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Cheminel L, Lupu A, Wallenhorst T, Lepilliez V, Leblanc S, Albouys J, Abou Ali E, Barret M, Lorenzo D, De Mestier L, Burtin P, Girot P, Le Baleur Y, Gerard R, Yzet C, Tchirikhtchian K, Degand T, Culetto A, Lemmers A, Schaefer M, Chevaux JB, Zhong P, Hervieu V, Subtil F, Rivory J, Fine C, Jacques J, Walter T, Pioche M. Systematic Resection of the Visible Scar After Incomplete Endoscopic Resection of Rectal Neuroendocrine Tumors. Am J Gastroenterol 2024; 119:378-381. [PMID: 37734341 DOI: 10.14309/ajg.0000000000002516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION When initial resection of rectal neuroendocrine tumors (r-NETs) is not R0, persistence of local residue could lead to disease recurrence. This study aimed to evaluate the interest of systematic resection of non-R0 r-NET scars. METHODS Retrospective analysis of all the consecutive endoscopic revisions and resections of the scar after non-R0 resections of r-NETs. RESULTS A total of 100 patients were included. Salvage endoscopic procedure using endoscopic submucosal dissection or endoscopic full-thickness resection showed an R0 rate of near 100%. Residual r-NET was found in 43% of cases. DISCUSSION In case of non-R0 resected r-NET, systematic scar resection by endoscopic full-thickness resection or endoscopic submucosal dissection seems necessary.
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Affiliation(s)
- Loïc Cheminel
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Lupu
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Department of Endoscopy and Gastroenterology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Vincent Lepilliez
- Department of Endoscopy and Gastroenterology, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Einas Abou Ali
- Department of Endoscopy and Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Maximilien Barret
- Department of Endoscopy and Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Diane Lorenzo
- Department of Endoscopy and Gastroenterology, Beaujon Hospital, APHP, Paris, France
| | - Louis De Mestier
- Department of Endoscopy and Gastroenterology, Beaujon Hospital, APHP, Paris, France
| | - Pascal Burtin
- Digestive Endoscopy Unit, Gustave Roussy Oncology Institute, Villejuif, France
| | - Paul Girot
- Department of Oncology, Loire Vendée Océan Hospital, La Roche sur Yon, France
| | - Yann Le Baleur
- Digestive Endoscopy Unit, Department of Gastroenterology, Paris Saint-joseph Hospital, Paris, France
| | - Romain Gerard
- Department of Digestive Diseases, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Thibault Degand
- Department of Endoscopy and Gastroenterology, Dijon University Hospital, Dijon, France
| | - Adrian Culetto
- Department of Gastroenterology and Pancreatology, Rangueil University Hospital, Toulouse, France
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Brussels, Belgium
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
| | | | - Peng Zhong
- Department of Endoscopy and Gastroenterology, Besançon Regional University Hospital, Besançon, France
| | | | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Caroline Fine
- Department of Endoscopy and Gastroenterology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France ; and
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thomas Walter
- Department of Medical Oncology, Pavillon E, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Jacques J, Schaefer M, Wallenhorst T, Rösch T, Lépilliez V, Chaussade S, Rivory J, Legros R, Chevaux JB, Leblanc S, Rostain F, Barret M, Albouys J, Belle A, Labrunie A, Preux PM, Lepetit H, Dahan M, Ponchon T, Crépin S, Marais L, Magne J, Pioche M. Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas : A Randomized Comparative Trial. Ann Intern Med 2024; 177:29-38. [PMID: 38079634 DOI: 10.7326/m23-1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Endoscopic resection of adenomas prevents colorectal cancer, but the optimal technique for larger lesions is controversial. Piecemeal endoscopic mucosal resection (EMR) has a low adverse event (AE) rate but a variable recurrence rate necessitating early follow-up. Endoscopic submucosal dissection (ESD) can reduce recurrence but may increase AEs. OBJECTIVE To compare ESD and EMR for large colonic adenomas. DESIGN Participant-masked, parallel-group, superiority, randomized controlled trial. (ClinicalTrials.gov: NCT03962868). SETTING Multicenter study involving 6 French referral centers from November 2019 to February 2021. PARTICIPANTS Patients with large (≥25 mm) benign colonic lesions referred for resection. INTERVENTION The patients were randomly assigned by computer 1:1 (stratification by lesion location and center) to ESD or EMR. MEASUREMENTS The primary end point was 6-month local recurrence (neoplastic tissue on endoscopic assessment and scar biopsy). The secondary end points were technical failure, en bloc R0 resection, and cumulative AEs. RESULTS In total, 360 patients were randomly assigned to ESD (n = 178) or EMR (n = 182). In the primary analysis set (n = 318 lesions in 318 patients), recurrence occurred after 1 of 161 ESDs (0.6%) and 8 of 157 EMRs (5.1%) (relative risk, 0.12 [95% CI, 0.01 to 0.96]). No recurrence occurred in R0-resected cases (90%) after ESD. The AEs occurred more often after ESD than EMR (35.6% vs. 24.5%, respectively; relative risk, 1.4 [CI, 1.0 to 2.0]). LIMITATION Procedures were performed under general anesthesia during hospitalization in accordance with the French health system. CONCLUSION Compared with EMR, ESD reduces the 6-month recurrence rate, obviating the need for systematic early follow-up colonoscopy at the cost of more AEs. PRIMARY FUNDING SOURCE French Ministry of Health.
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Affiliation(s)
- Jérémie Jacques
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Marion Schaefer
- Hépato-Gastro-Entérologie, CHRU de Nancy, Nancy, France (M.S., J.-B.C.)
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital, Hamburg-Eppendorf, Hamburg, Germany (T.R.)
| | - Vincent Lépilliez
- Hépato-Gastro-Entérologie, Hôpital Privé Jean Mermoz, Lyon, France (V.L., S.L.)
| | | | - Jérôme Rivory
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Romain Legros
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | | | - Sarah Leblanc
- Hépato-Gastro-Entérologie, Hôpital Privé Jean Mermoz, Lyon, France (V.L., S.L.)
| | - Florian Rostain
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Maximilien Barret
- Hépato-Gastro-Entérologie, Hôpital Cochin, Paris, France (S.C., M.B., A.B.)
| | - Jérémie Albouys
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Arthur Belle
- Hépato-Gastro-Entérologie, Hôpital Cochin, Paris, France (S.C., M.B., A.B.)
| | - Anaïs Labrunie
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Pierre-Marie Preux
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Hugo Lepetit
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Martin Dahan
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Thierry Ponchon
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Sabrina Crépin
- Service de Pharmacologie-Toxicologie et Pharmacovigilfance-Unité de Vigilance des Essais Cliniques, CHU de Limoges, Limoges, France (S.C.)
| | - Loïc Marais
- Direction de la Recherche et de l'Innovation, CHU de Limoges, Limoges, France (L.M.)
| | - Julien Magne
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Mathieu Pioche
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
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Michoud C, Khoury T, Lisotti A, Gincul R, Leblanc S, Lemaistre AI, Napoléon B. Needle-based confocal laser endomicroscopy for cystic lymphangiomas of the pancreas: the first case series. Endoscopy 2023; 55:E594-E595. [PMID: 36996892 PMCID: PMC10063352 DOI: 10.1055/a-2045-7649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Claire Michoud
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Tawfik Khoury
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Rodica Gincul
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Sarah Leblanc
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | - Bertrand Napoléon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
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De Cristofaro E, Rivory J, Masgnaux LJ, Grimaldi J, Yzet C, Leblanc S, Pioche M. Multipolar traction with an eight-point adaptive traction device allowed comfortable resection of a challenging giant rectal lesion in ulcerative colitis. Endoscopy 2023; 55:E1029-E1030. [PMID: 37714206 PMCID: PMC10504023 DOI: 10.1055/a-2155-4772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Affiliation(s)
- Elena De Cristofaro
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Louis-Jean Masgnaux
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean Grimaldi
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Gastroenterology and Endoscopy Unit, Amiens University Hospital, Amiens, France
| | - Sarah Leblanc
- Gastroenterology and Endoscopy Unit, Mermoz Hospital, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Grimaldi J, Napoléon B, Masgnaux LJ, Leblanc S, Rivory J, Lépilliez V, Pioche M. Endoscopic submucosal dissection of a laterally spreading tumor totally invading a deep sigmoidal diverticulum using an adaptive traction strategy. Endoscopy 2023; 55:E898-E899. [PMID: 37442163 PMCID: PMC10344621 DOI: 10.1055/a-2114-0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Jean Grimaldi
- Gastroenterology and Endoscopy Unit, Fleyriat Hospital, Bourg-en-Bresse, France
| | - Bertrand Napoléon
- Gastroenterology and Endoscopy Unit, Jean Mermoz Hospital, Lyon, France
| | - Louis-Jean Masgnaux
- Gastroenterology and Endoscopy Unit, Fleyriat Hospital, Bourg-en-Bresse, France
| | - Sarah Leblanc
- Gastroenterology and Endoscopy Unit, Jean Mermoz Hospital, Lyon, France
| | | | - Vincent Lépilliez
- Gastroenterology and Endoscopy Unit, Jean Mermoz Hospital, Lyon, France
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Coupier A, Khoury T, Gincul R, Fumex F, Lisotti A, Leblanc S, Napoléon B. Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas. Endoscopy 2023; 55:E951-E952. [PMID: 37604456 PMCID: PMC10442209 DOI: 10.1055/a-2127-4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Antoine Coupier
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Tawfik Khoury
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
- Galilee Medical Center, Gastroenterology, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rodica Gincul
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Sarah Leblanc
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
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Yzet C, Le Baleur Y, Albouys J, Jacques J, Doumbe-Mandengue P, Barret M, Abou Ali E, Schaefer M, Chevaux JB, Leblanc S, Lepillez V, Privat J, Degand T, Wallenhorst T, Rivory J, Chaput U, Berger A, Aziz K, Rahmi G, Coron E, Kull E, Caillo L, Vanbiervliet G, Koch S, Subtil F, Pioche M. Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study. Endoscopy 2023; 55:1002-1009. [PMID: 37500072 DOI: 10.1055/a-2116-9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. METHODS : All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. RESULTS : 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20-30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30-40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. CONCLUSION: ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.
