prat F. [Surveillance in Barrett's esophagus]. Presse Med 2011; 40:508-15. [PMID: 21450439 DOI: 10.1016/j.lpm.2011.02.017] [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: 01/31/2011] [Revised: 02/15/2011] [Accepted: 02/21/2011] [Indexed: 10/28/2022] Open
Abstract
Barrett's esophagus (BE) is a consequence of chronic gastroesophageal reflux. Barrett's esophagus is a well-established risk factor for adenocarcinoma. There is no effective method available to prevent the malignant transformation of Barrett's esophagus. Endoscopy is therefore the only means of patients' screening and monitoring. Endoscopic surveillance is recommended to detect precancerous or cancerous lesions at an early stage, where curative treatment can be proposed.
Collapse
Affiliation(s)
- Sarah Leblanc
- Assistance publique-Hôpitaux de Paris, CHU Cochin Port-Royal, service de gastroentérologie, 75014 Paris, France.
| | | | | | | |
Collapse
|
22
|
Coriat R, Leblanc S, Pommaret E, Chryssostalis A, Prat F, Chaussade S. Transmural air leak following endoscopic submucosal dissection: a non-useful computed tomography finding. Endoscopy 2010; 42:1117; author reply 1118. [PMID: 21120781 DOI: 10.1055/s-0030-1255920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
23
|
Coriat R, Pommaret E, Chryssostalis A, Viennot S, Gaudric M, Brezault C, Lamarque D, Roche H, Verdier D, Parlier D, Prat F, Chaussade S. Quality control of colonoscopy procedures: a prospective validated method for the evaluation of professional practices applicable to all endoscopic units. ACTA ACUST UNITED AC 2008; 33:103-8. [PMID: 18783903 DOI: 10.1016/j.gcb.2008.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/28/2008] [Accepted: 04/29/2008] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To produce valid information, an evaluation of professional practices has to assess the quality of all practices before, during and after the procedure under study. Several auditing techniques have been proposed for colonoscopy. The purpose of this work is to describe a straightforward original validated method for the prospective evaluation of professional practices in the field of colonoscopy applicable in all endoscopy units without increasing the staff work load. METHODS Pertinent quality-control criteria (14 items) were identified by the endoscopists at the Cochin Hospital and were compatible with: findings in the available literature; guidelines proposed by the Superior Health Authority; and application in any endoscopy unit. Prospective routine data were collected and the methodology validated by evaluating 50 colonoscopies every quarter for one year. RESULTS The relevance of the criteria was assessed using data collected during four separate periods. The standard checklist was complete for 57% of the colonoscopy procedures. The colonoscopy procedure was appropriate according to national guidelines in 94% of cases. These observations were particularly noteworthy: the quality of the colonic preparation was insufficient for 9% of the procedures; complete colonoscopy was achieved for 93% of patients; and 0.38 adenomas and 0.045 carcinomas were identified per colonoscopy. CONCLUSION This simple and reproducible method can be used for valid quality-control audits in all endoscopy units. In France, unit-wide application of this method enables endoscopists to validate 100 of the 250 points required for continuous medical training. This is a quality-control tool that can be applied annually, using a random month to evaluate any changes in routine practices.
Collapse
Affiliation(s)
- R Coriat
- Service de gastroentérologie, CHU Cochin, Faculté René-Descartes, Paris-V, 27, rue du faubourg Saint-Jacques, 75014 Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|