1
|
Marin FS, Assaf A, Oumrani S, Seta V, Gaudric M, Beuvon F, Belle A, Coriat R, Dupin N, Chaussade S, Barret M. Non eosinophilic chronic stricturing esophagitis: Lessons from thirty eight cases. Clin Res Hepatol Gastroenterol 2023; 47:102202. [PMID: 37657720 DOI: 10.1016/j.clinre.2023.102202] [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: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND AND AIMS The endoscopic workup of dysphagia can lead to the diagnosis of atypical esophagitis, with thickened esophageal mucosa, strictures, mucosal exudates, furrows, and sloughing. While these aspects suggest eosinophilic esophagitis, pathology might not report the presence of eosinophils, but rather chronic inflammation, with spongiosis, parakeratosis, and lymphocytic infiltrate. We aimed to report the management of this disease and assess the prevalence of associated dermatological conditions. METHODS We retrospectively evaluated the medical records of our patients with non-eosinophilic stricturing esophagitis for clinical, endoscopy, and pathology data. Patients were evaluated by a dermatologist. A blood immunoassay and skin biopsy were performed if needed. RESULTS Thirty-eight patients (twenty-six women) were included in the study. The median age at onset of symptoms was 56.5 years, with a median duration of symptoms of two years. Thirty-five patients presented with dysphagia at diagnosis and eighteen with weight loss. At endoscopy, a single esophageal stenosis was diagnosed in 19 patients, localized in the upper third in 22 patients. Thirty patients received endoscopic treatment (dilatation in 29/38 and local triamcinolone injection in 11/38 patients). In 21 patients, oral, skin or vulvo-anal lesions were found on dermatological examination. Nineteen patients received systemic treatment, including corticosteroids, immunosuppressive drugs and plasmapheresis. Five patients developed esophageal squamous cell carcinoma. CONCLUSION The management of non-eosinophilic chronic stricturing esophagitis is challenging, because of a low contribution of esophageal biopsies and the refractory nature of the strictures. In our experience, a dermatological evaluation helped in 55% of cases to introduce a systemic treatment, leading to limit the use of endoscopic dilatation. Endoscopic follow-up is needed, considering the significant risk of esophageal squamous cell carcinoma.
Collapse
Affiliation(s)
- Flavius-Stefan Marin
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France.
| | - Antoine Assaf
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris Cité, France
| | - Sarra Oumrani
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris Cité, France
| | - Vannina Seta
- Dermatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Marianne Gaudric
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Frédéric Beuvon
- Pathology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris Cité, France
| | - Nicolas Dupin
- University of Paris Cité, France; Dermatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris Cité, France
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris Cité, France
| |
Collapse
|
2
|
Dreanic J, Barret M, Dhooge M, Gaudric M, Leblanc S, Abitbol V, Prat F, Chaussade S, Coriat R. Small bowel capsule endoscopy: May we delegate it to nurses? Clin Res Hepatol Gastroenterol 2018; 42:168-173. [PMID: 29239850 DOI: 10.1016/j.clinre.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/05/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023]
Abstract
AIM Small bowel capsule endoscopy (CE) is a non-invasive and validated technique allowing the visualization of the small intestine mucosa. It generated more than 40,000 images per examination and induced a long median time of medical reading that may exceed 1 hour. In a transfer of skills' program, the CE reading might be transferred to nurses. We herein evaluate and present a feasibility study of the CE to nurses. METHODS Nurses experienced in endoscopy were trained for small bowel CE reading, selection and interpretation of pathological images. Two strategies were experienced: a partial delegation to nurses, restricted to the selection of picture and an interpretation of the selected pictures by experts in CE (strategy A) or a total delegation including the selection of pictures, their interpretation, and the realization of a report (strategy B). Nurses were volunteers to participate to the study. Strategies were compared to the reference procedure (control) and a blinded analysis of the CE by experts was performed. Selection of pictures and their interpretation were timely evaluated in all strategies. The stomach and small intestine transit times and the reading time were recorded. The accuracy of the whole CE interpretation was compared. Experts reviewed all discordant interpretations. RESULTS The extent of transit time in the stomach and the small intestine, and the identification of a normal endoscopic examination were not statistically different between strategy A and control (P=0.71). The accuracy of reports from strategy A and control was 95% (P=0.9). In one case, a nurse has not selected the pathological image, corresponding to a duodenal ulcer. The median medical time for reading was significantly shorter in strategy A than in control (9.2min [range: 4-20] vs 34.0min [range: 10-60]; P<0.01). The accuracy of reports performed by nurses in strategy B was 80% (P=0.11). In 4 cases, the medical interpretation in strategy B was discordant. The discrepancy was due to a lack of pathological images' selection of the selected pictures for the final report (n=1) and a lack of interpretation (n=3). The median time for analysis was not significantly different between strategy B and control (34.7 [range: 10-75] versus 34.0min [range: 15-60]; P=0.53). CONCLUSION In small bowel CE, a pre-selection of pathological images by a trained nurse could be integrated in a transfer of skills' program and appeared feasible. The gain of time for the gastroenterologists is significant and reduced the medical time for reading from 34 to 9minutes per examination. Meantime, an overall delegation of small bowel CE to nurses suffered for a lack of efficacy. Our study paved the way for a nurse' training program in the pre-selection and identification of CE images.
Collapse
Affiliation(s)
- Johann Dreanic
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Maximilien Barret
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Marion Dhooge
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Marianne Gaudric
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Sarah Leblanc
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Vered Abitbol
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Prat
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Stanislas Chaussade
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Romain Coriat
- Gastroenterology and endoscopy unit, hôpital Cochin, faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| |
Collapse
|
3
|
Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, Dousset B, Elizalde JI, Fumagalli U, Gaudric M, Merla A, Smout AJ, Tack J, Zaninotto G, Busch OR, Boeckxstaens GE. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65:732-9. [PMID: 26614104 DOI: 10.1136/gutjnl-2015-310602] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [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: 08/21/2015] [Accepted: 11/01/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking. DESIGN 201 newly diagnosed patients with achalasia were randomly assigned to PD (n=96) or LHM (n=105). Before randomisation, symptoms were assessed using the Eckardt score, functional test were performed and quality of life was assessed. The primary outcome was therapeutic success (presence of Eckardt score ≤3) at the yearly follow-up assessment. The secondary outcomes included the need for re-treatment, lower oesophageal sphincter pressure, oesophageal emptying and the rate of complications. RESULTS In the full analysis set, there was no significant difference in success rate between the two treatments with 84% and 82% success after 5 years for LHM and PD, respectively (p=0.92, log-rank test). Similar results were obtained in the per-protocol analysis (5-year success rates: 82% for LHM vs. 91% for PD, p=0.08, log-rank test). After 5 years, no differences in secondary outcome parameter were observed. Redilation was performed in 24 (25%) of PD patients. Five oesophageal perforations occurred during PD (5%) while 12 mucosal tears (11%) occurred during LHM. CONCLUSIONS After at least 5 years of follow-up, PD and LHM have a comparable success rate with no differences in oesophageal function and emptying. However, 25% of PD patients require redilation during follow-up. Based on these data, we conclude that either treatment can be proposed as initial treatment for achalasia. TRIAL REGISTRATION NUMBERS Netherlands trial register (NTR37) and Current Controlled Trials registry (ISRCTN56304564).
Collapse
Affiliation(s)
- An Moonen
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
| | - Vito Annese
- Head of Gastroenterology, Department of Emergency, AOU Careggi, Florence, Italy
| | - Ann Belmans
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU, Leuven, Belgium
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Bertrand Dousset
- Department of GI and Endocrine Surgery, Hôpital Cochin, Paris, France
| | - J I Elizalde
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Uberto Fumagalli
- Upper GI Surgery, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | | | - Antonio Merla
- Division of Gastroenterology, IRCCS, "Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andre J Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Tack
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
| | - Giovanni Zaninotto
- Department of Academic Surgery, St Mary's Hospital, Imperial College, London, UK
| | - Olivier R Busch
- Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Guy E Boeckxstaens
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Chaput U, Vienne A, Audureau E, Bauret P, Bichard P, Coumaros D, Napoléon B, Ponchon T, Duchmann JC, Laugier R, Lamouliatte H, Védrenne B, Gaudric M, Chaussade S, Robin F, Leblanc S, Prat F. Temporary placement of fully covered self-expandable metal stents for the treatment of benign biliary strictures. United European Gastroenterol J 2015; 4:403-12. [PMID: 27403307 DOI: 10.1177/2050640615606550] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/23/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Endoscopic treatment of benign biliary strictures (BBS) can be challenging. OBJECTIVE To evaluate the efficacy of fully covered self-expandable metal stents (FCSEMS) in BBS. METHODS Ninety-two consecutive patients with BBS (chronic pancreatitis (n = 42), anastomotic after liver transplantation (n = 36), and post biliary surgical procedure (n = 14)) were included. FCSEMS were placed across strictures for 6 months before endoscopic extraction. Early success rate was defined as the absence of biliary stricture or as a minimal residual anomaly on post-stent removal endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes were the final success and stricture recurrence rates as well as procedure-related morbidity. RESULTS Stenting was successful in all patients. Stenting associated complications were minor and occurred in 22 (23.9%) patients. Migration occurred in 23 (25%) patients. Stent extraction was successful in all but two patients with proximal stent migration. ERCP after the 6 months stenting showed an early success in 84.9% patients (chronic pancreatitis patients: 94.7%, liver transplant: 87.9%, post-surgical: 61.5%) (p = 0.01). Final success was observed in 57/73 (78.1%) patients with a median follow-up of 12 ± 3.56 months. Recurrence of biliary stricture occurred in 16/73 (21.9%) patients. CONCLUSIONS FCSEMS placement is efficient for patients with BBS, in particular for chronic pancreatitis patients. Stent extraction after 6 months indwelling, although generally feasible, may fail in a few cases.