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Affiliation(s)
- Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Yann Le Baleur
- Endoscopy and Gastroenterology Unit, Hospital Saint Joseph, Paris, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Paul Doumbe-Mandengue
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Einas Abou Ali
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
| | | | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lepillez
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jocelyn Privat
- Endoscopy and Gastroenterology Unit, Vichy Hospital, Vichy, France
| | - Thibault Degand
- Endoscopy and Gastroenterology Unit, Dijon University Hospital, Dijon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ulriikka Chaput
- Endoscopy and Gastroenterology Unit, Saint-Antoine University Hospital, Paris, France
| | - Arthur Berger
- Endoscopy and Gastroenterology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Karim Aziz
- Endoscopy and Gastroenterology Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - Gabriel Rahmi
- Endoscopy and Gastroenterology Unit, Georges Pompidou European Hospital, Paris, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
- Digestive Diseases Institute, University Hospital Nantes, Nantes, France
| | - Eric Kull
- Endoscopy and Gastroenterology Unit, Metz Hospital, Metz, France
| | - Ludovic Caillo
- Endoscopy and Gastroenterology Unit, Nîmes University Hospital, Nîmes, France
| | | | - Stéphane Koch
- Endoscopy and Gastroenterology Unit, Besançon University Hospital, Besançon, France
| | - Fabien Subtil
- Biostatistics Unit, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, and Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Figueiredo M, Yzet C, Wallenhorst T, Rivory J, Rostain F, Schaefer M, Chevaux JB, Leblanc S, Lépilliez V, Corre F, Rahmi G, Jacques J, Albouys J, Pioche M. Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video). Gastrointest Endosc 2023; 98:634-638. [PMID: 37380005 DOI: 10.1016/j.gie.2023.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is challenging for appendicular lesions. We report the outcomes of ESD in this context. METHODS We collected data of ESD procedures for appendiceal neoplasia in a multicenter prospective registry. Main study endpoints were R0, en-bloc, and curative resection rates and adverse event rate. RESULTS One hundred twelve patients were included, 47 (42%) with previous appendectomy. Fifty-six (50%) were Toyonaga type 3 lesions (15 [13.4%] postappendectomy). En-bloc and R0 resection rates were 86.6% and 80.4%, respectively, with no significant difference associated with different grades of appendiceal invasion (P = .9 and P = .4, respectively) or previous appendectomy (P = .3 for both). The curative resection rate was 78.6%. Additional surgery was performed in 16 cases (14.3%), including 10 (62.5%) Toyonaga type 3 lesions (P = .04). This included the treatment of 5 cases (4.5%) of delayed perforation and 1 acute appendicitis. CONCLUSIONS ESD for appendicular lesions is a potentially safer and effective alternative to surgery for a significant proportion of patients.
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Affiliation(s)
- Mariana Figueiredo
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
| | | | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lépilliez
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Felix Corre
- Endoscopy and Gastroenterology Unit, Hôpital Cochin, Paris, France
| | - Gabriel Rahmi
- Gastroenterology and Endoscopy Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Karsenti D, Privat J, Charissoux A, Perrot B, Leblanc S, Chaput U, Boytchev I, Levy J, Schaefer M, Bourgaux JF, Valats JC, Coron E, Moreno-Garcia M, Vanbiervliet G, Rahmi G, Robles EPC, Wallenhorst T. Multicenter randomized trial comparing diagnostic sensitivity and cellular abundance with aggressive versus standard biliary brushing for bile duct stenosis without mass syndrome. Endoscopy 2023; 55:796-803. [PMID: 36849106 DOI: 10.1055/a-2041-7687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND : The diagnosis of cholangiocarcinoma in patients with a biliary stricture without mass syndrome can be obtained by biliary brushing with a sensitivity of ~50 %. We performed a multicenter randomized crossover trial comparing the aggressive Infinity brush with the standard RX Cytology Brush. The aims were to compare sensitivity for cholangiocarcinoma diagnosis and cellularity obtained. METHODS : Biliary brushing was performed consecutively with each brush, in a randomized order. Cytological material was studied with blinding to the brush type used and order. The primary end point was sensitivity for cholangiocarcinoma diagnosis; the secondary end point was the abundance of cellularity obtained with each brush, with cellularity quantified in order to determine if one brush strongly outperformed the other. RESULTS : 51 patients were included. Final diagnoses were cholangiocarcinoma (n = 43; 84 %), benign (n = 7; 14 %), and indeterminate (n = 1; 2 %). Sensitivity for cholangiocarcinoma was 79 % (34 /43) for the Infinity brush versus 67 % (29/43) for the RX Cytology Brush (P = 0.10). Cellularity was rich in 31/51 cases (61 %) with the Infinity brush and in 10/51 cases (20 %) with the RX Cytology Brush (P < 0.001). In terms of quantification of cellularity, the Infinity brush strongly outperformed the RX Cytology Brush in 28/51 cases (55 %), while the RX Cytology Brush strongly outperformed the Infinity brush in 4/51 cases (8 %; P < 0.001). CONCLUSIONS : This randomized crossover trial showed that the Infinity brush is not significantly more effective than the RX Cytology Brush for biliary stenosis without mass syndrome in terms of sensitivity for cholangiocarcinoma diagnosis, but does offer a significantly higher abundance of cellularity.
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Affiliation(s)
- David Karsenti
- Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, France
| | - Jocelyn Privat
- Digestive Endoscopy Unit, Vichy Hospital Center, Vichy, France
| | - Aurélie Charissoux
- Department of Pathology, University Hospital Centre of Limoges, Limoges, France
| | - Bastien Perrot
- UMR 1246 SPHERE (MethodS in Patient-centered outcomes and HEalth ResEarch), INSERM, Nantes University, Tours University, France
| | - Sarah Leblanc
- Digestive Endoscopy Unit, Jean Mermoz Private Hospital, Lyon, France
| | - Ulriikka Chaput
- Department of Digestive Diseases, Hôpital Saint-Antoine, Paris, France
| | - Isabelle Boytchev
- Gastroenterology Department, Le Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Jonathan Levy
- Digestive Endoscopy Unit, Clinique des Cèdres, Cornebarrieu, France
| | - Marion Schaefer
- Hepatogastroenterology, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France
| | | | | | - Emmanuel Coron
- Digestive Diseases Institute, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Department of Gastroenterology and Hepatology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Maira Moreno-Garcia
- Research and Development Unit, French Society of Digestive Endoscopy, Paris, France
| | - Geoffroy Vanbiervliet
- Centre Hospitalier Universitaire de Nice, Pôle DIGi-TUNED, Endoscopie Digestive, Hôpital L'Archet 2, Nice, France
| | - Gabriel Rahmi
- Gastroenterology and Digestive Endoscopy, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Timothée Wallenhorst
- Department of Endoscopy and Gastroenterology, University Hospital Centre Rennes, Rennes, France
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10
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Yzet C, Rivory J, Wallenhorst T, Grainville T, Legros R, Lepilliez V, Leblanc S, Figueiredo Ferreira M, Perron L, Lafeuille P, Mochet M, Virely M, Leplat-Bonnevialle P, Jacques J, Pioche M. A 3D-printed pedal fixator for connecting different pedal-operated tools reduces the number of mistakes during endoscopic submucosal dissection. Endosc Int Open 2023; 11:E635-E640. [PMID: 37928772 PMCID: PMC10623429 DOI: 10.1055/a-2095-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/12/2023] [Indexed: 11/07/2023] Open
Abstract
Background and study aims What distinguishes endoscopic submucosal dissection (ESD) from endoscopic mucosal resection is the need for three foot pedals to activate the electrosurgical unit, flushing and knife injection. The lack of connection between the various pedals of different shapes and brands leads to numerous pedals displacements and potential mistakes. The aim of this study was to evaluate an Innovative PEdal FIXator (IPEFIX) to reduce pedal mistakes during ESD. Methods This was a prospective, multicenter, randomized study. Consecutive ESD procedures were randomly assigned to two groups: a control group with the three pedals free and the IPEFIX group in which the three pedals were linked by IPEFIX. The main outcome evaluated was the number of foot mistakes (wrong pedal, foot push beside the pedal). Results A total of 107 ESDs were performed by eight experts in five centers. The median number of mistakes per hour of ESD procedure was 0/h in the IPEFIX group and 1.9/h in the control group ( P <0.001). The mean number of times to look down to control the position of the pedals was 2.2/h the IPEFIX group and 7.7/h in the control group ( P <0.001). Mean replacements of the pedals were 0./h in the IPEFIX group and 1.7/h in the control group ( P <0.001). Similar results were obtained in trainees in simulated ESD on animal models. Conclusions IPEFIX is a simple device to connect different pedals during endoscopic procedures. It helps to reduce the numbers of foot mistakes during ESD and improves operator comfort.
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Affiliation(s)
- Clara Yzet
- Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Jérôme Rivory
- Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Thimothee Wallenhorst
- Department of Endoscopy and Gastroenterology, University Hospital Centre Rennes, Rennes, France
| | - Thomas Grainville
- Department of Endoscopy and Gastroenterology, University Hospital Centre Rennes, Rennes, France
| | - Romain Legros
- Gastrenterology, Centre Hospitalier Universitaire Limoges Dupuytren, Limoges, France
| | - V. Lepilliez
- Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Sarah Leblanc
- Gastroenterology, chin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, France, Paris, France
| | - Mariana Figueiredo Ferreira
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Léa Perron
- Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | | | - Mikael Mochet
- Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | | | | | - Jeremie Jacques
- service d'hépato-gastro-entérologie, CHU Dupuytren Limoges, Limoges, France
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11
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Barret M, Doridot L, Le Gall M, Beuvon F, Jacques S, Pellat A, Belle A, Abou Ali E, Dhooge M, Leblanc S, Camus M, Nicco C, Coriat R, Chaussade S, Batteux F, Prat F. Mechanisms of esophageal stricture after extensive endoscopic resection: a transcriptomic analysis. Endosc Int Open 2023; 11:E149-E156. [PMID: 36741340 PMCID: PMC9894697 DOI: 10.1055/a-2000-8801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Esophageal stricture is the most frequent adverse event after endoscopic resection for early esophageal neoplasia. Currently available treatments for the prevention of esophageal stricture are poorly effective and associated with major adverse events. Our aim was to identify transcripts specifically overexpressed or repressed in patients who have developed a post-endoscopic esophageal stricture, as potential targets for stricture prevention. Patients and methods We conducted a prospective single-center study in a tertiary endoscopy center. Patients scheduled for an endoscopic resection and considered at risk of esophageal stricture were offered inclusion in the study. The healthy mucosa and resection bed were biopsied on Days 0, 14, and 90. A transcriptomic analysis by microarray was performed, and the differences in transcriptomic profile compared between patients with and without esophageal strictures. Results Eight patients, four with esophageal stricture and four without, were analyzed. The mean ± SD circumferential extension of the mucosal defect was 85 ± 11 %. The transcriptomic analysis in the resection bed at day 14 found an activation of the interleukin (IL)-1 group (Z score = 2.159, P = 0.0137), while interferon-gamma (INFγ) and NUPR1 were inhibited (Z score = -2.375, P = 0.0022 and Z score = -2.333, P = 0.00131) in the stricture group. None of the activated or inhibited transcripts were still significantly so in any of the groups on Day 90. Conclusions Our data suggest that IL-1 inhibition or INFγ supplementation could constitute promising targets for post-endoscopic esophageal stricture prevention.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Ludivine Doridot
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France,Department of Immunology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Morgane Le Gall
- 3P5 Proteom’IC facility, Université de Paris, Institut Cochin, INSERM, CNRS, F-75014, France
| | - Frédéric Beuvon
- Genomʼic CNRS UMR8104, Paris, France,Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Marion Dhooge
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Marine Camus
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Department of Gastroenterology, St Antoine Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Carole Nicco
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France
| | - Frédéric Batteux
- Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France,Department of Immunology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, France,Université de Paris, France,INSERM U1016, Institut Cochin, Paris, France
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12
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Patenotte A, Yzet C, Wallenhorst T, Subtil F, Leblanc S, Schaefer M, Walter T, Lambin T, Fenouil T, Lafeuille P, Chevaux JB, Legros R, Rostain F, Rivory J, Jacques J, Lépilliez V, Pioche M. Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion. Endoscopy 2023; 55:192-197. [PMID: 35649429 DOI: 10.1055/a-1866-8080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. METHODS In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). RESULTS 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4). CONCLUSION ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities.
