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Napoléon B, Lisotti A, Caillol F, Gasmi M, Ah-Soune P, Belle A, Charachon A, Cholet F, Eyraud PY, Grandval P, Gonzalez JM, Habersetzer F, Koch S, Le Rhun M, Mangialavori L, Musquer N, Palazzo M, Poincloux L, Privat J, Sportes A, Stouvenot M, Subtil C, Thomassin L, Vanbiervliet G, Vidal G, Vuitton L, Giovannini M, Barthet M. Risk factors for EUS-guided radiofrequency ablation adverse events in patients with pancreatic neoplasms: a large national French study (RAFPAN study). Gastrointest Endosc 2023; 98:392-399.e1. [PMID: 37059368 DOI: 10.1016/j.gie.2023.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/05/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS EUS-guided radiofrequency ablation (EUS-RFA) has been described as a potentially curative option for solid and cystic pancreatic neoplasms. We aimed to assess the safety and efficacy of pancreatic EUS-RFA in a large study population. METHODS A retrospective study retrieving all consecutive patients who underwent pancreatic EUS-RFA during 2019 and 2020 in France was conducted. Indication, procedural characteristics, early and late adverse events (AEs), and clinical outcomes were recorded. Risk factors for AEs and factors related to complete tumor ablation were assessed on univariate and multivariate analyses. RESULTS One hundred patients (54% men, 64.8 ± 17.6 years old) affected by 104 neoplasms were included. Sixty-four neoplasms were neuroendocrine neoplasms (NENs), 23 were metastases, and 10 were intraductal papillary mucinous neoplasms with mural nodules. No procedure-related mortality was observed, and 22 AEs were reported. Proximity of pancreatic neoplasms (≤1 mm) to the main pancreatic duct was the only independent risk factor for AEs (odds ratio [OR), 4.10; 95% confidence interval [CI), 1.02-15.22; P = .04). Fifty-nine patients (60.2%) achieved a complete tumor response, 31 (31.6%) a partial response, and 9 (9.2%) achieved no response. On multivariate analysis, NENs (OR, 7.95; 95% CI, 1.66-51.79; P < .001) and neoplasm size <20 mm (OR, 5.26; 95% CI, 2.17-14.29; P < .001) were independently related to complete tumor ablation. CONCLUSIONS The results of this large study confirm an overall acceptable safety profile for pancreatic EUS-RFA. Close proximity (≤1 mm) to the main pancreatic duct represents an independent risk factor for AEs. Good clinical outcomes in terms of tumor ablation were observed, especially for small NENs.
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Affiliation(s)
- Bertrand Napoléon
- Digestive Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Digestive Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Fabrice Caillol
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Mohamed Gasmi
- Digestive Endoscopy Unit, Hôpital Nord, Marseille, France
| | | | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Franck Cholet
- Digestive Endoscopy Unit, University Hospital, Brest, France
| | - Pierre-Yves Eyraud
- Hepato-Gastroenterology Department, University Hospital, Grenoble, France
| | | | | | | | - Stéphane Koch
- Digestive Endoscopy Unit, Jean Minjoz Hospital, Besançon, France
| | - Marc Le Rhun
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Luigi Mangialavori
- Digestive Endoscopy Unit, Hopital Privé A Brillard, Ramsay Sante, Nogent sur Marne, France
| | - Nicolas Musquer
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Maxime Palazzo
- Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Laurent Poincloux
- Digestive Endoscopy Unit, Estaing University Hospital, Clermont-Ferrand, France
| | | | - Adrien Sportes
- Digestive Endoscopy, Institut Arnault Tzanck Gastroenterology Unit, Saint-Laurent-du-Var, France
| | | | - Clement Subtil
- Digestive Endoscopy Unit, University Hospital, Bordeaux, France
| | - Lucie Thomassin
- Department of Gastroenterology, Rouen University Hospital, University of Rouen, France
| | | | - Guillaume Vidal
- Digestive Endoscopy Unit, Estaing University Hospital, Clermont-Ferrand, France
| | - Lucine Vuitton
- Digestive Endoscopy Unit, Jean Minjoz Hospital, Besançon, France
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Marc Barthet
- Digestive Endoscopy Unit, Hôpital Nord, Marseille, France