Collapse
Affiliation(s)
| | - Ariane Vienne
- Gastroenterology Department, Cochin Hospital, Paris, France
| | - Etienne Audureau
- Public Health Department, Henri Mondor Hospital, LIC EA4393 Paris Est Créteil University (UPEC), Paris, France
| | - Paul Bauret
- Gastroenterology Department, Saint Eloi Hospital, Montpellier, France
| | - Philippe Bichard
- Gastroenterology Department, La Tronche Hospital, Grenoble, France
| | - Dimitri Coumaros
- Gastroenterology Department, Civil Hospital of Strasbourg, Strasbourg, France
| | - Bertrand Napoléon
- Gastroenterology Department, Private Hospital Jean Mermoz, Lyon, France
| | - Thierry Ponchon
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | | | - René Laugier
- Gastroenterology Department, La Timone Hospital, Marseille, France
| | | | - Bruno Védrenne
- Gastroenterology Department, Emile Muller Hospital, Mulhouse, France
| | | | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital, Paris, France; Paris-Descartes University, Paris, France
| | - Françoise Robin
- French Society of Digestive Endoscopy, Lyon and Paris, France
| | - Sarah Leblanc
- Gastroenterology Department, Cochin Hospital, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Cochin Hospital, Paris, France; Paris-Descartes University, Paris, France
| |
Collapse
|
5
|
Sacher-Huvelin S, Calès P, Bureau C, Valla D, Vinel JP, Duburque C, Attar A, Archambeaud I, Benamouzig R, Gaudric M, Luet D, Couzigou P, Planche L, Galmiche JP, Coron E. Screening of esophageal varices by esophageal capsule endoscopy: results of a French multicenter prospective study. Endoscopy 2015; 47:486-92. [PMID: 25730284 DOI: 10.1055/s-0034-1391393] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIM Esophageal video capsule endoscopy (ECE) is a new technique that allows examination of the esophagus using a noninvasive approach. The aim of this study was to compare ECE with esophagogastroduodenoscopy (EGD) for the diagnosis of esophageal varices in patients with cirrhosis. PATIENTS AND METHODS A total of 330 patients with cirrhosis and with no known esophageal varices were prospectively enrolled. Patients underwent ECE first, followed by EGD (gold standard). The endoscopists who performed EGD were blind to the ECE result. Patient satisfaction was assessed using a visual analog scale (maximum score 100). RESULTS A total of 30 patients were excluded from the analysis because they did not undergo any endoscopic examinations. Patients (mean age 56 years; 216 male) had mainly alcoholic (45 %) or viral (27 %) cirrhosis. The diagnostic indices of ECE to diagnose and correctly stage esophageal varices were: sensitivity 76 % and 64 %, specificity 91 % and 93 %, positive predictive value 88 % and 88 %, and negative predictive value 81 % and 78 %, respectively. ECE patient satisfaction scored significantly higher than EGD (87 ± 22 vs. 58 ± 35; P < 0.0001). CONCLUSIONS ECE was well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension. The sensitivity of ECE is not currently sufficient to replace EGD as a first exploration in these patients. However, due to its excellent specificity and positive predictive value, ECE may have a role in cases of refusal or contraindication to EGD. ECE might also improve compliance to endoscopic follow-up and aid important therapeutic decision making in the prophylaxis of bleeding. TRIAL REGISTRATION EudraCT (ID RCB 2009-A00532-55) and ClinicalTrials.gov (NCT00941421).
Collapse
Affiliation(s)
| | - Paul Calès
- Department of Hepatology, CHU Angers, Angers. France
| | - Christophe Bureau
- Department of Hepato- gastroenterology, CHU Toulouse, Toulouse, France
| | - Dominique Valla
- Liver Unit, DHU UNITY, Hôpital Beaujon, HUPNVS, APHP; Université Paris Diderot et Inserm UMR U1149, Clichy, France
| | - Jean Pierre Vinel
- Department of Hepato- gastroenterology, CHU Toulouse, Toulouse, France
| | | | - Alain Attar
- Liver Unit, DHU UNITY, Hôpital Beaujon, HUPNVS, APHP; Université Paris Diderot et Inserm UMR U1149, Clichy, France
| | - Isabelle Archambeaud
- Department of Gastroenterology, IMAD, CHU and University of Nantes, Nantes, France
| | | | | | | | | | - Lucie Planche
- Department of Biostatistics, CHU Nantes, Nantes, France
| | - Jean Paul Galmiche
- Department of Gastroenterology, IMAD, CHU and University of Nantes, Nantes, France
| | - Emmanuel Coron
- Department of Gastroenterology, IMAD, CHU and University of Nantes, Nantes, France
| |
Collapse
|
6
|
Rahmi G, Lecomte T, Malka D, Maniere T, Le Rhun M, Guimbaud R, Lapalus MG, Le Sidaner A, Moussata D, Caron O, Barbieux JP, Gaudric M, Coron E, Barange K, Ponchon T, Sautereau D, Samaha E, Saurin JC, Chaussade S, Laurent-Puig P, Chatellier G, Cellier C. Impact of chromoscopy on adenoma detection in patients with Lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study. Am J Gastroenterol 2015; 110:288-98. [PMID: 25601014 DOI: 10.1038/ajg.2014.423] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 05/06/2014] [Accepted: 12/02/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome. METHODS We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected. RESULTS A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001). CONCLUSION The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.
Collapse
Affiliation(s)
- Gabriel Rahmi
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Thierry Lecomte
- 1] Université François-Rabelais, Paris, France [2] Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - David Malka
- Département de Médecine Oncologique, Unité d'oncologie digestive, Institut Gustave Roussy, Villejuif, France
| | - Thibault Maniere
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Le Rhun
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Rosine Guimbaud
- 1] Service d'oncologie, Hôpital Purpan, Toulouse, France [2] Université de Toulouse 3 University, Toulouse, France
| | | | - Anne Le Sidaner
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Driffa Moussata
- Service de Gastroentérologie, Hôpital Lyon Sud, Lyon, France
| | - Olivier Caron
- Service d'oncogénétique, Institut Gustave Roussy, Villejuif, France
| | - Jean-Pierre Barbieux
- Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - Marianne Gaudric
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Emmanuel Coron
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Karl Barange
- Service d'Hépato-gastroentérologie, Hôpital Purpan, Toulouse, France
| | - Thierry Ponchon
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France
| | - Denis Sautereau
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Elia Samaha
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Stanislas Chaussade
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Pierre Laurent-Puig
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'oncogénétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chatellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, Hôpital européen Georges Pompidou, Paris, France
| | - Christophe Cellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| |
Collapse
|
7
|
Launay D, Savale L, Berezne A, Le Pavec J, Hachulla E, Mouthon L, Sitbon O, Lambert B, Gaudric M, Jais X, Stephan F, Hatron PY, Lamblin N, Vignaux O, Cottin V, Farge D, Wallaert B, Guillevin L, Simonneau G, Mercier O, Fadel E, Dartevelle P, Humbert M, Mussot S. Lung and heart-lung transplantation for systemic sclerosis patients. A monocentric experience of 13 patients, review of the literature and position paper of a multidisciplinary Working Group. Presse Med 2014; 43:e345-63. [DOI: 10.1016/j.lpm.2014.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/23/2014] [Indexed: 12/14/2022] Open
|
8
|
Chaput U, Heresbach D, Audureau E, Vanbiervliet G, Gaudric M, Bichard P, Bauret P, Coumaros D, Ponchon T, Fumex F, Bensoussan E, Lamouliatte H, Chryssostalis A, Robin F, Prat F. Comparison of a standard fully covered stent with a super-thick silicone-covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study. United European Gastroenterol J 2014; 1:93-102. [PMID: 24917946 DOI: 10.1177/2050640613476501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 12/07/2012] [Accepted: 01/07/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents. OBJECTIVE Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS). PATIENTS AND METHODS The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N = 24), and BS-FCMS were used in group 2 (N = 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months' recurrence rate and stent-related morbidity. RESULTS Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p < 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p = 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p = 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6-12 months) and 1 month (group 2, 0.1-6 months). Study limitations include its nonrandomized design. CONCLUSION The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.
Collapse
Affiliation(s)
- Ulriikka Chaput
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Denis Heresbach
- Hepato-gastroenterology Department, Hôpital Pontchaillou, Rennes, France
| | - Etienne Audureau
- Biostatistical and Epidemiology Unit, Hôpital Hôtel Dieu, Université Paris Descartes, Paris, France
| | | | - Marianne Gaudric
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Philippe Bichard
- Hepato-gastroenterology Department, Centre Hospitalier Universitaire La Tronche, Grenoble, France
| | - Paul Bauret
- Hepato-gastroenterology Department, Hôpital Saint Eloi, Montpellier, France
| | - Dimitri Coumaros
- Hepato-gastroenterology Department, Hôpital Civil de Strasbourg, Strasbourg, France
| | - Thierry Ponchon
- Hepato-gastroenterology Department, Hôpital Edouard Herriot, Lyon, France
| | - Fabien Fumex
- Hepato-gastroenterology Department, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint Priest en Jarez, France
| | | | - Hervé Lamouliatte
- Hepato-gastroenterology Department, Hôpital Saint-André, Bordeaux, France
| | - Ariane Chryssostalis
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Françoise Robin
- Société Française d'Endoscopie Digestive, Lyon and Paris, France
| | - Frédéric Prat
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| |
Collapse
|
9
|
Laurain A, de Leusse A, Gincul R, Vanbiervliet G, Bramli S, Heyries L, Martane G, Amrani N, Serraj I, Saurin JC, Borentain P, Filoche B, Duburque C, Gaudric M, Sogni P, Dumortier J. Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: a prospective multicentre study. Dig Liver Dis 2014; 46:535-40. [PMID: 24631032 DOI: 10.1016/j.dld.2014.02.002] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/22/2014] [Accepted: 02/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam Eso capsule endoscopy in this setting. METHODS Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures. RESULTS 80 patients (80% males, mean age: 57±12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2-930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication. CONCLUSION This study demonstrates that accuracy of PillCam Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.