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Affiliation(s)
- Adrien Patenotte
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon and CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
| | - Thomas Walter
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lambin
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Institute of Pathology - East site, Groupement hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Vincent Lépilliez
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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13
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Masson E, Ewers M, Paliwal S, Kume K, Scotet V, Cooper DN, Rebours V, Buscail L, Rouault K, Abrantes A, Aguilera Munoz L, Albouys J, Alric L, Amiot X, Archambeaud I, Audiau S, Bastide L, Baudon J, Bellaiche G, Bellon S, Bertrand V, Bideau K, Billiemaz K, Billioud C, Bonnefoy S, Borderon C, Bournet B, Breton E, Brugel M, Buscail L, Cadiot G, Camus M, Carpentier-Pourquier M, Chamouard P, Chaput U, Chen JM, Cholet F, Ciocan DM, Clavel C, Coffin B, Coimet-Berger L, Cosconea S, Creveaux I, Culetto A, Daboussi O, De Mestier L, Degand T, D'engremont C, Denis B, Dermine S, Drouet D'Aubigny A, Enaud R, Fabre A, Férec C, Gargot D, Gelsi E, Gentilcore E, Gincul R, Ginglinger-Favre E, Giovannini M, Gomercic C, Gondran H, Grainville T, Grandval P, Grasset D, Grimaldi S, Grimbert S, Hagege H, Heissat S, Hentic O, Herber-Mayne A, Hervouet M, Hoibian S, Jacques J, Jais B, Kaassis M, Koch S, Lacaze E, Lacroute J, Lamireau T, Laurent L, Le Guillou X, Le Rhun M, Leblanc S, Levy P, Lievre A, Lorenzo D, Maire F, Marcel K, Masson E, Mauillon J, Morgant S, Moussata D, Muller N, Nambot S, Napoleon B, Olivier A, Pagenault M, Pelletier AL, Pennec O, Pinard F, Pioche M, Prost B, Queneherve L, Rebours V, Reboux N, Rekik S, Riachi G, Rohmer B, Roquelaure B, Rosa Hezode I, Rostain F, Saurin JC, Servais L, Stan-Iuga R, Subtil C, Tanneche J, Texier C, Thomassin L, Tougeron D, Vuitton L, Wallenhorst T, Wangerme M, Zanaldi H, Zerbib F, Bhaskar S, Kikuta K, Rao GV, Hamada S, Reddy DN, Masamune A, Chandak GR, Witt H, Férec C, Chen JM. The PRSS3P2 and TRY7 deletion copy number variant modifies risk for chronic pancreatitis. Pancreatology 2023; 23:48-56. [PMID: 36517351 DOI: 10.1016/j.pan.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND PRSS1 and PRSS2 constitute the only functional copies of a tandemly-arranged five-trypsinogen-gene cluster (i.e., PRSS1, PRSS3P1, PRSS3P2, TRY7 and PRSS2) on chromosome 7q35. Variants in PRSS1 and PRSS2, including missense and copy number variants (CNVs), have been reported to predispose to or protect against chronic pancreatitis (CP). We wondered whether a common trypsinogen pseudogene deletion CNV (that removes two of the three trypsinogen pseudogenes, PRSS3P2 and TRY7) might be associated with CP causation/predisposition. METHODS We analyzed the common PRSS3P2 and TRY7 deletion CNV in a total of 1536 CP patients and 3506 controls from France, Germany, India and Japan by means of quantitative fluorescent multiplex polymerase chain reaction. RESULTS We demonstrated that the deletion CNV variant was associated with a protective effect against CP in the French, German and Japanese cohorts whilst a trend toward the same association was noted in the Indian cohort. Meta-analysis under a dominant model yielded a pooled odds ratio (OR) of 0.68 (95% confidence interval (CI) 0.52-0.89; p = 0.005) whereas an allele-based meta-analysis yielded a pooled OR of 0.84 (95% CI 0.77-0.92; p = 0.0001). This protective effect is explicable by reference to the recent finding that the still functional PRSS3P2/TRY7 pseudogene enhancers upregulate pancreatic PRSS2 expression. CONCLUSIONS The common PRSS3P2 and TRY7 deletion CNV was associated with a reduced risk for CP. This finding provides additional support for the emerging view that dysregulated PRSS2 expression represents a discrete mechanism underlying CP predisposition or protection.
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Affiliation(s)
- Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Maren Ewers
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Sumit Paliwal
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Virginie Scotet
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, CHU Rangueil and University of Toulouse, Toulouse, France
| | - Karen Rouault
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Hervouet
- Hôpital d'instruction des Armées Percy, Clamart, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seema Bhaskar
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Heiko Witt
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France.
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Schoch A, Lisotti A, Walter T, Fumex F, Leblanc S, Artru P, Desramé J, Brighi N, Marsot J, Souquet JC, Napoléon B. Efficacy of EUS-guided hepaticogastrostomy in prolonging survival of patients with perihilar cholangiocarcinoma. Endosc Ultrasound 2022; 11:487-494. [PMID: 36537386 PMCID: PMC9921975 DOI: 10.4103/eus-d-22-00014] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives The background of this study was to evaluate the outcomes of perihilar cholangiocarcinoma (pCCA) patients treated with EUS-guided hepaticogastrostomy (EUS-HGS). Methods All patients with pCCA who underwent EUS-HGS from 2010 to 2020 were analyzed. The primary outcome was clinical success; the secondary outcomes were technical success, adverse events (AEs), stent patency, and oncological outcomes. Cox proportional-hazards regression and Kaplan-Meier curves were analyzed to identify variables related to survival. Results Thirty-four patients (50% females, 76 years old) were included; 24 (70.6%) presented with distant metastasis. Indications for EUS-HGS were ERCP failure (64.7%), duodenal stricture (23.5%), postsurgical anatomy (5.9%), and dilation limited to the left intrahepatic duct (5.9%). The technical success rate was 97.1%. The clinical success rate was 64.7%. Nine (26.5%) presented AEs, 2 fatal (bleeding and leakage). The overall survival was 91 (31-263) days. On multivariate analysis, EUS-HGS clinical success (Exp[b]: 0.23 [0.09-0.60]; P = 0.003) and chemotherapy (Exp[b]: 0.06 [0.02-0.23]; P < 0.001) were significantly associated with survival. The survival was longer in patients who achieved EUS-HGS clinical success (178[61-393] vs. 15[73-24] days; hazard ratio: 6.3; P < 0.001) and in those starting chemotherapy (324[178-439] vs. 31 [9-48]; hazard ratio: 1.2; P < 0.001). Conclusions EUS-HGS is effective in pCCA patients despite a not negligible AE rate. Clinical success, potentially leading to jaundice resolution and chemotherapy start, significantly improves survival.
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Affiliation(s)
- Armelle Schoch
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Andrea Lisotti
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France,Hospital of Imola, University of Bologna, Italy
| | - Thomas Walter
- Department of Medical Oncology, Edoard Herriot Hospital, Lyon, France
| | - Fabien Fumex
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Sarah Leblanc
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Pascal Artru
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Jérôme Desramé
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Nicole Brighi
- Department of Medical Oncology, IRCCS Institute for the Study of Cancer (IRST) “Dino Amadori”, Meldola, Italy
| | - Julien Marsot
- Department of Radiology, Jean Mermoz Private Hospital, Lyon, France
| | | | - Bertrand Napoléon
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France,Address for correspondence Dr. Bertrand Napoléon, Endoscopic Department, Jean Mermoz Private Hospital, Ramsay Sante, 55 avenue Jean Mermoz, 69008 Lyon, France. E-mail:
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Machicado JD, Napoleon B, Lennon AM, El-Dika S, Pereira SP, Tan D, Pannala R, Girotra M, Kongkam P, Bertani H, Feng Y, Sijie H, Zhong N, Valantin V, Leblanc S, Hinton A, Krishna SG. Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions. Pancreatology 2022; 22:994-1002. [PMID: 36089484 PMCID: PMC10548449 DOI: 10.1016/j.pan.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 08/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although emerging data evidences that EUS-guided needle-based confocal laser endomicroscopy (nCLE) accurately diagnoses pancreatic cystic lesions (PCLs), there are a lack of interobserver agreement (IOA) studies utilizing reference histopathological diagnosis and for specific PCL subtypes. Hence, we sought to assess the IOA, intra-observer reliability (IOR), and diagnostic performance of EUS-nCLE using a large cohort of patients with histopathological diagnosis amongst a broad panel of international observers. METHODS EUS-nCLE videos (n = 76) of subjects with PCLs [intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystadenoma (SCA), pseudocyst, and cystic-neuroendocrine tumors/solid pseudopapillary neoplasm (cystic-NET/SPN)], simulating clinical prevalence rates were obtained from 3 prospective studies. An international panel of 13 endosonographers with nCLE experience, blinded to all PCL data, evaluated the video library twice with a two-week washout for PCL differentiation (mucinous vs. non-mucinous) and subtype diagnosis. RESULTS The IOA (κ = 0.82, 95% CI 0.77-0.87) and IOR (κ = 0.82, 95% CI 0.78-0.85) were "almost perfect" to differentiate mucinous vs. non-mucinous PCLs. For PCL subtype, IOA was highest for SCA (almost perfect; κ = 0.85), followed by IPMN (substantial, κ = 0.72), and cystic-NET/SPN (substantial, κ = 0.73). The IOA was moderate for MCN (κ = 0.47), and pseudocyst (κ = 0.57). Compared to histopathology, observers differentiated mucinous vs. non-mucinous PCLs with high accuracy (94.8%, 95% CI 93.3-96.1). For detecting specific PCLs subtypes, EUS-nCLE was highly accurate in diagnosing non-mucinous cysts (SCA: 98%; cystic-NET/SPN: 96%; pseudocyst: 96%) and slightly less accurate for mucinous lesions (IPMN: 86%; MCN: 84%). CONCLUSION Diagnosis of PCLs by EUS-nCLE guided virtual biopsy is very accurate and reliable for the most prevalent pancreatic cysts in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pradermchai Kongkam
- Division of Hospital and Ambulatory Medicine, Department of Medicine, Chulalongkorn University, Thailand
| | - Helga Bertani
- Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Yunlu Feng
- Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Hao Sijie
- Huashan Hospital Fudan University, Shanghai, China
| | - Ning Zhong
- Qilu Hospital of Shandong University Qingdao, Qingdao, Shandong, China
| | | | - Sarah Leblanc
- Hopital Privé Jean Mermoz, Ramsay Generale de Sante, Lyon, France
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
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El Bacha H, Harizi R, Laugier R, Lorenzo D, Rivallin P, Leblanc S, Barange K, Fumex F, Laquière A, Napoléon B, Vedrenne B, Grabar S, Prat F. Identification of endoscopic predictors of biliary malignancy during digital cholangioscopy. Dig Endosc 2022; 34:1224-1233. [PMID: 35138664 DOI: 10.1111/den.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Biliary brushings and biopsies obtained during endoscopic retrograde cholangiopancreatography (ERCP) have a low sensitivity for the diagnosis of malignant biliary strictures. While cholangioscopic analysis is useful, visual criteria have not yet been defined. The aim of this study was to identify visual criteria for the diagnosis of indeterminate biliary strictures (IDBS). METHODS A multicenter study was conducted based on the analysis of cholangioscopic recordings of IBDS. Diagnostic criteria were identified in a study group and verified in a validation group. RESULTS Four criteria were identified to be associated with malignancy, one negatively ("endobiliary material," odds ratio [OR] 0.62, 95% confidence interval [CI] 0.41-0.92) and three positively ("vascularized villous projections," OR 1.52, 95% CI 1.03-2.24; "twisted or dilated vessels," OR 2.18, 95% CI 1.47-3.24; and "dark color of the mucosa," OR 1.82, 95% CI 1.23-2.70). Between two playbacks, the mean (95% CI) sensitivity of the observer's visual diagnosis increased from 66.1% (60-72) to 73.8% (69-78) (P = 0.004); in the second playback, the kappa value for interobserver agreement ranged between 0.36 (color) and 0.56 (endobiliary material), with a significant improvement (P = 0.0031-0.0001) between the first and second playbacks. Blind assessment by endoscopists not involved in this study had a diagnostic accuracy of 73% (71.4-74.5). CONCLUSION The four identified cholangioscopic features are easy to implement in clinical practice and have the potential to increase the level of diagnostic confidence during the workup of IDBS.