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Masson E, Ewers M, Paliwal S, Kume K, Scotet V, Cooper DN, Rebours V, Buscail L, Rouault K, Abrantes A, Aguilera Munoz L, Albouys J, Alric L, Amiot X, Archambeaud I, Audiau S, Bastide L, Baudon J, Bellaiche G, Bellon S, Bertrand V, Bideau K, Billiemaz K, Billioud C, Bonnefoy S, Borderon C, Bournet B, Breton E, Brugel M, Buscail L, Cadiot G, Camus M, Carpentier-Pourquier M, Chamouard P, Chaput U, Chen JM, Cholet F, Ciocan DM, Clavel C, Coffin B, Coimet-Berger L, Cosconea S, Creveaux I, Culetto A, Daboussi O, De Mestier L, Degand T, D'engremont C, Denis B, Dermine S, Drouet D'Aubigny A, Enaud R, Fabre A, Férec C, Gargot D, Gelsi E, Gentilcore E, Gincul R, Ginglinger-Favre E, Giovannini M, Gomercic C, Gondran H, Grainville T, Grandval P, Grasset D, Grimaldi S, Grimbert S, Hagege H, Heissat S, Hentic O, Herber-Mayne A, Hervouet M, Hoibian S, Jacques J, Jais B, Kaassis M, Koch S, Lacaze E, Lacroute J, Lamireau T, Laurent L, Le Guillou X, Le Rhun M, Leblanc S, Levy P, Lievre A, Lorenzo D, Maire F, Marcel K, Masson E, Mauillon J, Morgant S, Moussata D, Muller N, Nambot S, Napoleon B, Olivier A, Pagenault M, Pelletier AL, Pennec O, Pinard F, Pioche M, Prost B, Queneherve L, Rebours V, Reboux N, Rekik S, Riachi G, Rohmer B, Roquelaure B, Rosa Hezode I, Rostain F, Saurin JC, Servais L, Stan-Iuga R, Subtil C, Tanneche J, Texier C, Thomassin L, Tougeron D, Vuitton L, Wallenhorst T, Wangerme M, Zanaldi H, Zerbib F, Bhaskar S, Kikuta K, Rao GV, Hamada S, Reddy DN, Masamune A, Chandak GR, Witt H, Férec C, Chen JM. The PRSS3P2 and TRY7 deletion copy number variant modifies risk for chronic pancreatitis. Pancreatology 2023; 23:48-56. [PMID: 36517351 DOI: 10.1016/j.pan.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND PRSS1 and PRSS2 constitute the only functional copies of a tandemly-arranged five-trypsinogen-gene cluster (i.e., PRSS1, PRSS3P1, PRSS3P2, TRY7 and PRSS2) on chromosome 7q35. Variants in PRSS1 and PRSS2, including missense and copy number variants (CNVs), have been reported to predispose to or protect against chronic pancreatitis (CP). We wondered whether a common trypsinogen pseudogene deletion CNV (that removes two of the three trypsinogen pseudogenes, PRSS3P2 and TRY7) might be associated with CP causation/predisposition. METHODS We analyzed the common PRSS3P2 and TRY7 deletion CNV in a total of 1536 CP patients and 3506 controls from France, Germany, India and Japan by means of quantitative fluorescent multiplex polymerase chain reaction. RESULTS We demonstrated that the deletion CNV variant was associated with a protective effect against CP in the French, German and Japanese cohorts whilst a trend toward the same association was noted in the Indian cohort. Meta-analysis under a dominant model yielded a pooled odds ratio (OR) of 0.68 (95% confidence interval (CI) 0.52-0.89; p = 0.005) whereas an allele-based meta-analysis yielded a pooled OR of 0.84 (95% CI 0.77-0.92; p = 0.0001). This protective effect is explicable by reference to the recent finding that the still functional PRSS3P2/TRY7 pseudogene enhancers upregulate pancreatic PRSS2 expression. CONCLUSIONS The common PRSS3P2 and TRY7 deletion CNV was associated with a reduced risk for CP. This finding provides additional support for the emerging view that dysregulated PRSS2 expression represents a discrete mechanism underlying CP predisposition or protection.
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Affiliation(s)
- Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Maren Ewers
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Sumit Paliwal
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Virginie Scotet
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, CHU Rangueil and University of Toulouse, Toulouse, France
| | - Karen Rouault
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Hervouet
- Hôpital d'instruction des Armées Percy, Clamart, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seema Bhaskar
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Heiko Witt
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France.
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Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
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Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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