Collapse
Affiliation(s)
- Anne Laurain
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France
| | - Antoine de Leusse
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Jean Mermoz Hospital, Lyon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Rodica Gincul
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Geoffroy Vanbiervliet
- Archet II Hospital, Department of Digestive Diseases, Nice, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Slim Bramli
- Avignon Hospital, Department of Digestive Diseases, Avignon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Laurent Heyries
- Conception Hospital - AP-HM, Department of Digestive Diseases, Marseille, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Gabriel Martane
- Avignon Hospital, Department of Digestive Diseases, Avignon, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Naima Amrani
- Ibn Sina Hospital, Department of Digestive Diseases, Rabat, Morocco; Société Française d'Endoscopie Digestive, Paris, France
| | - Ilham Serraj
- Ibn Sina Hospital, Department of Digestive Diseases, Rabat, Morocco
| | - Jean-Christophe Saurin
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France; Lyon Sud Hospital, Department of Digestive Diseases, Pierre Benite, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Patrick Borentain
- Conception Hospital - AP-HM, Department of Digestive Diseases, Marseille, France
| | - Bernard Filoche
- Saint Philibert Hospital, Department of Digestive Diseases, Lomme, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Clotilde Duburque
- Saint Philibert Hospital, Department of Digestive Diseases, Lomme, France
| | - Marianne Gaudric
- Cochin Hospital - AP-HP, Department of Digestive Endoscopy, Paris, France; Société Française d'Endoscopie Digestive, Paris, France
| | - Philippe Sogni
- Cochin Hospital - AP-HP, Department of Digestive Endoscopy, Paris, France
| | - Jérôme Dumortier
- Edouard Herriot Hospital - HCL, Department of Digestive Diseases, Claude Bernard Lyon 1 University, Lyon, France.
| |
Collapse
|
10
|
Alatawi A, Leblanc S, Vienne A, Pratico CA, Gaudric M, Duchmann JC, Boyer J, Mangialavori L, Chaussade S, Prat F. Pancreatoscopy-guided intracorporeal laser lithotripsy for difficult pancreatic duct stones: a case series with prospective follow-up (with video). Gastrointest Endosc 2013; 78:179-83. [PMID: 23540440 DOI: 10.1016/j.gie.2013.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 08/30/2012] [Accepted: 02/11/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Abdullah Alatawi
- Department of Gastroenterology and Digestive Endoscopy, Cochin Hospital APHP, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Dhooge M, Gaudric M. Non-surgical access for enteral nutritional: gastrostomy and jejunostomy, technique and results. J Visc Surg 2013; 150:S19-26. [PMID: 23790717 DOI: 10.1016/j.jviscsurg.2013.05.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gastrostomy is the most efficient and best tolerated method of prolonged nutritional support. Jejunostomy is used more rarely. Indications for both techniques have increased because of progress in insertion techniques under endoscopic or radiologic guidance. The procedure is simple and rapid, performed under simple sedation with a success rate over 95% for gastrostomy, irrespective of the technique. Mortality directly related to the technique is less than 5%, but associated co-morbidity also explains a more variable but often higher 30-day mortality. Local care and maintenance of the catheter should help avoid most of the late complications such as peristomal leaks, local infection or sepsis of the tunneled catheter in the abdominal wall. The main indications are neurologic swallowing disorders, mechanical dysphagia from ENT or esophageal disease, when the expected duration of enteral nutrition is at least longer than 3 weeks. In patients with severe dementia, no benefit for either nutritional status or quality of life has been demonstrated. In all cases, adequate patient information and careful evaluation of the risk/benefit ratio are capital.
Collapse
Affiliation(s)
- M Dhooge
- Service de gastroentérologie, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | | |
Collapse
|
12
|
Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, Elizalde JI, Gaudric M, Smout AJ, Tack J, Busch OR, Zaninotto G, Boeckxstaens GE. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 2013; 144:718-25; quiz e13-4. [PMID: 23277105 DOI: 10.1053/j.gastro.2012.12.027] [Citation(s) in RCA: 280] [Impact Index Per Article: 25.5] [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: 10/06/2012] [Revised: 12/08/2012] [Accepted: 12/20/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients with achalasia are treated with either pneumatic dilation (PD) or laparoscopic Heller myotomy (LHM), which have comparable rates of success. We evaluated whether manometric subtype was associated with response to treatment in a large population of patients treated with either PD or LHM (the European achalasia trial). METHODS Esophageal pretreatment manometry data were collected from 176 patients who participated in the European achalasia trial. Symptoms (weight loss, dysphagia, retrosternal pain, and regurgitation) were assessed using the Eckardt score; treatment was considered successful if the Eckardt score was 3 or less. Manometric tracings were classified according to the 3 Chicago subtypes. RESULTS Forty-four patients had achalasia type I (25%), 114 patients had achalasia type II (65%), and 18 patients had achalasia type III (10%). After a minimum follow-up period of 2 years, success rates were significantly higher among patients with type II achalasia (96%) than type I achalasia (81%; P < .01, log-rank test) or type III achalasia (66%; P < .001, log-rank test). The success rate of PD was significantly higher than that of LHM for patients with type II achalasia (100% vs 93%; P < .05), but LHM had a higher success rate than PD for patients with type III achalasia (86% vs 40%; P = .12, difference was not statistically significant because of the small number of patients). For type I achalasia, LHM and PD had similar rates of success (81% vs 85%; P = .84). CONCLUSIONS A higher percentage of patients with type II achalasia (based on manometric tracings) are treated successfully with PD or LHM than patients with types I and III achalasia. Success rates in type II are high for both treatment groups but significantly higher in the PD group. Patients with type III can probably best be treated by LHM. Trialregister.nl number NTR37; ISRCTN56304564.
Collapse
Affiliation(s)
- Wout O Rohof
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abbes L, Leconte M, Coriat R, Dousset B, Chaussade S, Gaudric M. [Achalasia: role of endoscopic therapy and surgery]. Presse Med 2012; 42:814-8. [PMID: 22959337 DOI: 10.1016/j.lpm.2012.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/25/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022] Open
Abstract
Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia.
Collapse
Affiliation(s)
- Leila Abbes
- CHU Cochin Port Royal, université Sorbonne Paris V, faculté de médecine, service de gastroentérologie, 75014 Paris, France
| | | | | | | | | | | |
Collapse
|
14
|
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
|
15
|
Prost à la Denise J, Hubert D, Gaudric M, Scatton O, Soubrane O. Pancreatic mucinous cystadenoma in an adult with cystic fibrosis. Clin Res Hepatol Gastroenterol 2011; 35:759-61. [PMID: 21856266 DOI: 10.1016/j.clinre.2011.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/24/2011] [Accepted: 06/28/2011] [Indexed: 02/06/2023]
Abstract
Cystic fibrosis (CF) is the most frequent genetic disease in the Caucasian population. It seems to be associated with an increased risk of digestive cancer but only few cases of pancreatic tumors have been reported. As pancreatic lesions of the pancreas in CF patients are not rare, their etiological diagnosis is substantial. We report herein a case of a mucinous cystadenoma in a patient with CF. Diagnosis and management of pancreatic cystic tumors in patients at high risk of operative morbidity are challenging. When the potential malignancy of a pancreatic cystic mass cannot be well established in a CF patient, partly because of frequent chronic pancreatitis lesions, we suggest that surgical management should be undertaken instead of radiological surveillance.
Collapse
Affiliation(s)
- Justine Prost à la Denise
- Service de chirurgie hépatobiliaire et de transplantation hépatique, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | | | | | | | | |
Collapse
|
16
|
Chaput U, Alberto SF, Terris B, Beuvon F, Audureau E, Coriat R, Roche H, Gaudric M, Prat F, Chaussade S. Risk factors for advanced adenomas amongst small and diminutive colorectal polyps: a prospective monocenter study. Dig Liver Dis 2011; 43:609-12. [PMID: 21764012 DOI: 10.1016/j.dld.2011.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 08/12/2010] [Revised: 01/20/2011] [Accepted: 02/01/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The management of colorectal polyps <10mm in diameter is controversial. Our aim was to evaluate the rate and risk factors for advanced adenomas and high grade neoplasia amongst small (6-9 mm) and diminutive (1-5mm) colorectal polyps. METHODS Endoscopic and pathological reports of colonoscopies performed in our centre were collected prospectively. Advanced adenoma was defined by presence of a villous component and/or high grade dysplasia; high grade neoplasia by presence of high grade dysplasia and/or intramucosal carcinoma. RESULTS 1468 patients were included (53.1% male, mean age 59.5±14 years); 414 polyps <10mm were detected, 9.9% advanced adenomas and 1.7% high grade neoplasia. Amongst small polyps, 25 (35.2%) were advanced adenomas, mainly due to villous features, and 3 (4.2%) were high grade neoplasia. Polyp size was associated with advanced adenomas (odds ratio=8.47). CONCLUSION The rate of advanced adenomas amongst small polyps was 35%, mainly due to the presence of villous features. Polyp size was identified as a risk factor of advanced adenoma amongst polyps <10mm. Given these results, we believe that polypectomy should be warranted for patients presenting with small polyps at computed tomography colonography.