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Affiliation(s)
- Hicham El Bacha
- Gastroenterology and Endoscopy Unit Medicine B, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Rafik Harizi
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu, University Hospitals of Paris (AP-HP), Paris, France
| | - René Laugier
- Gastroenterology and Endoscopy Unit, La Timone University Hospital, Marseilles, France
| | - Diane Lorenzo
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
| | - Paul Rivallin
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
| | - Sarah Leblanc
- Digestive Endoscopy Unit, Jean Mermoz Clinic, Lyon, France
| | - Karl Barange
- Gastroenterology and Endoscopy Unit, Toulouse University Hospital, Toulouse, France
| | - Fabien Fumex
- Digestive Endoscopy Unit, Jean Mermoz Clinic, Lyon, France
| | - Arthur Laquière
- Gastroenterology and Endoscopy Unit, Saint Joseph Hospital, Marseilles, France
| | | | - Bruno Vedrenne
- Gastroenterology and Endoscopy Unit, Mulhouse and Southern Alsace Regional Hospital, Mulhouse, France
| | - Sophie Grabar
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu, University Hospitals of Paris (AP-HP), Paris, France
| | - Frederic Prat
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
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Grimaldi D, Legriel S, Pichon N, Colardelle P, Leblanc S, Canouï-Poitrine F, Salem OBH, Muller G, de Prost N, Herrmann S, Marque S, Baron A, Sauneuf B, Messika J, Dior M, Creteur J, Bedos JP, Boutin E, Cariou A. Ischemic injury of the upper gastrointestinal tract after out-of-hospital cardiac arrest: a prospective, multicenter study. Crit Care 2022; 26:59. [PMID: 35287719 PMCID: PMC8919548 DOI: 10.1186/s13054-022-03939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity.
Methods Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal ischemic injury using multivariate regression analysis. We also compared the outcomes (organ failure during ICU stay and neurological status at hospital discharge) of the three groups of patients. Results Among the 214 patients included in the analysis, 121 (57%, 95% CI 50–63%) had an upper gastrointestinal ischemic lesion, most frequently on the fundus. Ischemic lesions were severe in 55/121 (45%) patients. In multivariate regression, higher adrenaline dose during cardiopulmonary resuscitation (OR 1.25 per mg (1.08–1.46)) was independently associated with increased odds of severe upper gastrointestinal ischemic lesions; previous proton pump inhibitor use (OR 0.40 (0.14–1.00)) and serum bicarbonate on day 1 (OR 0.89 (0.81–0.97)) were associated with lower odds of ischemic lesions. Patients with severe lesions had a higher SOFA score during the ICU stay and worse neurological outcome at hospital discharge. Conclusions More than half of the patients successfully resuscitated from OHCA had upper gastrointestinal tract ischemic injury. Presence of ischemic lesions was independently associated with the amount of adrenaline used during resuscitation. Patients with severe lesions had higher organ failure scores during the ICU stay and a worse prognosis. Clinical Trial RegistrationNCT02349074. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03939-9.
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Affiliation(s)
- D Grimaldi
- Department of Intensive Care CUB-Erasme, Route de Lennik, 808, Université Libre de Bruxelles (ULB), 1070, Brussels, Belgium. .,AfterROSC Network Group, Paris, France.
| | - S Legriel
- AfterROSC Network Group, Paris, France.,Medico-Surgical Intensive Care Unit, Versailles Hospital, Le Chesnay, Paris, France
| | - N Pichon
- AfterROSC Network Group, Paris, France.,Medico-surgical Intensive Care Unit, General Hospital Center, Brive-la-Gaillarde, France
| | - P Colardelle
- Gastroenterology, C.H. Versailles, Le Chesnay, France
| | - S Leblanc
- Gastroenterology, APHP, Hôpital Cochin, Paris, France
| | - F Canouï-Poitrine
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France
| | - O Ben Hadj Salem
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France.,Intensive Care Unit, Centre Hospitalier Intercommunal Meulan - Les Mureaux, Meulan en Yvelines, France
| | - G Muller
- AfterROSC Network Group, Paris, France.,Intensive Care Unit, Centre Hospitalier Intercommunal Meulan - Les Mureaux, Meulan en Yvelines, France.,ICU, Centre Hospitalier Régional Orleans, Orléans, France
| | - N de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri-Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.,Université Paris-Est Créteil Val de Marne, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - S Herrmann
- Gastro-enterology, Centre Hospitalier Régional d'Orleans, Orléans, France
| | - S Marque
- ICU, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - A Baron
- Gastroenterology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - B Sauneuf
- AfterROSC Network Group, Paris, France.,ICU, Chpc - Centre Hospitalier Public Du Cotentin : Hospital Louis Pasteur, Cherbourg-en-Cotentin, France
| | - J Messika
- APHP.Nord-Université de Paris, Medico-surgical ICU, Hôpital Louis Mourier, Colombes, France.,INSERM, PHERE UMRS 1152, Université de Paris, Paris, France
| | - M Dior
- DMU ESPRIT, Department of Gastroenterology, AP-HP, Hopital Louis Mourier, 92700, Colombes, France
| | - J Creteur
- Department of Intensive Care CUB-Erasme, Route de Lennik, 808, Université Libre de Bruxelles (ULB), 1070, Brussels, Belgium
| | - J P Bedos
- Medico-Surgical Intensive Care Unit, Versailles Hospital, Le Chesnay, Paris, France
| | - E Boutin
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France
| | - A Cariou
- AfterROSC Network Group, Paris, France.,Medical Intensive Care Unit, Cochin University Hospital (APHP), Paris, France; University of Paris - Medical School, Paris, France.,University of Paris - Medical School, Paris, France
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Bonniaud P, Jacques J, Lambin T, Gonzalez JM, Dray X, Coron E, Leblanc S, Chevaux JB, Léger-Nguyen F, Hamel B, Lienhart I, Rivory J, Ponchon T, Saurin JC, Monzy F, Legros R, Lépilliez V, Subtil F, Barret M, Pioche M. Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification. Endosc Int Open 2022; 10:E145-E153. [PMID: 35047345 PMCID: PMC8759940 DOI: 10.1055/a-1613-5328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 10/26/2022] Open
Abstract
Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen's Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different ( P < 0.001): the highest sensitivities were for NICE 2 (84.2 %) and CONECCT IIC (78.9 %), and the lowest for Kudo Vi (31.6 %). Conclusions The CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma.
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Affiliation(s)
- Paul Bonniaud
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University hospital, Limoges, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gonzalez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France
| | - Xavier Dray
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Emmanuel Coron
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nantes University Hospital, Nantes, France
| | - Sarah Leblanc
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Jean-Baptiste Chevaux
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nancy University Hospital, Nancy, France
| | | | - Benjamin Hamel
- Department of Gastroenterology, North-Ouest Hospital, Villefranche-Sur-Saône, France
| | | | - Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Frédéric Monzy
- Department of Gastroenterology, Clinique Claude Bernard, Albi, France
| | - Romain Legros
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Vincent Lépilliez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Maximilien Barret
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Hôpital Cochin, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France,Inserm U1032 LabTau, Lyon, France
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Belle A, Lorut C, Lefebvre A, Ali EA, Hallit R, Leblanc S, Bordacahar B, Coriat R, Roche N, Chaussade S, Barret M. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9:E1350-E1354. [PMID: 34466358 PMCID: PMC8367450 DOI: 10.1055/a-1490-9001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.
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Affiliation(s)
- Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Lorut
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Lefebvre
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France
| | - Benoit Bordacahar
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Nicolas Roche
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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Leblanc S, Roux J, Tillaut H, Le Page E, Leray E. Disease-modifying therapy usage in patients with multiple sclerosis in France: A 6-year population-based study. Rev Neurol (Paris) 2021; 177:1250-1261. [PMID: 34253346 DOI: 10.1016/j.neurol.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most data regarding the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) comes from clinical series or regional databases that have a risk of recruitment bias. French health administrative data offers the significant advantage of being extensive in regards to both MS population coverage and DMT prescriptions. OBJECTIVES To describe patterns of DMTs usage at the level of the entire French population of MS patients from 2010 to 2015. METHODS MS patients were identified during a 6-year study period via the French national health data system (covering 97% of the general population) and characteristics of patients who received at least one treatment were compared to those that never received treatment over the indicated period. A state sequence analysis was performed to study in a longitudinal way MS patients who started DMTs in 2010 and then to classify them into groups of similar therapeutic patterns. DMTs were categorized into first-line, second-line and off-label use, and included untreated periods for at least six months. Groups that were obtained were described and compared using a multinomial logistic regression. RESULTS A total of 112,415 patients with MS were identified, of whom 54.0% received at least one DMT over the 6 years. The probability of being treated significantly decreased with age. Comorbidities and physical limitations appeared to be more frequent in not treated patients than in treated patients. Significant differences were also found between the two groups regarding the use of healthcare services (hospitalizations and visits to general practitioner, neurologist and nurse). Based on the 6-year therapeutic sequences, a four-cluster typology was obtained on the 4,474 patients who started a DMT in 2010. The first group which consisted of more than half of the patients (57.0%) mainly used first-line DMTs. The second group (13.1%) represented patients with second-line DMTs whereas the third group (7.3%) was comprised of off-label users and the last group (22.6%) was composed of MS patients who received no or minimal treatments. Classification into one of these groups was associated with patient's age, long-term disease status, pregnancy occurrence, estimated level of disability, levels of care (visits to a neurologist, nurse and/or physiotherapist and hospital/rehabilitation stays) and occurrence of death. CONCLUSIONS The exhaustive population-based dataset from the French national health data system gave the opportunity to provide a detailed description regarding the use of DMTs for MS at national level. The innovative method of state sequence analysis allowed obtaining four homogeneous groups of patients among thousands of longitudinal therapeutic sequences. The predominant place of first-line treatments was confirmed even if the type of first-line treatments has probably changed since 2015.
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Affiliation(s)
- S Leblanc
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, 15, avenue du Professeur Léon Bernard, CS 74312, 35000 Rennes, France.
| | - J Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, 15, avenue du Professeur Léon Bernard, CS 74312, 35000 Rennes, France
| | - H Tillaut
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, 15, avenue du Professeur Léon Bernard, CS 74312, 35000 Rennes, France
| | - E Le Page
- Inserm CIC-P 1414, Rennes University Hospital, Rennes University, 2, rue Henri le Guilloux, 35000 Rennes, France; Neurology department, Rennes University Hospital, Rennes University, 2, rue Henri le Guilloux, 35000 Rennes, France
| | - E Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, 15, avenue du Professeur Léon Bernard, CS 74312, 35000 Rennes, France; Inserm CIC-P 1414, Rennes University Hospital, Rennes University, 2, rue Henri le Guilloux, 35000 Rennes, France
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21
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Barret M, Pioche M, Terris B, Ponchon T, Cholet F, Zerbib F, Chabrun E, Le Rhun M, Coron E, Giovannini M, Caillol F, Laugier R, Jacques J, Legros R, Boustiere C, Rahmi G, Metivier-Cesbron E, Vanbiervliet G, Bauret P, Escourrou J, Branche J, Jilet L, Abdoul H, Kaddour N, Leblanc S, Bensoussan M, Prat F, Chaussade S. Endoscopic radiofrequency ablation or surveillance in patients with Barrett's oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial. Gut 2021; 70:1014-1022. [PMID: 33685969 DOI: 10.1136/gutjnl-2020-322082] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 06/03/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Due to an annual progression rate of Barrett's oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design. DESIGN A prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity. RESULTS 125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (p<0.001). At the same time, the prevalence LGD was 34.3% (95% CI 18.6 to 50.0) in the RFA group vs 58.1% (95% CI 40.7 to 75.4) in the surveillance group (OR=0.38 (95% CI 0.14 to 1.02), p=0.05). Neoplastic progression was found in 12.5% (RFA) vs 26.2% (surveillance; p=0.15). The complication rate was maximal after the first RFA treatment (16.9%). CONCLUSION RFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD. TRIAL REGISTRATION NUMBER NCT01360541.
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Affiliation(s)
- Maximilien Barret
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, Île-de-France, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy, Groupement Hospitalier Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Benoit Terris
- Pathology, Hopital Cochin, Paris, Île-de-France, France
| | - Thierry Ponchon
- Gastroenterology, Groupement Hospitalier Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Franck Cholet
- Digestive Endoscopy, CHRU de Brest, Brest, Bretagne, France
| | - Frank Zerbib
- Gastroenterology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Edouard Chabrun
- Gastroenterology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Marc Le Rhun
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Emmanuel Coron
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Marc Giovannini
- Gastroenterology, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Fabrice Caillol
- Gastroenterology, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - René Laugier
- Gastroenterology, Hospital Timone, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jeremie Jacques
- Gastroenterology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Romain Legros
- Gastroenterology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Christian Boustiere
- Gastroenterology, Hopital Saint Joseph, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Gabriel Rahmi
- Gastroenterology and Digestive Endoscopy, Hopital Europeen Georges Pompidou, Paris, France
| | - Elodie Metivier-Cesbron
- Digestive Endoscopy Unit, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France
| | - Geoffroy Vanbiervliet
- Gastroenterology, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Paul Bauret
- Gastroenterology, Centre Hospitalier Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jean Escourrou
- Gastroenterology, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Julien Branche
- Gastroenterology, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
| | - Lea Jilet
- Clinical Research Unit, Hospital Cochin, Paris, Île-de-France, France
| | - Hendy Abdoul
- Clinical Research Unit, Hospital Cochin, Paris, Île-de-France, France
| | - Nadira Kaddour
- Clinical Research Unit, Hospital Cochin, Paris, Île-de-France, France
| | - Sarah Leblanc
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, Île-de-France, France
| | - Michael Bensoussan
- Gastroenterology, Centre intégré de santé et de services sociaux de la Montérégie-Centre du Québec territoire Champlain-Charles-Le Moyne, Saint-Hubert, Quebec, Canada
| | - Frederic Prat
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, Île-de-France, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, Île-de-France, France
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22
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Ragi O, Jacques J, Branche J, Leblanc S, Vanbiervliet G, Legros R, Pioche M, Rivory J, Chaussade S, Barret M, Wallenhorst T, Barthet M, Kerever S, Gonzalez JM. One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study. Endoscopy 2021; 53:480-490. [PMID: 32575130 DOI: 10.1055/a-1205-5686] [Citation(s) in RCA: 18] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. METHODS This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). RESULTS 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % - 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 - 4.0). Clinical success was achieved in 65.8 % of the patients at 1 year, with a median rate of reduction in the GCSI score of 41 %. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 1.01 - 11.54; P = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95 %CI 0.95 - 1.00; P = 0.03). CONCLUSIONS The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.
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Affiliation(s)
- Olivier Ragi
- Service de gastroentérologie, CHU Limoges, France
| | - Jérémie Jacques
- Service de gastroentérologie, CHU Limoges, France.,CNRS, XLIM, UMR 7252, Limoges, France
| | - Julien Branche
- Service de gastroentérologie, CHU Claude Huriez, Lille, France
| | - Sarah Leblanc
- Service de gastroentérologie, APHP, Hôpital Cochin, Paris, France
| | | | | | - Mathieu Pioche
- Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
| | - Jérôme Rivory
- Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
| | | | | | | | - Marc Barthet
- Service de gastroentérologie, APHM, Hôpital Nord, Marseille, France
| | - Sébastien Kerever
- Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Fernand Widal University Hospital, AP-HP, Paris, France
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23
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Abou Ali E, Belle A, Hallit R, Terris B, Beuvon F, Leconte M, Dohan A, Leblanc S, Dermine S, Palmieri LJ, Coriat R, Chaussade S, Barret M. Management of esophageal strictures after endoscopic resection for early neoplasia. Therap Adv Gastroenterol 2021; 14:1756284820985298. [PMID: 33519974 PMCID: PMC7816530 DOI: 10.1177/1756284820985298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. METHODS We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. RESULTS Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett's neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0-4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2-7); range 1-17; p = 0.02], and in the case of circumferential resection [4.0 (3.0-7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. CONCLUSION Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.
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Affiliation(s)
- Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris France,University of Paris, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Solène Dermine
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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24
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Alnasser S, MacDonald D, Atoui R, Shurrab M, Alqahtani A, Nalla B, Cote S, Mireau J, Spadofore J, Hannessey H, Stringer M, Boyle D, Leblanc S, Collin J, Fenton J, Pullkkinen C, Pudupakkam S, Willoughby R, Henderson M, Bittira B. THE SAFTEY OF EARLY DISCHARGE FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT AMONG PATIENTS IN NORTHERN ONTARIO AND RURAL AREAS UTILIZING THE VANCOUVER 3M TAVR STUDY CLINICAL PATHWAY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.085] [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: 11/25/2022] Open
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25
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El Bacha H, Jung C, Brieau B, Bordacahar B, Leblanc S, Barret M, de Chaumont A, Dousset B, Prat F. Endoscopic ultrasound-guided luminal remodeling as a novel technique to restore gastroduodenal continuity. SAGE Open Med Case Rep 2020; 8:2050313X20950047. [PMID: 32974023 PMCID: PMC7491220 DOI: 10.1177/2050313x20950047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/26/2020] [Indexed: 01/21/2023] Open
Abstract
Pyloric exclusion is a method of treatment for duodenal injury. Surgery is usually needed to restore digestive continuity in due time, yet a new surgical procedure can be challenging due to fibrotic adhesion development. We present here a retrospective case series of three patients with pyloric exclusion who underwent endoscopic ultrasound–guided duodenal repermeabilization using metallic stents. All procedures were successful with no complication and allowed regular feeding. This case series shows that endoscopic ultrasound–guided recanalization is a feasible and safe procedure.
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Affiliation(s)
- Hicham El Bacha
- Hôpital ibn-sina, Service d'hépatogastro-entérologie et proctologie Medecine B, Rabat, Morocco.,Mohammed V University in Rabat, Rabat, Morocco
| | - Carlo Jung
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France
| | - Bertrand Brieau
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Benoit Bordacahar
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Sarah Leblanc
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Maximillien Barret
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | | | - Bertand Dousset
- Paris V, Paris Descartes faculty of medicine.,AP-HP, Cochin hospital, department of digestive, hepatobiliary and pancreatic surgery, 75014 Paris, France
| | - Frederic Prat
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
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Barret M, Guillaumot MA, Leandri C, Leblanc S, Coriat R, Belle A, Chaussade S. Intraoperative high-resolution esophageal manometry during peroral endoscopic myotomy. Sci Rep 2020; 10:14198. [PMID: 32848175 PMCID: PMC7450054 DOI: 10.1038/s41598-020-71136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
Peroral endoscopic myotomy is an accepted treatment of achalasia. Some of the treatment failures can be attributable to an insufficient length of the myotomy on the gastric side, because of a more technically challenging submucosal dissection. We assessed the feasibility and the impact of an intraoperative esophageal manometry during the peroral endoscopic myotomy procedure. A high-resolution manometry catheter was introduced through the nostril before the endoscope, and left in place during the peroral endoscopic myotomy procedure. The lower esophageal sphincter pressure was recorded throughout the peroral endoscopic myotomy. The myotomy was extended on the gastric side until the lower esophageal sphincter pressure dropped below 10 mmHg. We included 10 patients (mean age = 55 years old, 3 men) treated by peroral endoscopic myotomy for type I (3/10), type II (3/10), type III achalasia (3/10) or esophagogastric junction outflow obstruction (1/10). Manometric recording was possible in all patients. The median (IQR) lower esophageal sphincter resting pressure was 23 (17-37) mmHg before myotomy, 15 (13-19) mmHg at the end of the tunnel, and 7 (6-11) mmHg at the end of the myotomy. In 4 patients out of 10, the myotomy was extended on the base of the intraoperative manometry findings. High-resolution esophageal manometry is feasible during the peroral endoscopic myotomy procedure, and leads to increase the length of the gastric myotomy in 4 out of 10 patients. However, the cumbersome nature of intraoperative high-resolution manometry during peroral endoscopic myotomy and the high frequency of gastro-esophageal reflux disease after extended gastric myotomy suggest to limit this technique to selected patients refractory to a first myotomy.