Collapse
Affiliation(s)
- Ulriikka Chaput
- Hepato-gastroenterology Department, CHU Cochin Port-Royal, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Pioche M, Gaudin JL, Filoche B, Jacob P, Lamouliatte H, Lapalus MG, Duburque C, Chaput U, Ben Soussan E, Daudet J, Tournan R, Gaudric M, Edery J, Cellier C, Halluin PN, Saurin JC. Prospective, randomized comparison of two small-bowel capsule endoscopy systems in patients with obscure GI bleeding. Gastrointest Endosc 2011; 73:1181-8. [PMID: 21628014 DOI: 10.1016/j.gie.2011.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [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: 11/23/2010] [Accepted: 02/14/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Video capsule endoscopy is the first-intention examination in patients with obscure GI bleeding. The new MiroCam capsule, when using electric-field propagation for transmission, has been poorly evaluated in a clinical setting, in contrast with the PillCam SB2 capsule. OBJECTIVE To evaluate the diagnostic concordance (κ value) between PillCam SB2 and MiroCam capsule examinations performed in the same patients. DESIGN AND SETTING Prospective, randomized study in 7 endoscopy units. PATIENTS AND INTERVENTION Eighty-three consecutive patients, ingesting the 2 capsules at a 1-hour interval. RESULTS Seventy-three patients were analyzed (10 technical issues). There were 31 concordant negative cases (42.4%) and 30 concordant positive cases (41.1%). The study showed satisfactory diagnostic concordance between the 2 systems (κ = 0.66). In 12 patients (16.4%), the final diagnosis was different: 9 patients had positive findings on MiroCam examination but no image detected with PillCam SB2, 2 had positive findings on PillCam examination only, and 1 patient had 2 different diagnoses. A positive diagnosis was obtained in 46.6% and 56.2% of patients with PillCam SB2 and MiroCam capsule, respectively, so that the procedures identified 78.6% and 95.2% of positive cases, respectively (P = .02). Small-bowel transit time and capsule reading time were significantly longer in MiroCam procedures. LIMITATIONS Technical failures possibly related to capsule interference. CONCLUSION This study shows at least comparable efficiency of the MiroCam compared with the PillCam SB2 capsule system for the diagnosis of obscure GI bleeding.
Collapse
Affiliation(s)
- Mathieu Pioche
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364:1807-16. [PMID: 21561346 DOI: 10.1056/nejmoa1010502] [Citation(s) in RCA: 551] [Impact Index Per Article: 42.4] [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: 12/13/2022]
Abstract
BACKGROUND Many experts consider laparoscopic Heller's myotomy (LHM) to be superior to pneumatic dilation for the treatment of achalasia, and LHM is increasingly considered to be the treatment of choice for this disorder. METHODS We randomly assigned patients with newly diagnosed achalasia to pneumatic dilation or LHM with Dor's fundoplication. Symptoms, including weight loss, dysphagia, retrosternal pain, and regurgitation, were assessed with the use of the Eckardt score (which ranges from 0 to 12, with higher scores indicating more pronounced symptoms). The primary outcome was therapeutic success (a drop in the Eckardt score to ≤3) at the yearly follow-up assessment. The secondary outcomes included the need for retreatment, pressure at the lower esophageal sphincter, esophageal emptying on a timed barium esophagogram, quality of life, and the rate of complications. RESULTS A total of 201 patients were randomly assigned to pneumatic dilation (95 patients) or LHM (106). The mean follow-up time was 43 months (95% confidence interval [CI], 40 to 47). In an intention-to-treat analysis, there was no significant difference between the two groups in the primary outcome; the rate of therapeutic success with pneumatic dilation was 90% after 1 year of follow-up and 86% after 2 years, as compared with a rate with LHM of 93% after 1 year and 90% after 2 years (P=0.46). After 2 years of follow-up, there was no significant between-group difference in the pressure at the lower esophageal sphincter (LHM, 10 mm Hg [95% CI, 8.7 to 12]; pneumatic dilation, 12 mm Hg [95% CI, 9.7 to 14]; P=0.27); esophageal emptying, as assessed by the height of barium-contrast column (LHM, 1.9 cm [95% CI, 0 to 6.8]; pneumatic dilation, 3.7 cm [95% CI, 0 to 8.8]; P=0.21); or quality of life. Similar results were obtained in the per-protocol analysis. Perforation of the esophagus occurred in 4% of the patients during pneumatic dilation, whereas mucosal tears occurred in 12% during LHM. Abnormal exposure to esophageal acid was observed in 15% and 23% of the patients in the pneumatic-dilation and LHM groups, respectively (P=0.28). CONCLUSIONS After 2 years of follow-up, LHM, as compared with pneumatic dilation, was not associated with superior rates of therapeutic success. (European Achalasia Trial Netherlands Trial Register number, NTR37, and Current Controlled Trials number, ISRCTN56304564.).
Collapse
|
19
|
Saurin JC, Pilleul F, Soussan EB, Manière T, D'Halluin PN, Gaudric M, Cellier C, Heresbach D, Gaudin JL. Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome. Endoscopy 2010; 42:1057-62. [PMID: 20821360 DOI: 10.1055/s-0030-1255742] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND STUDY AIMS Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation. PATIENTS AND METHODS We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination. RESULTS Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58). CONCLUSION Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.
Collapse
Affiliation(s)
- J-C Saurin
- Centre Hospitalier Lyon Sud, Pierre Bénite, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Chaput U, Scatton O, Bichard P, Ponchon T, Chryssostalis A, Gaudric M, Mangialavori L, Duchmann JC, Massault PP, Conti F, Calmus Y, Chaussade S, Soubrane O, Prat F. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc 2010; 72:1167-74. [PMID: 20970790 DOI: 10.1016/j.gie.2010.08.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [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: 02/16/2010] [Accepted: 08/12/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Management of anastomotic biliary strictures after liver transplantation deserves optimization. OBJECTIVE To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting. DESIGN Prospective, multicenter, uncontrolled study. SETTING Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers. PATIENTS Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting. INTERVENTIONS PCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal. MAIN OUTCOME MEASUREMENT The ability to remove PCSEMS. RESULTS PCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective. LIMITATIONS Uncontrolled study with limited follow-up. CONCLUSIONS Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.
Collapse
Affiliation(s)
- Ulriikka Chaput
- Hepato-gastroenterology Department, Hôpital Cochin, Paris-Descartes University, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sacher-Huvelin S, Coron E, Gaudric M, Planche L, Benamouzig R, Maunoury V, Filoche B, Frédéric M, Saurin JC, Subtil C, Lecleire S, Cellier C, Coumaros D, Heresbach D, Galmiche JP. Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer. Aliment Pharmacol Ther 2010; 32:1145-53. [PMID: 21039676 DOI: 10.1111/j.1365-2036.2010.04458.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a new, non-invasive technology. AIM To conduct a prospective, multicentre trial to compare CCE and colonoscopy in asymptomatic subjects enrolled in screening or surveillance programmes for the detection of colorectal neoplasia. METHODS Patients underwent CCE on day one and colonoscopy (gold standard) on day two. CCE and colonoscopy were performed by independent endoscopists. RESULTS A total of 545 patients were recruited. CCE was safe and well-tolerated. Colon cleanliness was excellent or good in 52% of cases at CCE. Five patients with cancer were detected by colonoscopy, of whom two were missed by CCE. CCE accuracy for the detection of polyps ≥ 6 mm was 39% (95% CI 30-48) for sensitivity, 88% (95% CI 85-91) for specificity, 47% (95% CI 37-57) for positive predictive value and 85% (95% CI 82-88) for negative predictive value. CCE accuracy was better for the detection of advanced adenoma, in patients with good or excellent cleanliness and after re-interpretation of the CCE videos by an independent expert panel. CONCLUSIONS Although well-tolerated, CCE cannot replace colonoscopy as a first line investigation for screening and surveillance of patients at risk of cancer. Further studies should pay attention to colonic preparation (Clinicaltrial.gov number NCT00436514).
Collapse
|
22
|
Vienne A, Hobeika E, Gouya H, Lapidus N, Fritsch J, Choury AD, Chryssostalis A, Gaudric M, Pelletier G, Buffet C, Chaussade S, Prat F. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72:728-35. [PMID: 20883850 DOI: 10.1016/j.gie.2010.06.040] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [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: 11/19/2009] [Accepted: 06/23/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal endoscopic approach to the drainage of malignant hilar strictures remains controversial, especially with regard to the extent of desirable drainage and unilateral or bilateral stenting. OBJECTIVE To identify useful criteria for predicting successful endoscopic drainage. DESIGN AND SETTING Retrospective 2-center study in the greater Paris area in France. PATIENTS A total of 107 patients who had undergone endoscopic stenting for hilar tumors Bismuth type II, III, or IV and a set of contemporaneous cross-sectional imaging data available. INTERVENTIONS The relative volumetry of the 3 main hepatic sectors (left, right anterior, and right posterior) was assessed on CT scans. The liver volume drained was estimated and classified into 1 of 3 classes: less than 30%, 30% to 50%, and more than 50% of the total liver volume. MAIN OUTCOME MEASUREMENTS The primary outcome was effective drainage, defined as a decrease in the bilirubin level of more than 50% at 30 days after drainage. Secondary outcomes were early cholangitis rate and survival. RESULTS The main factor associated with drainage effectiveness was a liver volume drained of more than 50% (odds ratio 4.5, P = .001), especially in Bismuth III strictures. Intubating an atrophic sector (<30%) was useless and increased the risk of cholangitis (odds ratio 3.04, P = .01). A drainage > 50% was associated with a longer median survival (119 vs 59 days, P = .005). LIMITATIONS Heterogeneous population and volume assessment methodology to improve in further prospective studies. CONCLUSION Draining more than 50% of the liver volume, which frequently requires bilateral stent placement, seems to be an important predictor of drainage effectiveness in malignant, especially Bismuth III, hilar strictures. A pre-ERCP assessment of hepatic volume distribution on cross-sectional imaging may optimize endoscopic procedures.