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Affiliation(s)
- Maximilien Barret
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France.
| | - Marie-Anne Guillaumot
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Chloé Leandri
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Sarah Leblanc
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Arthur Belle
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
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Juin C, Barret M, Belle A, Abouali E, Leblanc S, Oudjit A, Dohan A, Coriat R, Chaussade S. Endoscopic treatment of Zenker's diverticulum by complete septotomy: initial experience in 19 patients. Endosc Int Open 2020; 8:E885-E890. [PMID: 32617393 PMCID: PMC7297605 DOI: 10.1055/a-1153-8985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/25/2020] [Indexed: 11/03/2022] Open
Abstract
Background and study aims Endoscopic treatment of Zenker's Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1-5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1-3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO 2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0-4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.
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Affiliation(s)
- Charlotte Juin
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abouali
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ammar Oudjit
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, France
| | - Anthony Dohan
- University of Paris, France,Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, France
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Guillaumot MA, Barret M, Jacques J, Legros R, Pioche M, Rivory J, Rahmi G, Lepilliez V, Chabrun E, Leblanc S, Chaussade S. Endoscopic full-thickness resection of early colorectal neoplasms using an endoscopic submucosal dissection knife: a retrospective multicenter study. Endosc Int Open 2020; 8:E611-E616. [PMID: 32355878 PMCID: PMC7164998 DOI: 10.1055/a-1127-3092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Patients and methods Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Results Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Conclusion Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.
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Affiliation(s)
- Marie-Anne Guillaumot
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hopitaux de Paris, and University of Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hopitaux de Paris, and University of Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - Romain Legros
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - Mathieu Pioche
- Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Jérome Rivory
- Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hopitaux de Paris, and University of Paris, France
| | - Vincent Lepilliez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Edouard Chabrun
- Department of Endoscopy and Gastroenterology, Bordeaux University Hospital, Bordeaux, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hopitaux de Paris, and University of Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hopitaux de Paris, and University of Paris, France
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Bresteau C, Barret M, Guillaumot MA, Abou Ali E, Belle A, Leblanc S, Oudjit A, Dohan A, Coriat R, Chaussade S. Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum? J Gastroenterol Hepatol 2020; 35:630-633. [PMID: 31693762 DOI: 10.1111/jgh.14923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/27/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Zenker's diverticulum (ZD) is the most common type of diverticulum in the esophagus. The endoscopic septotomy of the diverticular wall has become a widely accepted treatment modality, but the recurrence rate is unclear. Our aim was to assess short-term and long-term success rates after flexible endoscopic septotomy for the treatment of ZD. METHODS All consecutive patients treated at our department for a ZD between November 2014 and September 2018 were included. Endoscopic septotomy was conducted using a diverticuloscope or a distal attachment cap. Data were retrospectively analyzed from a prospectively collected database. We collected data concerning patients, endoscopic procedures, and short-term clinical outcomes. All patients were reached by phone between October and December 2018 to assess long-term results. RESULTS Seventy-seven patients were referred to our department for a ZD. Sixty patients were treated using a diverticuloscope and 17 patients with a distal attachment cap. For all 77 patients, the myotomy was technically successful. Three patients treated with a diverticuloscope reported complications. Initial treatment success was 93%. After a mean (±SEM) follow up of 23 ± 2 months, 66% of patients had persistent clinical remission. The rate of long-term treatment success was 72% in treatment-naïve and 50% in previously treated patients (P = 0.13). Treatment success was 68% in patients treated with the diverticuloscope versus 60% in the group treated with a cap (P = 0.75). CONCLUSION The flexible endoscopic septotomy for the treatment of ZD is a safe and effective treatment of ZD, with or without a diverticuloscope.
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Affiliation(s)
- Clément Bresteau
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Marie-Anne Guillaumot
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ammar Oudjit
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
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Barret M, Dohan A, Oudjit A, Leblanc S, Belle A, Abouali E, Coriat R, Chaussade S, Soyer P. Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay. Eur Radiol 2020; 30:4175-4181. [PMID: 32170414 DOI: 10.1007/s00330-020-06758-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes. METHODS The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis. RESULTS A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99). CONCLUSIONS Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay. KEY POINTS • Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France. .,University of Paris, Descartes Paris 5, 75006, Paris, France.
| | - Anthony Dohan
- University of Paris, Descartes Paris 5, 75006, Paris, France.,Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France
| | - Ammar Oudjit
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France
| | - Einas Abouali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France.,University of Paris, Descartes Paris 5, 75006, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France.,University of Paris, Descartes Paris 5, 75006, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France.,University of Paris, Descartes Paris 5, 75006, Paris, France
| | - Philippe Soyer
- University of Paris, Descartes Paris 5, 75006, Paris, France.,Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France
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Roland D, Rahmi G, Pérez-Cuadrado-Robles E, Perrod G, Jacques J, Barret M, Leblanc S, Berger A, Albouys J, Chaussade S, Cellier C. Endoscopic submucosal dissection in rectal tumors extending or not to the dentate line: A comparative analysis. Dig Liver Dis 2020; 52:296-300. [PMID: 31744774 DOI: 10.1016/j.dld.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/19/2019] [Revised: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The feasibility of endoscopic submucosal dissection (ESD) in rectal tumors extending to the dentate line (RTDL) is unclear. AIMS To analyze the outcomes of ESD in RTDL compared to non-RTDL, with a special focus on the lower rectum location. METHODS Observational multicenter retrospective study. All patients with a rectal tumor who underwent ESD in 2013-2017 were included. A comparative analysis between RTDL and non-RTDL groups was done. RESULTS Two-hundred and twenty-eight patients (median age: 69 years, range: 33-89, 51.3% male) with RTDL (n = 65, 28.5%) and non-RTDL lesions (n = 163, 71.5%) were included. There were no significant differences between the en-bloc (89.2% vs. 90.8%, p = 0.718), complete (60% vs. 71.8%, p = 0.084) and curative resection rates (58.5% vs. 68.7%, p = 0.141). The overall complication rate (4.6% vs. 8%, p = 0.370) was not different, independently of the rectal location. Local recurrence was higher in RTDL (7.3% vs. 1.5%, p = 0.065). The indication for surgery due to non-curative resections in the lower rectum was lower in RTDL (9.2% vs. 14.6%, p = 0.378). CONCLUSION The safety, effectiveness and long-term impact of ESD in RTDL and non-RTDLs is comparable. Local recurrence in the lower rectum may be higher in RTDL.
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Affiliation(s)
- Déborah Roland
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France.
| | | | - Guillaume Perrod
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Arthur Berger
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Christophe Cellier
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
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Orlandini B, Barret M, Guillaumot MA, Léandri C, Leblanc S, Prat F, Chaussade S. Per-oral endoscopic myotomy for esophageal diverticula with or without esophageal motility disorders. Clin Res Hepatol Gastroenterol 2020; 44:82-89. [PMID: 31080116 DOI: 10.1016/j.clinre.2019.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Mid-esophageal and epiphrenic diverticula (MED) can be associated with esophageal motility disorders. Per-oral endoscopic myotomy (POEM) is an established treatment for esophageal motility disorders that has also been introduced for the treatment of MED. METHODS Data were prospectively collected from patients with MED treated with POEM at our institution. When esophageal motility disorders were present, myotomy was performed extending the myotomy to the lower esophageal sphincter (LES) to treat the motility dysfunction associated with the diverticulum. In the absence of esophageal motility disorder, POEM was performed without including the LES in the myotomy to achieve diverticulotomy. RESULTS Four patients were treated with POEM for MED between April 2017 and March 2018. The patients suffered from distal esophageal spasm, jackhammer esophagus or esophago-gastric junction outflow obstruction. One patient had no esophageal motility disorder. Diverticulum size was 3 cm in one case and 6 cm in the others. Preoperative Eckardt scores ranged from 6 to 8. No life-threatening complications were reported. Intraoperative pneumoperitoneum was described in two cases and one patient experienced aspiration pneumonia. The patients with motility disorders were asymptomatic at 6-8 months follow-up. The patient without documented underlying esophageal motility disorder had an Eckardt score of 3 at 9-months follow-up. Two cases of gastro-esophageal reflux were successfully managed with proton pump inhibitors. CONCLUSIONS In the case of MED and esophageal motility disorder, POEM permitted treatment of the underlying cause of the diverticulum, achieving favorable early clinical outcomes. In the absence of motility disorder, POEM was feasible with promising early outcomes, and could be a valid alternative to surgical diverticulectomy in selected patients.
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Affiliation(s)
- Beatrice Orlandini
- Department of gastroenterology, department of experimental and clinical biomedical sciences, Careggi hospital, University of Florence, Viale San Luca, 50134, Florence, Italy; Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
| | - Maximilien Barret
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France.
| | - Marie-Anne Guillaumot
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
| | - Chloé Léandri
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
| | - Sarah Leblanc
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
| | - Frédéric Prat
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
| | - Stanislas Chaussade
- Department of gastroenterology, Cochin hospital, assistance publique - Hôpitaux de Paris, Paris Descartes university, 27, rue du Faubourg St Jacques 75014, Paris, France
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Dermine S, Leconte M, Leblanc S, Dousset B, Terris B, Berger A, Berger A, Rahmi G, Lepilliez V, Plomteux O, Leclercq P, Coriat R, Chaussade S, Prat F, Barret M. Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer. Therap Adv Gastroenterol 2019; 12:1756284819892556. [PMID: 31839807 PMCID: PMC6902379 DOI: 10.1177/1756284819892556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. PATIENTS AND METHODS A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. RESULTS A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins (n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion (n = 3 and 9), adenocarcinoma with deep submucosal invasion (n = 11), poorly differentiated tumor (n = 6) and lymphovascular invasion (n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status (n = 3) or lymph node metastases (n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. CONCLUSION In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.
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Affiliation(s)
- Solène Dermine
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Dousset
- Paris Descartes University, Paris, France,Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Paris Descartes University, Paris, France,Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arthur Berger
- Gastroenterology and Gastrointestinal Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Berger
- Paris Descartes University, Paris, France,Department of Digestive Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gabriel Rahmi
- Paris Descartes University, Paris, France,Gastroenterology and Gastrointestinal Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Olivier Plomteux
- Department of Gastroenterology, Les Cliniques Saint Joseph, Liège, Belgium
| | | | - Romain Coriat
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Frédéric Prat
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
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Braud A, Wurth S, Leblanc S, Mahé A. Infection cutanée à Scedosporium apiospermum chez un patient traité par une corticothérapie systémique prolongée. Ann Dermatol Venereol 2019; 146:757-759. [DOI: 10.1016/j.annder.2019.06.005] [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] [Received: 03/24/2019] [Revised: 05/19/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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Oumrani S, Barret M, Roseau G, Brieau B, Leblanc S, Coriat R, Prat F, Chaussade S. Do we need endoscopic ultrasonography for the workup of patients with esophageal motility disorder? Clin Res Hepatol Gastroenterol 2019; 43:608-613. [PMID: 30880097 DOI: 10.1016/j.clinre.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Endoscopic ultrasonography (EUS) is advised in the workup of achalasia patients to rule out secondary achalasia or pseudoachalasia, and search for a typical esophageal wall thickening. The purpose of this study was to assess the clinical contribution of EUS findings in achalasia and other esophageal motility disorders (EMD). METHODS We conducted a single center retrospective study at a tertiary referral centre. We included all patients with an EUS for the workup of a suspected EMD from January 2012 to December 2017. RESULTS Sixty-nine patients were included, 52% were men, with a median (±SD) age of 61 ± 14 years. Median (±SD) Eckardt Score was 7 ± 2. EUS was normal in 26 (38%) patients, and showed an esophageal wall thickening in 43 (62%) patients. Three cases of secondary achalasia were diagnosed at mucosal biopsies: 2 esophageal carcinomas and one eosinophilic esophagitis. Esophageal wall thickening was not significantly associated with the type of EMD or achalasia subtype and there was no statistical correlation between the presence of a wall thickening at EUS and therapeutic outcomes. CONCLUSION In our work, the presence of an esophageal wall thickening was not predictive of the type of EMD nor achalasia subtype or treatment outcome. The contribution of endoscopic ultrasonography in achalasia and other EMD seems limited.
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Affiliation(s)
- Sarra Oumrani
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France
| | - Maximilien Barret
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France.
| | - Gilles Roseau
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Brieau
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France
| | - Frédéric Prat
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France
| | - Stanislas Chaussade
- Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France
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Durand H, Lamy F, Parratte T, Brinet A, Blain A, Lamy F, Gaultier C, Droy-Dupré L, Leblanc S, Oesterlé H, Olteanu S, Atlani D, Voirin J, Mokhtari K, Ahle G. P14.87 Leptomeningeal dissemination in high grade glioma: Correlation of MRI, cytology and standard CSF indices. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Only few studies report the incidence of leptomeningeal dissemination (LMD) in patients with high grade glioma (HGG), although LMD is not a rare condition of recurrence. We aimed to describe the diagnostic features and treatment modalities in a series of patients treated for HGG in our institution.
METHODS
Review of clinical presentation, radiological features and CSF analysis in a case series.
RESULTS
17 patients from our institution were diagnosed with LMD. The diagnosis of LMD was based on magnetic resonance image and/or cerebrospinal fluid (CSF) analysis. The spectrum of clinical presentation was broad, mainly intracranial hypertension, impaired general condition, pain, worsening of pre-existing symptoms, and epileptic seizures. Median time from onset of clinical deterioration to diagnosis of LMD was 3 weeks (0–16). Leptomeningial involvement was reported in 6/17 at initial MRI reading, whereas reassessment with careful comparison to previous MRI showed signs of LMD in all patients. CSF analysis revealed pleocytosis (11/17), high proteinorrachia (13/17), elevated lactate levels (15/16), low glucose levels (5/17), and increased CSF pressure (5/9). Nevertheless, diagnostic accuracy of initial CSF cytological analysis was low (2/17). A reassessment of the specimen by an experienced neuropathologist disclosed 1 additional positive and 1 additional suspect cytology. After diagnosis of LMD, salvage treatments comprised Bevacizumab, Lomustine, Fotemustine, liposomal cytarabine and best supportive care. The median overall survival after the diagnosis was 3 months.
DISCUSSION AND CONCLUSIONS
LMD in HGG is not a rare condition of recurrence, and its outcome is poor. It remains a diagnostic challenge, as it may be overlooked on MRI follow-up at its early stage. In case of clinical progression with no overt cause reported on MRI, we recommend careful second MRI reading. In case of doubt lumbar puncture should be performed in order to prove LMD and eliminate infection (i.e. HSV). Upon standard CSF indices, elevated lactate levels should give rise to the suspicion of LMD. Cytological CSF analysis seems to be of low diagnostic yield: This may be improved by faster processing after sampling and by standardized workup including staining with IDH, GFAP and Olig2.
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Affiliation(s)
- H Durand
- Hôpitaux Civils de Colmar, Colmar, France
| | - F Lamy
- Hôpitaux Civils de Colmar, Colmar, France
| | - T Parratte
- Hôpitaux Civils de Colmar, Colmar, France
| | - A Brinet
- Hôpitaux Civils de Colmar, Colmar, France
| | - A Blain
- Hôpitaux Civils de Colmar, Colmar, France
| | - F Lamy
- Hôpitaux Civils de Colmar, Colmar, France
| | - C Gaultier
- Hôpitaux Civils de Colmar, Colmar, France
| | | | - S Leblanc
- Hôpitaux Civils de Colmar, Colmar, France
| | - H Oesterlé
- Hôpitaux Civils de Colmar, Colmar, France
| | - S Olteanu
- Hôpitaux Civils de Colmar, Colmar, France
| | - D Atlani
- Hôpitaux Civils de Colmar, Colmar, France
| | - J Voirin
- Hôpitaux Civils de Colmar, Colmar, France
| | - K Mokhtari
- Hôpital Pitié-Salpêtrière, Paris, France
| | - G Ahle
- Hôpitaux Civils de Colmar, Colmar, France
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Prat F, Leblanc S, Foissac F, Ponchon T, Laugier R, Bichard P, Maire F, Coumaros D, Charachon A, Vedrenne B, Boytchev I, Chaussade S, Kaddour N, Laquière A, Gaujoux S. Impact of peroral cholangioscopy on the management of indeterminate biliary conditions: a multicentre prospective trial. Frontline Gastroenterol 2019; 10:236-243. [PMID: 31281624 PMCID: PMC6583565 DOI: 10.1136/flgastro-2018-100985] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Single-operator cholangioscopy (SOC) can help diagnose biliopancreatic conditions. The impact of SOC on patient outcome has never been specifically addressed. PATIENTS AND METHODS Consecutive patients bearing indeterminate biliary strictures (IDBS), or primary sclerosing cholangitis (PSC) with suspected cholangiocarcinoma, were included. Patients with IDBS had at least one previous inconclusive endoscopic retrograde cholangio pancreatography (ERCP) + cytology. Primary endpoint was the difference in adequacy of management planned before and after SOC with regard to final diagnosis obtained after surgery or 24 months follow-up. DESIGN Prospective open-label multicentre trial. RESULTS 61 patients were included (IDBS: 48; PSC: 13); 70.5% had a benign lesion (IDBS 66.7%, PSC 84.6%). The management adequacy rate was significantly higher after SOC than before SOC overall (p<10-5), in IDBS (p<0.001) and PSC (p<0.05) patients. SOC induced changes in the management of the majority of patients in all groups (60.3%). The overall sensitivity of combined visual impression and biopsy ranged from 52% to 63.6% depending on investigator or independent expert rating (κ 0.92-0.96), whereas specificity, positive and negative predictive values of SOC were, respectively, 100%, 100% and 83.6%. Patient management observed at the end of follow-up was consistent with that anticipated after SOC in 88.5% overall. CONCLUSION Despite a moderate sensitivity for the diagnosis of malignancy, SOC has a dramatic impact on the management of patients with IDBS and PSC with suspected carcinoma. Cholangioscopy might be implemented in the workup of selected patients with challenging diagnosis, when a significant impact on outcome (essentially resection vs conservative management) is to be expected.
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Affiliation(s)
- Frederic Prat
- Department of Gastroenterology, Assistance Publique Hopitaux de Paris, Paris-Descartes University, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Assistance Publique Hopitaux de Paris, Paris-Descartes University, Paris, France
| | | | | | - René Laugier
- Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Philippe Bichard
- Digestive Endoscopy Unit, Centre Hospitalier Universitaire de Grenoble, Grenoble, France,Service de Gastro-entérologie et Hépatologie, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | | | | | | | - Bruno Vedrenne
- Groupe Hospitalier de la Region de Mulhouse et Sud Alsace, Mulhouse, France
| | | | | | | | - Arthur Laquière
- Gastroenterology and Endoscopy Unit, Hopital st joseph, Marseille, France
| | - Sèbastien Gaujoux
- Department of Surgery, Assistance Publique - Hopitaux de Paris, Paris, France
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Sportes A, Leblanc S, Bordacahar B, Barret M, Prat F. Peroral intraductal cholangioscopy-guided laser lithotripsy via endoscopic ultrasound-guided hepaticogastrostomy for intrahepatic bile duct lithiasis. Endoscopy 2019; 51:E135-E136. [PMID: 30909305 DOI: 10.1055/a-0866-8986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Adrien Sportes
- Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France.,Gastroenterology Unit, Institut Arnault Tzanck, Saint-Laurent-du-Var, France
| | - Sarah Leblanc
- Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France
| | | | | | - Frederic Prat
- Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France
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Lorenzo D, Barret M, Leblanc S, Terris B, Beuvon F, Coriat R, Chaussade S, Prat F. Outcomes of endoscopic submucosal dissection for early oesophageal squamous cell neoplasia at a Western centre. United European Gastroenterol J 2019; 7:1084-1092. [PMID: 31662865 DOI: 10.1177/2050640619852260] [Citation(s) in RCA: 5] [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: 03/02/2019] [Accepted: 04/28/2019] [Indexed: 01/11/2023] Open
Abstract
Background and aims Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma. However, data from Western centres are scarce. Methods We conducted a retrospective study from a prospectively collected database at a tertiary care centre in France. All consecutive patients undergoing endoscopic submucosal dissection for oesophageal squamous cell carcinoma were included. The main outcome was the curative resection rate. Secondary outcomes were en-bloc resection rates, histologically complete resection rates, morbidity, recurrence-free and overall survival. Results Fifty-six cases of oesophageal squamous cell carcinoma (49 patients; mean age 61.5 ± 10 years; 36 men) were included. En-bloc, histologically complete and curative resection rates were 98%, 86% and 71%, respectively. Fifteen (30%) patients received an additional treatment after endoscopic submucosal dissection, nine treated by chemoradiotherapy, four by surgery and two by further endoscopic submucosal dissection. Within a mean follow-up of 21 ± 15 months, recurrences occurred in 14 (29%) patients (four local, eight metachronous and three distant recurrences). Eight patients died during follow-up, of which two (4%) patients died from oesophageal squamous cell carcinoma. Factors significantly associated with mortality in this series were: moderate or poor differentiation of oesophageal squamous cell carcinoma (p = 0.02) and recurrence of oesophageal squamous cell carcinoma (p = 0.028). Conclusion Moderately or poorly differentiated cancer is a major prognostic factor and should probably be taken into account when indicating an additional treatment after endoscopic submucosal dissection. Close endoscopic follow-up is essential considering the high recurrence rate.