Collapse
Affiliation(s)
- Ariane Vienne
- Gastroenterology, Saint Antoine Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Gaudric M. [Is there a future for wireless endoscopy?]. Presse Med 2010; 39:1119-21. [PMID: 20739138 DOI: 10.1016/j.lpm.2010.05.011] [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] [Received: 05/09/2010] [Revised: 05/24/2010] [Accepted: 05/26/2010] [Indexed: 11/30/2022] Open
|
24
|
Huppertz J, Coriat R, Leblanc S, Gaudric M, Brezault C, Grandjouan S, Chaput U, Prat F, Chaussade S. Application of ANAES guidelines for colonoscopy in France: a practical survey. ACTA ACUST UNITED AC 2010; 34:541-8. [PMID: 20739131 DOI: 10.1016/j.gcb.2010.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 02/22/2010] [Accepted: 03/07/2010] [Indexed: 01/09/2023]
Abstract
OBJECTIVES In 2004, the French health authorities published guidelines on the indications for colonoscopy. However, no study has evaluated the awareness of healthcare practitioners of these guidelines. The aim of this study was to determine the level of awareness of the ANAES guidelines among French gastroenterologists. PATIENTS AND METHODS A questionnaire comprising 20 multiple choice questions (MCQ) was presented to a group of 79 gastroenterologists between February and June in 2008. The questions covered screening tests for colon cancer (one question), endoscopic mucosal resection (two questions) and the ANAES guidelines (17 questions). According to the number of colonoscopies performed per year (less than 100, 100-500, more than 500), the answers to these questions were analyzed separately. RESULTS Among the practitioners carrying out less than 100, 100-500 and more than 500 colonoscopies per year, the guidelines for colon cancer screening were known by 33, 50 and 56%, respectively, the quality criteria for endoscopic mucosal resection by 0, 0 and 3.7%, respectively, and the ANAES guideline indications for colonoscopy by 34.3, 51.2 and 48.9%, respectively (P<0.001). The ANAES guidelines were significantly better known by practitioners who were performing more than 100 colonoscopies per year, while the indications for control colonoscopy were less often correctly anticipated. No differences were found concerning postponed indications. CONCLUSION The ANAES guidelines consists of the following elements: (1) awareness of the ANAES guidelines is poor, with control colonoscopy being correctly anticipated in just over a third of the gastroenterologists; (2) performing more than 100 colonoscopies per year improves knowledge of the ANAES guidelines; and (3) the ANAES guidelines need to be simplified and should be covered by continuing medical education.
Collapse
Affiliation(s)
- J Huppertz
- Service de gastroentérologie, CHU Cochin, faculté René-Descartes-Paris-V, 27 rue du Faubourg-Saint-Jacques, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Heresbach D, Leray E, d'Halluin PN, Cholet F, Lapalus MG, Gaudric M, Ben Soussan E, Gaudin JL, Vahedi K, Quentin V, Filoche B, Saurin JC, Chaussade S, Ponchon T. Diagnostic accuracy of esophageal capsule endoscopy versus conventional upper digestive endoscopy for suspected esophageal squamous cell carcinoma. Endoscopy 2010; 42:93-7. [PMID: 20140825 DOI: 10.1055/s-0029-1243856] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND STUDY AIM A video capsule similar to that used in small-bowel capsule endoscopy is now available for esophageal exploration. The aim of our study was to compare the accuracy of upper endoscopy (esophageal gastroduodenoscopy [EGE]) with esophageal capsule endoscopy (ECE) in patients at risk of esophageal squamous cell cancer (SCC). PATIENTS AND METHODS 68 patients at risk of SCC secondary to a history of head and neck neoplasia were included in this comparison of techniques for detecting SCC and dysplasia. ECE was done using the first generation Pillcam ESO and EGE was performed in accordance with the usual practice of each center, followed by examination with 2 % Lugol staining and biopsy of unstained areas (39 neoplasia comprising 5 low grade dysplasia, 8 high grade dysplasia and 26 SCC). RESULTS Compared with EGE with and without Lugol staining, the sensitivities of ECE for neoplasia diagnosis were 46 % and 54 %, respectively. On a per-patient basis, the sensitivity, specificity, and positive and negative predictive value of ECE were 63 %, 86 %, 77 % and 76 %, respectively, compared with EGE without staining, and 61 %, 86 %, 77 % and 73 % compared with EGE with iodine staining. Neither the ECE transit time nor the distance between the esopharyngeal line and the neoplastic lesion differed between the 21 false-negative and 18 true-positive cases diagnosed by ECE; the only difference was a smaller median diameter among false negatives ( P < 0.001). CONCLUSION In a cohort at high risk for esophageal SCC, ECE is not sensitive enough to diagnose neoplastic lesions.
Collapse
Affiliation(s)
- D Heresbach
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Rennes, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
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
|
27
|
Leconte M, Douard R, Gaudric M, Dousset B. [Surgical management of primary esophageal motility disorders]. J Chir (Paris) 2008; 145:428-436. [PMID: 19106862 DOI: 10.1016/s0021-7697(08)74651-9] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primary esophageal motility disorders are rare, the most common diagnoses being achalasia and diffuse esophageal spasm. Treatment aims to alleviate symptoms and may be medical, endoscopic, or surgical. Achalasia is most commonly treated by pneumatic dilatation or by laparoscopic Heller cardiomyotomy. Pneumatic dilatation is effective in 60-80% of cases, but functional results deteriorate over time. Surgical treatment is indicated when endoscopic dilatation is contraindicated or has failed. Functional results after cardiomyotomy are satisfactory in 90% of cases and results appear to be stable over time. The need for an associated antireflux procedure and the type of fundoplication remain controversial. For diffuse esophageal spasm, extended esophageal myotomy has yielded satisfactory functional results, but surgical treatment should be reserved for selected patients with severe symptoms.
Collapse
Affiliation(s)
- M Leconte
- Service de chirurgie digestive et endocrinienne, hôpital Cochin - Paris.
| | | | | | | |
Collapse
|
28
|
Chryssostalis A, Gaudric M, Terris B, Coriat R, Prat F, Chaussade S. Esophageal lichen planus: a series of eight cases including a patient with esophageal verrucous carcinoma. A case series. Endoscopy 2008; 40:764-8. [PMID: 18535938 DOI: 10.1055/s-2008-1077357] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal lichen planus is a rare condition. Its risk of malignant transformation is unknown. We report a series of eight patients with esophageal lichen planus referred to our unit between 1990 and 2005. Clinical, endoscopic, radiological and histological data of these patients were retrospectively reviewed. Seven patients were women. All patients had oral lichen planus. Endoscopic lesions were located in the upper third of the esophagus in seven patients and in the mid third in two patients. Five patients had esophageal stricture. Seven patients had peeling, friable esophageal mucosa. Histological examination of esophageal biopsies found characteristic features of lichen planus in two patients and nonspecific changes in five patients. All patients received corticosteroids. Patients with stricture underwent esophageal dilation. Esophageal perforation after dilation occurred in one patient. Corticosteroids improved dysphagia in all patients; steroid dependence occurred in two patients with stricture. One patient had an esophageal verrucous carcinoma, which was treated with radiotherapy and chemotherapy. Upper endoscopy should be performed in patients with mucosal lichen planus presenting with dysphagia to assess esophageal involvement. Esophageal strictures are frequent and require dilation. Corticosteroids are the first-line treatment, but steroid dependence may occur. Cancer can arise on esophageal lichen planus and justifies endoscopic follow-up.
Collapse
Affiliation(s)
- A Chryssostalis
- Department of Gastroenterology, Cochin Hospital, APHP, Paris, France.
| | | | | | | | | | | |
Collapse
|
29
|
Lapalus MG, Ben Soussan E, Saurin JC, Favre O, D'Halluin PN, Coumaros D, Gaudric M, Fumex F, Antonietti M, Gaudin JL, Jacob P, Heresbach D, Pilichos C, Fan R, Mozer M, Heyries L, Dumortier J, Ponchon T. Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial. Gastrointest Endosc 2008; 67:1091-6. [PMID: 18513551 DOI: 10.1016/j.gie.2007.11.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [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: 09/04/2007] [Accepted: 11/24/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is the first procedure to explore the small bowel in obscure GI bleeding (OGB). OBJECTIVE To evaluate the role of bowel preparation with oral sodium phosphate (NaP) in this indication. DESIGN A prospective multicenter, controlled, randomized, blind study. METHODS A total of 129 patients with the diagnosis of OGB were included and were randomized into 2 groups (group A [n = 64] and group B [n = 63]). In group A, a CE was performed after an 8-hour fasting period. In group B, patients were asked to drink 2 doses of 45 mL NaP before swallowing the capsule. The quality of the images was assessed at 5 different locations of the small bowel. Bowel cleanliness and visibility were evaluated by using 2 scoring systems, which included assessing the presence of bubbles, liquid, and the rate of visibility. RESULTS A total of 127 patients (53 men; mean age 56.9 years, range 19-90 years) were analyzed for the preparation and detection of lesions (2 patients were not able to swallow the capsule). No difference was observed for cleanliness and visibility between the 2 groups at any of the small-bowel segments; no difference was found for gastric transit time (39.8 minutes vs 35.7 minutes, P = .63), small-bowel transit time (257.5 minutes vs 248.6 minutes, P = .59), and the detection of lesions (35.9% vs 42.8%, P = .54). LIMITATIONS The evaluation of bowel cleanliness was based on subjective features. CONCLUSIONS The results of the present study, despite a significant number of limitations, did not support that small-bowel preparation with oral NaP can be recommended for CE exploration in patients with OGB.
Collapse
|
30
|
Coriat R, Chryssostalis A, Zeitoun JD, Deyra J, Gaudric M, Prat F, Chaussade S. Computed virtual chromoendoscopy system (FICE): a new tool for upper endoscopy? ACTA ACUST UNITED AC 2008; 32:363-9. [PMID: 18355995 DOI: 10.1016/j.gcb.2007.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 10/25/2007] [Accepted: 11/04/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A newly developed computed virtual chromoendoscopy system, Fuji Intelligent Color Enhancement (FICE) technology, decomposes images by wavelength, then directly produces reconstructed images with enhanced mucosal surface contrast. The aims of the present study were to determine the quality of information provided by computed virtual chromoendoscopy for detecting gastrointestinal polyps and to identify the best channel setting for imaging. PATIENTS AND METHODS Thirty-one upper endoscopy procedures were performed in 31 patients using Fujinon 1.3-million-pixel endoscopes with zoom. A polyp was diagnosed in 45% of the patients. Six experienced endoscopists, who had never used the computed virtual chromoendoscopy system before, analysed the 31 endoscopy reports. Each endoscopy report included 11 images (one conventional image and one image for each FICE channel). The endoscopists used a 10-cm analog visual scale to determine the three best FICE channels, and to evaluate the quality and pit pattern of the chromoendoscopy images. RESULTS Channel 4 (red: 520; green: 500; blue: 405) was considered the best channel in 39.7% of the reports (p<0.0001) and was among the best three in 77%. For 94.1% of the reports, the best FICE channel image was considered superior to the conventional image (p<0.0001). Median pit pattern score was 9.43 for computed virtual chromoendoscopy and 7.08 for conventional endoscopy (p<0.001). CONCLUSION Fuji Intelligent Color Enhancement (FICE) channel 4 images were significantly better than conventional images. Computed virtual chromoendoscopy enabled better analysis of the pit pattern and the normal-pathological mucosal junction. Computed virtual chromoendoscopy can be used to identify gastroduodenal polyps and to assist in complete polypectomy.
Collapse
Affiliation(s)
- R Coriat
- Service de Gastroentérologie, CHU Cochin, 27 Rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | | | | | | | | | | | | |
Collapse
|
31
|
Leconte M, Douard R, Gaudric M, Dumontier I, Chaussade S, Dousset B. Functional results after extended myotomy for diffuse oesophageal spasm. Br J Surg 2007; 94:1113-8. [PMID: 17497756 DOI: 10.1002/bjs.5761] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of surgery in the management of patients with diffuse oesophageal spasm (DOS) remains controversial. The aim of this study was to assess functional results after extended myotomy for DOS. METHODS This prospective study evaluated 20 patients who had extended myotomy (14 cm on the oesophagus and 2 cm below the oesophagogastric junction) with anterior fundoplication via a laparotomy for severe DOS. Median follow-up was 50 (range 6-84) months. Functional data were assessed by means of dysphagia (range 0-3), chest pain (range 0-3) and overall clinical (range 0-12, including dysphagia, chest pain, regurgitation, gastro-oesophageal reflux) scores. RESULTS All patients had severe DOS. The median preoperative overall clinical score was 6 (range 3-8) with a dysphagia score of at least 2. Median postoperative functional scores were significantly lower than preoperative values (overall clinical score 1 versus 6, dysphagia score 0 versus 3, chest pain score 0 versus 2). At final follow-up, good or excellent results were obtained for overall clinical score in 16 patients, for dysphagia score in 18 and for chest pain score in all 20 patients. Postoperative gastro-oesophageal reflux was noted in two of the 20 patients. CONCLUSION Extended myotomy with anterior fundoplication is an effective treatment for severe DOS. Medium-term postoperative functional results were excellent, especially in terms of dysphagia and chest pain.
Collapse
Affiliation(s)
- M Leconte
- Department of Digestive and Endocrine Surgery, Cochin University Hospital (AP-HP), René Descartes Paris 5 University, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding. Endoscopic treatment turned out to be successful.
Collapse
|
33
|
Douard R, Gaudric M, Chaussade S, Couturier D, Houssin D, Dousset B. Functional results after laparoscopic Heller myotomy for achalasia: A comparative study to open surgery. Surgery 2004; 136:16-24. [PMID: 15232534 DOI: 10.1016/j.surg.2004.01.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prospective studies comparing laparoscopic to open Heller myotomy for esophageal achalasia are lacking. The aim of this study was to compare functional outcome after laparoscopic and open Heller myotomy for esophageal achalasia. METHODS Eighty-two patients who underwent Heller-Dor myotomy for achalasia, via laparoscopy (n=52) or open surgery (n=30) were recorded prospectively (1993-2002). Median follow-up was 51 (12-111) months. Perioperative functional data were assessed via dysphagia and overall clinical (dysphagia, chest pain, regurgitation, gastroesophageal reflux) scores. RESULTS In laparoscopy patients, the operative time was longer (145 [95-290] vs 120 [70-230] minutes, P <.0001); the postoperative hospital stay and feeding resumption time was shorter (4 [2-25] vs 7.5 [5-18] days, P <.0001 and 2 [1-15] vs 4 [1-14] days, P <.0001). Three mucosal tears necessitated conversion to open surgery (6%). The rates of " excellent" or " satisfactory" results after laparoscopic and open surgery were 92% (n=48/52) versus 93% (n=28/30), and 83% (n=43/52) versus 83% (n=25/30) on overall clinical score. In both groups, the overall clinical score indicated significant improvement during 12-month follow-up. The laparoscopy and open surgery symptomatic gastroesophageal reflux rates were 10% and 7%, respectively. CONCLUSIONS Laparoscopic Heller myotomy favorably compares with open surgery regarding dysphagia relief and gastroesophageal reflux rate. Overall clinical score indicates gradual improvement in patient functional status during 12-month follow-up.
Collapse
Affiliation(s)
- Richard Douard
- Department of Surgery, Cochin University Hospital, Paris, France
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
INTRODUCTION the aim of this work was to check literature to assess botulinum toxin injection efficacy in gastrointestinal motor disorders with special emphasis on controlled clinical trials. METHODS literature was carried out with the Medline data bank. RESULTS seventy three articles in French and in English including a recent general review were retained. Comparative clinical trials only concerned achalasia and anal fissure. The other gastrointestinal motor disorders only gave rise to open non-controlled trials assessed on clinical end points. DISCUSSION this review of literature helps to determine usefulness and safety of Botulinum toxin injection in the treatment of esophageal achalasia and anal fissure. The main limitation is its brief duration of action. Studies concerning the others spastic motor disorders are based on unknown physiopathology and controlled trials are required to assess its efficacy. CONCLUSION botulinum toxin is increasingly used for gastrointestinal motor disorders with worthwhile results. Its efficacy has been yet established for only two disorders : it has a valuable palliative role in achalasia and may be curative for anal fissure.
Collapse
Affiliation(s)
- M Gaudric
- Service d'hépatogastroentérologie, hôpital Cochin, 27, rue du faubourg-Saint-Jacques, 75014 Paris, France.
| | | |
Collapse
|
35
|
Kmieciak Le Corguillé M, Gaudric M, Sogni P, Roche H, Brézault C, Dieumegard B, Couturier D, Chaussade S. [Appropiateness of colonoscopy in a gastrointestinal unit in 2001: a prospective study using criteria established by a European panel of experts]. Gastroenterol Clin Biol 2003; 27:213-8. [PMID: 12658131] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
UNLABELLED Criteria for appropriateness of colonoscopy have been elaborated by an European Panel (EPAGE). OBJECTIVES 1) To assess the feasibility of EPAGE criteria in clinical practice, 2) to assess colonoscopy appropriateness using EPAGE criteria, 3) to compare colonoscopy appropriateness and findings. PATIENTS AND METHODS Four hundred and six consecutive examinations were included. The referral indication was judged using a scoring system on the basis of the EPAGE criteria. RESULTS Appropriateness could be assessed in 94% of the colonoscopies. Fifty-four percent were appropriate, 40% equivocal, and 6% inappropriate. Rate of abnormal colonoscopy was not different between the 3 groups, however endoscopic findings were more severe when the indication was appropriate. In the appropriate group, adenomatous polyps were more frequent (24%) than in the two other groups (13% and 12%; P<0.05) and tended to be larger in size. In the inappropriate group, patients were significantly younger, and no cancer was found. There were 5 colonic cancers in the inappropriate group and 12 in the appropriate group. CONCLUSION Colonoscopy is generally not overused according to EPAGE guidelines. However, on an individual basis it could be rather difficult to determine colonoscopy appropriateness using a scoring system. Indeed, a third of the indications was judged equivocal and the endoscopic findings were no different whether indication was appropriate or equivocal.
Collapse
|
36
|
Scatton O, Gaudric M, Massault PP, Chaussade S, Houssin D, Dousset B. [Conservative management of esophageal perforation after pneumatic dilatation for achalasia]. Gastroenterol Clin Biol 2002; 26:883-7. [PMID: 12434098] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
PURPOSE To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. PATIENTS AND METHODS Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. RESULTS Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. CONCLUSION Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.
Collapse
|
37
|
Desramé J, Sabaté JM, Agher R, Bremont C, Gaudric M, Couturier D, Chaussade S. Assessment of hypothalamic-pituitary-adrenal axis function after corticosteroid therapy in inflammatory bowel disease. Am J Gastroenterol 2002; 97:1785-91. [PMID: 12135036 DOI: 10.1111/j.1572-0241.2002.05786.x] [Citation(s) in RCA: 17] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In patients with inflammatory bowel disease (IBD), little is known about the effect of long term corticosteroid therapy (CT) on the hypothalamic-pituitary-adrenal (HPA) axis function. Our aim was to assess HPA axis function in IBD, before the end of CT, during the tapering phase. METHODS HPA axis function was assessed with cortisol (ng/ml) measurement before (T0) (normal > 100) and 60 min (normal > 210) after 0.25 mg tetracosactide (Synacthen immédiat) injection (T60) in 55 consecutive cases of IBD attacks. Abnormal response was defined as a T60 <210. The attacks were separated into two groups according to the result of the Synacthen test (ST). RESULTS In all, 36 of 55 ST were abnormal. The time for recovery normal HPA axis function was 7.2+/-1.3 months. Duration of disease since onset, past history of surgical or immunosuppressive treatment, severity and extension of the attack, need for surgical or immunosuppressive treatment, total cumulative and mean daily corticosteroid dose, total duration of CT, and steroid dose at the time of ST were not significantly different in the two groups. In multivariate analysis a past history of CT was predictive of abnormal ST (OR = 8.4, 95% CI = 2.2-31.5, p = 0.0009). Among patients with a past history of CT, the time (months) elapsed between the last course of CT was significantly longer in those with normal ST than in those with abnormal ST (45.5+/-13.5 vs 15.4+/-6.0; p = 0.02), and in multivariate analysis a duration free of CT < 15 months was predictive of abnormal ST (OR = 15.00, CI = 1.23-183.00, p = 0.03). CONCLUSIONS In all, 65% of the ST were abnormal. These results suggest that ST should be performed before corticosteroid withdrawal, especially in patients with recent past history of CT.
Collapse
Affiliation(s)
- J Desramé
- Services d'Hépato-Gastroentérologie, Hôpital Cochin, Paris, France
| | | | | | | | | | | | | |
Collapse
|
38
|
Abitbol V, Selinger-Leneman H, Gallais Y, Piette F, Bouchon JP, Piera JB, Beinis JY, Laurent M, Moulias R, Gaudric M. [Percutaneous endoscopic gastrostomy in elderly patients. A prospective study in a geriatric hospital]. Gastroenterol Clin Biol 2002; 26:448-53. [PMID: 12122353] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The purpose of this work was to search for prognostic factors after percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in geriatric patients by studying complications, nutritional benefits, and impact on quality of life. METHODS In this prospective study, 59 elderly patients referred for PEG were followed for 1 year or until tube removal or death. Complications, tolerance to enteral nutrition, nutritional status, infection, bedsores and quality of life were assessed by a questionnaire at tube insertion, at 1 month and every 3 months. Multivariate analysis was performed to look for factors predictive of early mortality before one month. RESULTS Insertion of the PEG tube was always successful. Pneumonia in the week before tube insertion was predictive of early mortality (odds-ratio: 8.77 [1.63-47.2], P=0.01). Thirty-day mortality was 25%, but was never related to PEG tube insertion. During follow up, no local complication was observed and enteral feeding was well tolerated. After 3 months, serum albumin and prealbumin levels increased (P<0.001). There were fewer infections (P<0.001) and bedsores remained unchanged. Quality-of-life scores were not modified. At one year, the PEG tube was removed in 16 patients who resumed normal oral nutrition, and 6 other patients were able to return to their home. CONCLUSION In a cohort of aged institutionalized patients, PEG for enteral nutrition was well tolerated and not definitive in more than one-quarter of them. Active lung infection is a risk factor of early mortality.
Collapse
Affiliation(s)
- Vered Abitbol
- Hôpital Charles Foix, 7, avenue de la République, 94205 Ivry-sur-Seine Cedex, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Landi B, Cellier C, Gaudric M, Demont H, Guimbaud R, Cuillerier E, Couturier D, Barbier JP, Marteau P. Long-term outcome of patients with gastrointestinal bleeding of obscure origin explored by push enteroscopy. Endoscopy 2002; 34:355-9. [PMID: 11972265 DOI: 10.1055/s-2002-25276] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [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: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Little is known of the long-term outcome in patients with gastrointestinal bleeding of obscure origin, who undergo investigation by means of push enteroscopy. The aim of this study was to assess the rate of recurrent bleeding and its predictive factors in patients with gastrointestinal bleeding of obscure origin, after exploration by push enteroscopy. PATIENTS AND METHODS 105 patients with gastrointestinal bleeding of obscure origin (iron-deficiency anemia: n = 56; overt bleeding: n = 49) underwent exploration by push enteroscopy from December 1994 to December 1998. They were classified into three groups according to enteroscopy findings: no lesion found (group A; 56 patients), arteriovenous malformations (group B; 18 patients), and other gastrointestinal lesions (group C; 31 patients). Actuarial rates of rebleeding during follow-up were calculated and factors associated with rebleeding were assessed by means of univariate and multivariate analysis. RESULTS Follow-up data were obtained for 101 patients (96 %). The mean follow-up was 29 months (6 - 54 months). The 2-year actuarial rate of rebleeding was 31 % in the overall population, and 27.6 %, 56 % and 24 % in groups A, B, and C, respectively (P = 0.13). The number of previous bleeding episodes and the number of packed red cell units transfused were two independent factors predictive of recurrent bleeding. The modality of recurrent bleeding (anemia or overt bleeding) was similar to that of the initial episode in 94 % of cases. In group A, a gastrointestinal lesion was found after rebleeding in one of the 12 patients with iron-deficiency anemia, and in four of the five patients with overt bleeding. CONCLUSION Recurrent bleeding occurs in about one-third of patients who undergo investigation by push enteroscopy for gastrointestinal bleeding of obscure origin, with a trend towards more frequent rebleeding in patients with arteriovenous malformations. Frequent previous bleeding episodes and transfusion requirements are predictive of recurrent bleeding.
Collapse
Affiliation(s)
- B Landi
- Department of Hepatogastroenterology, Georges Pompidou European Hospital, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abitbol V, Gaudric M. Existe-t-il des facteurs pronostiques qui prédisent le devenir d'un malade âgé après la pose d'une gastrostomie percutanée endoscopique (GPE)? NUTR CLIN METAB 2000. [DOI: 10.1016/s0985-0562(00)80070-9] [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: 11/24/2022]
|
41
|
Abstract
BACKGROUND The mechanisms and treatment of persistent dysphagia after antireflux surgery are not well established. The results of pneumatic dilatation were evaluated in a retrospective study. METHODS Sixteen patients were reviewed. All had severe and persistent postoperative dysphagia evaluated by oesophageal manometry before pneumatic dilatation. RESULTS Seven patients had one dilatation and nine had two dilatations. There was no complication and no relapse of reflux symptoms. Results were satisfactory in nine patients (mean(s.e.m.) follow-up 19.2(6.9) months) and poor in seven, who required revisional surgery. Age, time since operation and weight loss were not related to the outcome. Thirteen patients had abnormal manometry with an 'achalasia-like' motor pattern in four. Lower oesophageal sphincter (LOS) pressure, LOS relaxation and oesophageal contraction amplitude were similar in the two groups. The only difference was in the percentage of normal peristaltic contractions (mean(s.e.m.) 82.2(11) versus 39.1(13.8) per cent for satisfactory and poor results respectively; P < 0.05). CONCLUSION In this retrospective study pneumatic dilatation was effective and safe in nine of 16 patients with dysphagia following antireflux surgery. Peristalsis was normal in eight patients, in seven of whom it was associated with satisfactory results.
Collapse
Affiliation(s)
- M Gaudric
- Service d'Hépato-gastroentérologie, Hopital Cochin, 27 rue du Faubourg Saint Jacques, 75679 Paris cedex 14, France
| | | | | | | | | |
Collapse
|
42
|
Sabaté JM, Gaudric M, Dousset B, Chaussade S, Couturier D. [Dysphagia in a trisomic adult operated on for esophageal atresia: achalasia or pseudo-achalasia?]. Gastroenterol Clin Biol 1999; 23:573-6. [PMID: 10429866] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Esophageal involvement is frequent in Down syndrome. We report a case of dysphagia in a 21-year-old patient with Down syndrome and repaired esophageal atresia. Radiology, endoscopy, and manometry showed typical features of achalasia. The patient was treated first by botulinum toxin injection and afterwards by Heller myotomy with good result. The role of motor disorders associated with esophageal atresia or with primary achalasia in this patient is discussed.
Collapse
Affiliation(s)
- J M Sabaté
- Service de Gastroentérologie, Hôpital Cochin, Paris
| | | | | | | | | |
Collapse
|
43
|
Guimbaud R, Beades E, Chauvelot-Moachon L, Quartier G, Gaudric M, Bertrand V, Cellier C, Vidon N, Devaux JY, Richard B, Couturier D, Chaussade S. Technetium Tc 99m hexamethyl propylene amine oxine leukocyte scintigraphy in patients with ulcerative colitis: correlation with clinical, biologic, endoscopic, and pathologic intensity, and local release of interleukin 8. Gastrointest Endosc 1998; 48:491-6. [PMID: 9831837 DOI: 10.1016/s0016-5107(98)70090-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 12/10/2022]
Abstract
BACKGROUND Technetium Tc 99m hexamethyl propylene amine oxine (99mTc-HMPAO) has been used to radiolabel leukocytes with promising results for its clinical use in inflammatory bowel disease. During active ulcerative colitis, colonoscopy is indicated to determine the extent and the intensity of the disease for proper management. The aim of this prospective study was to determine whether 99mTc-HMPAO-labeled leukocyte scintigraphy can give information similar to that obtained with colonoscopy during acute attacks of ulcerative colitis. METHODS Thirty-three consecutive patients with 50 acute episodes of ulcerative colitis underwent 99mTc-HMPAO scintigraphy and colonoscopy with biopsies. Scintigraphic determination of disease extent and intensity were compared with those obtained by colonoscopy with biopsies and clinicobiologic markers. RESULTS The scintigraphic index of disease intensity was correlated with endoscopic index, Truelove index, biologic markers, and local release of interleukin-8. The extent measured by scintigraphy was well correlated to the endoscopic and histologic extent. CONCLUSIONS 99mTc-HMPAO scintigraphy accurately determines the extent and the intensity of acute ulcerative colitis lesions. This noninvasive method can specify the extent and the intensity of an acute attack in patients with previously known ulcerative colitis.
Collapse
Affiliation(s)
- R Guimbaud
- Service d'Hépato-Gastroentérologie, CNRS 1534, Hôpital Cochin et Université René Descartes, Paris V, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Artru P, Sabaté JM, Perlemuter G, Gaudric M, Couturier D, Chaussade S. [Pseudo-achalasia secondary to esophageal amyloidosis treated by pneumatic dilatation]. Gastroenterol Clin Biol 1998; 21:1000-1. [PMID: 9587570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
45
|
Cellier C, Tkoub M, Gaudric M, Guimbaud R, Auroux J, Chaussade S, Couturier D, Barbier JP, Landi B. [Comparison of push-type endoscopy and barium transit study of the small intestine in digestive bleeding and unexplained iron-deficiency anemia]. Gastroenterol Clin Biol 1998; 22:491-4. [PMID: 9762286] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES A radiological examination of the small bowel is often performed in case of gastrointestinal bleeding of obscure origin. More recently, push-type enteroscopy has been reported as a valuable tool in this indication. The purpose of this study was to compare the diagnosis efficiency of these two procedures. METHODS From February 1994 to February 1996, 40 patients (mean age: 52 years) with obscure gastrointestinal bleeding (iron-deficiency anemia without obvious cause of blood loss or malabsorption: n = 17; macroscopic gastrointestinal bleeding: n = 23) were examined by small bowel follow-through and push-type enteroscopy (jejunoscopy n = 19; double way examination n = 21). Each patient had negative upper and lower gastrointestinal tract endoscopies prior to small bowel examinations. RESULTS Small bowel follow-through revealed only one lesion potentially responsible for blood loss (2.5%), corresponding to a jejunal leiomyoma. Push-type enteroscopy detected small bowel lesions potentially responsible for blood loss in 6 patients (15%). The lesions were located in the jejunum in 5 cases (arteriovenous malformations: n = 3; metastasis: n = 1; leiomyoma: n = 1), in the ileum in 1 case (leiomyoma). The efficiency of push-type enteroscopy for the detection of a small bowel lesion was of 22% in case of macroscopic bleeding and of 6% in case of iron-deficiency anemia. Push-type enteroscopy also revealed lesions previously undetected by gastroscopy or colonoscopy in 8 patients (20%). CONCLUSION Push-type enteroscopy was more effective than small bowel follow-through to detect the origin of obscure gastrointestinal bleeding. Push-type enteroscopy revealed a cause of bleeding in 35% of patients, located in the small bowel in only 15% of the patients.
Collapse
Affiliation(s)
- C Cellier
- Services d'Hépato-Gastroentérologie, Hôpital Laennec, Paris
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Balian A, Gaudric M, Guimbaud R, Sogni P, Couturier D, Chaussade S. [Cholesterol crystal embolization in the digestive tract]. Gastroenterol Clin Biol 1998; 22:290-7. [PMID: 9762213] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- A Balian
- Service d'Hépato-Gastroentérologie, Hôpital Cochin, Paris
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Push-type enteroscopy, a recent method for investigating the small intestine, is currently undergoing assessment. Its diagnostic yield varies in the studies reported to date. AIM To assess the diagnostic value of push-type enteroscopy according to indication. PATIENTS AND METHODS From January 1994 to September 1995, 152 consecutive patients (mean age 34 years) underwent push-type enteroscopy (jejunoscopy, n = 93; retrograde ileoscopy, n = 17; and double way enteroscopy, n = 42). The indications were: unexplained iron deficiency anaemia or macroscopic gastrointestinal bleeding (n = 76), radiological abnormalities of the small intestine (n = 23), chronic diarrhoea and/or malabsorption syndrome (n = 18), abdominal pain (n = 12), and miscellaneous (n = 23). All patients had undergone previous negative aetiological investigations. RESULTS The jejunum and ileum were explored through 120 cm (30-160 cm) and 60 cm (20-120 cm). Digestive bleeding: lesions of the small bowel were found in 6% of the patients with isolated iron deficiency anaemia and 20% of patients with patent digestive haemorrhage. Radiological abnormalities of the small intestine: push-type enteroscopy provided a diagnosis or modified the interpretation of radiological findings in 18/23 cases (78%). Chronic diarrhoea and/or malabsorption: push-type enteroscopy yielded explanatory findings in four cases (22%). Abdominal pain: push-type enteroscopy provided no diagnosis. CONCLUSION In this series, push-type enteroscopy was of particular value in investigating patients with radiological abnormalities of the small intestine. It was of some value in the exploration of patent digestive haemorrhage or chronic diarrhoea, but not of abdominal pain. Its value was limited in the exploration of iron deficiency anaemia.
Collapse
Affiliation(s)
- B Landi
- Laennec Hospital, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Perlemuter G, Gaudric M, Chaussade S. [Botulinum toxin: use in a case of achalasia of the lower sphincter of esophagus]. Presse Med 1997; 26:818. [PMID: 9205490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
49
|
Abstract
BACKGROUND/AIMS Biliary obstruction secondary to portal cavernoma is a rare and little-known entity. From 1985 to 1994, we observed eight cases of portal cavernoma compressing the biliary tract. We report here the features of biliary involvement in these cases of portal cavernoma including the circumstances of diagnosis, biliary tract morphology, liver pathology and the efficiency of various treatments. METHODS AND RESULTS The causes of portal vein obstruction were portal vein thrombosis in one case, peritonitis in another, omphalitis in two cases, portal vein catheterization in one case and unknown in two cases. The portal cavernoma was revealed through esophageal varices ruptures in four patients. The mean time from portal cavernoma diagnosis to biliary involvement was 8 years (range 0-21). Six patients had acute cholangitis, one of whom revealed portal vein obstruction. All the patients had abnormal liver function tests. Imaging techniques (transparietal abdominal ultrasonography and abdominal computed tomography scan [n = 8], endosonography [n = 5] and endoscopic retrograde cholangiography [n = 7]) showed in all cases an extraluminal obstacle, laminating the common bile duct. Pathologic examination of the liver showed secondary biliary cirrhosis in one patient, periportal and perisinusoidal fibrosis in another and no abnormalities in three other cases. Three patients were treated by endoscopic sphincterotomy but cholangitis persisted in two cases, leading to death in one. One patient who underwent a splenorenal shunt was symptom-free 60 months after surgery. Balloon endoscopic dilatation of the common bile duct, performed in one case, led to normalization of liver biological tests. The patients with abnormal liver pathology were treated by propranolol and ursodesoxycholic acid. No complication had occurred after 6 and 24 months of follow-up. CONCLUSIONS In conclusion, eliminating biliary obstruction seems to be essential in providing the best change of survival for patients when biliary obstruction becomes symptomatic. In cases of abnormal liver pathology, associating propranolol with ursodesoxycholic acid would seem to be useful.
Collapse
Affiliation(s)
- G Perlemuter
- Service des Maladies du Foie et de l'Appareil Digestif, Hôpital de Bicêtre, Kremlin Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND/AIMS Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of cases. The aim of this retrospective survey was to identify predictive risk factors for perforation in a consecutive series of 218 patients with achalasia. METHODS Between 1983 and 1993, 270 pneumatic dilatations were performed in 218 patients. A Witzel dilator was used in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations occurred (3%). The clinical, radiological, endoscopic, manometric, and technical data for the eight perforated patients were compared with those of 30 patients randomly sampled among those without perforation. RESULTS All perforations occurred during the first dilatation. Perforations were fewer during dilatations with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%). Perforations were all located above the cardia, on the left side of the oesophagus. In a multivariate analysis, a small weight loss and a high amplitude of oesophageal contractions in the group of patients with perforations were predictive of complications (respectively, p = 0.001 and p = 0.026). A contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus was observed in three of eight patients with perforations but was not seen in any of the 30 patients without perforation (p < 0.01). CONCLUSIONS This identification of risk factors should facilitate the choice between pneumatic dilatation or a surgical approach.
Collapse
Affiliation(s)
- E Borotto
- Service d'Hépatogastroentérologie, Hopital Cochin, Paris, France
| | | | | | | | | | | | | |
Collapse
|