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Affiliation(s)
- Diane Lorenzo
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Sarah Leblanc
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France
| | - Benoit Terris
- Faculté Paris Descartes, Paris, France.,Pathology Department, Cochin Hospital, Paris, France
| | - Frédéric Beuvon
- Faculté Paris Descartes, Paris, France.,Pathology Department, Cochin Hospital, Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
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Jacques J, Chaussade S, Ponchon T, Coron E, Lepilliez V, Dahan M, Albouys J, Sautereau D, Leblanc S, Rahmi G, Legros R, Pioche M. Endoscopic submucosal dissection or endoscopic mucosal resection for large colorectal laterally spreading lesions? Scientific and economic data are still lacking. Gut 2019; 68:577-578. [PMID: 29563143 DOI: 10.1136/gutjnl-2018-316192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Jérémie Jacques
- Service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | - Thierry Ponchon
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Lyon, France
| | - Emmanuel Coron
- Service d'hépato-gastro-entérologie, CHU Nantes, Nantes, France
| | - Vincent Lepilliez
- Service de gastroentérologie, Hopital Privé Jean Mermoz, Lyon, France
| | - Martin Dahan
- Service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jeremie Albouys
- Service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Denis Sautereau
- Service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Sarah Leblanc
- Service d'hépato-gastro-entérologie, CHU Cochin, Paris, France
| | - Gabriel Rahmi
- Service d'hépato-gastro-entérologie, Hopital Européen Georges Pompidou, Paris, France
| | - Romain Legros
- Service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Lyon, France
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Barret M, Leblanc S, Rouquette A, Chaussade S, Terris B, Prat F. EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model. Endosc Int Open 2019; 7:E138-E143. [PMID: 30705944 PMCID: PMC6336466 DOI: 10.1055/a-0668-5653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/13/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction Two devices are currently available to perform pancreatic radiofrequency ablation (P-RFA). Potential clinical indications might extend from the treatment of pancreatic cystic lesions to ablation of small pancreatic solid lesions or cytoreduction of advanced pancreatic adenocarcinomas, but more preclinical data from animal models are needed to optimize P-RFA operation. Methods P-RFA was performed under laparotomy and under endoscopic ultrasonographic guidance on the liver and pancreatic parenchyma of four live swine using the Habib EUS RFA (EMcision Ltd, London, UK) probe and the EUS-RA needle (Taewoong Medical, Gyeonggi-do, South Korea). Animals were sacrificed 2 hours after the procedure. Influence of tuning ablation time and power on tissue ablation were studied by histopathological assessment of the maximal depth of tissue damage on representative slides for each P-RFA shot. Results The Habib probe in the liver parenchyma resulted in tissue necrosis increasing within the range of 1.9 ± 0.5 mm (Power = 8 W, Time = 120 s) to 2.5 ± 1 mm (Power = 10 W, Time = 120 s). In the pancreatic parenchyma, tissue damage ranged from 3.1 ± 0.4 mm (Power = 8 W, Time = 120 s) to 2.3 ± 0.1 mm (12 W, 120 s) in depth. EUS RFA ablation of the liver parenchyma resulted in tissue damage ranging from 1.6 ± 0.2 mm (Power = 30 W, Time = 11 s) to 1.5 ± 0.1 mm (Power = 70 W, Time = 9 s); in the pancreas, ablation depth ranged from 3.6 ± 0.5 mm (Power = 30 W, Time = 15 s) to 3.8 ± 0.4 mm (Power = 70 W, Time = 11 s). Conclusion Both devices allow for effective ablation of pancreatic tissue within 1.5 to 3.8 mm around the RFA electrode, with a modest influence of tuning power settings. Specific settings are recommended for each of the devices studied. Ablation of larger lesions may require more repeat P-RFA shots in different locations rather than a simple modulation of ablation parameters.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | | | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Benoit Terris
- Paris-Descartes University, Paris, France,Department of Pathology, Cochin Hospital, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France,Corresponding author Frédéric Prat Department of GastroenterologyCochin Hospital27 rue du Faubourg St Jacques75014 Paris+33-1-58411965
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Collard MK, Danion J, Cauchy F, Perdigao F, Leblanc S, Prat F, Soubrane O, Scatton O. Duct-To-Duct Biliary Anastomosis with Removable Internal Biliary Stent During Major Hepatectomy Extended to the Biliary Confluence. J Gastrointest Surg 2018; 22:2201-2208. [PMID: 30091039 DOI: 10.1007/s11605-018-3905-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Roux-en-Y hepaticojejunostomy (HJ) currently represents the gold standard after resection of the biliary confluence. This non-physiological reconstruction poses several problems such as repeated cholangitis or stricture without conventional endoscopic access. Our aim was to describe and to report both feasibility and results of duct-to-duct anastomosis with removable internal biliary drain (RIBS) as an alternative technique to the HJ after resection of the biliary confluence in patients undergoing major liver resection. METHODS Between January 2014 and January 2018, all patients who underwent a major hepatectomy associated with resection of the biliary confluence and reconstruction by duct-to-duct biliary anastomosis with RIBS were retrospectively included. Patient demographics, tumor characteristics, pre- and postoperative outcomes, early and late biliary complications, endoscopic complications, and clinical follow-up were collected. RESULTS Twelve patients were included. The operative time was 326 ± 45 min (range 240-380 min). There was no postoperative mortality. Only one patient experienced biliary anastomotic leakage treated exclusively by radiological and endoscopic drainage. Four patients had an asymptomatic stricture of the biliary anastomosis detected by endoscopic retrograde cholangiopancreatography (ERCP) during the extraction of the RIBS requiring iterative dilatation and replacement of the RIBS. Among 21 performed ERCP, no complications such as failure of RIBS extraction, duodenal perforation, bleeding after sphincterotomy, cholangitis, or pancreatitis were observed. After a mean and a median follow-up of respectively 15.0 ± 14.9 and 8.7 months (range 2.0-46.1 months), no cholangitis occurred. CONCLUSION Duct-to-duct biliary anastomosis with RIBS insertion after resection of the biliary confluence represents a feasible and safe alternative to the HJ.
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Affiliation(s)
- Maxime K Collard
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jérôme Danion
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, 100, Boulevard du Général Leclerc, 92110, Clichy, France
| | - Fabiano Perdigao
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Endoscopy, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Endoscopy, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Paris-V Descartes University, Paris, France
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, 100, Boulevard du Général Leclerc, 92110, Clichy, France.,Paris-VII Diderot University, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris, France.
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Camus M, Beuvon F, Barret M, Dalimier E, El Bacha H, Leblanc S, Coriat R, Chaussade S, Terris B, Prat F. Full-field Optical Coherence Tomography: A New Imaging Modality for Rapid On-Site Evaluation of Resected Polyps During Colonoscopy. Gastroenterology 2018; 155:1692-1694. [PMID: 30218668 DOI: 10.1053/j.gastro.2018.07.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Marine Camus
- Sorbonne Université, Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France.
| | - Frederic Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Maximilien Barret
- INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | | | - Hicham El Bacha
- INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Romain Coriat
- INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Stanislas Chaussade
- INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Frederic Prat
- INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
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Dermine S, Barret M, Prieux C, Ribière S, Leblanc S, Dhooge M, Brezault C, Abitbol V, Terris B, Beuvon F, Rouquette A, Dousset B, Gaujoux S, Soyer P, Dohan A, Bibault JE, Coriat R, Prat F, Chaussade S. Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract. Endosc Int Open 2018; 6:E1470-E1476. [PMID: 30574537 PMCID: PMC6291401 DOI: 10.1055/a-0658-1350] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/11/2018] [Indexed: 01/26/2023] Open
Abstract
Background The recent development of endoscopic resection for superficial gastrointestinal cancers could justify the need for a dedicated oncological multidisciplinary meeting (MDM). The aim of our study was to evaluate the impact of the dedicated MDM on the management of superficial cancers of the digestive tract. Methods A dedicated MDM was developed at our tertiary referral center. A retrospective review of the MDM conclusions for all patients referred from March 2015 to March 2017 was performed. Outcomes measurements were the outcomes of endoscopic resection, and the concordance rate between the MDM recommendations, European Society of Gastrointestinal Endoscopy (ESGE) guidelines, and final patient management. Results In total, 153 patients with a median age of 69 years were included. Half of the patients had major comorbidities. The mean lesion size was 25 mm, and R0 and curative resection rate were 73.9 % and 56.9 %, respectively. Forty-three patients had an indication for surgery after endoscopic resection. The concordance rate between ESGE guidelines and MDM recommendation was 92.2 %, and 12 patients did not receive the treatment recommended due to comorbidities. Conclusion A MDM dedicated to superficial tumors helped tailor the ESGE guidelines to each patient in order to avoid unnecessary surgery.
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Affiliation(s)
- Solène Dermine
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Caroline Prieux
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Sophie Ribière
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Marion Dhooge
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Catherine Brezault
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Vered Abitbol
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Alexandre Rouquette
- Department of Pathology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Bertrand Dousset
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Sébastien Gaujoux
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Philippe Soyer
- Department of Radiology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Jean-Emmanuel Bibault
- Department of Radiotherapy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France,Paris-Descartes University, Paris, France
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Soliman H, Brieau B, Guillaumot MA, Leblanc S, Barret M, Camus M, Dior M, Terris B, Coriat R, Prat F, Chaussade S. Invasive pit pattern, macronodule and depression are predictive factors of submucosal invasion in colorectal laterally spreading tumours from a Western population. United European Gastroenterol J 2018; 6:1569-1577. [PMID: 30574328 DOI: 10.1177/2050640618804713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Laterally spreading tumours are separated in subclasses: granular, homogenous or nodular mixed; and non-granular, flat or pseudodepressed. For every subtype, a proper risk of submucosal invasive cancer has been described in Asian series. Objective The aim of the study was to determine the rate of cancer and submucosal invasive cancer in a Western series of endoscopic-resected laterally spreading tumours and their endoscopic predictive factors. Methods A total of 374 laterally spreading tumours ≥20 mm were resected by endoscopy in our single centre between 2012-2016. We analysed endoscopic and pathological data from our prospective database, determining the rates of cancer and submucosal invasive cancer according to the subtype of laterally spreading tumour. Results The rates of submucosal invasive cancer for granular homogenous, granular nodular mixed, non-granular flat, non-granular pseudodepressed laterally spreading tumours were 4.9%, 15.9%, 3.0% and 19.4%, respectively. Endoscopic mucosal resection was used in 58.0% and endoscopic submucosal dissection in 42.0%. Endoscopic submucosal dissection was associated with a higher rate of en-bloc resection (87.3% vs 26.3%; p < 0.0001), and a lower risk of recurrence (7.6% vs 15.2%; p = 0.026). Adverse event rates were not statistically different (9.5% vs 6.4%, p = 0.26). Predictive endoscopic factors of submucosal invasive cancer were: invasive pit pattern (hazard ratio = 33 (8.81-143.3)), non-granular pseudodepressed laterally spreading tumours (hazard ratio = 11.9 (0.89-146.2)), and granular nodular mixed laterally spreading tumours (hazard ratio = 3.42 (0.99-13.0)). Conclusions The risk of submucosal invasive cancer varies according to the laterally spreading tumour subtype. Three factors were associated with submucosal invasion and should justify an endoscopic submucosal dissection: non-granular pseudodepressed laterally spreading tumours, granular nodular mixed laterally spreading tumours subtypes and invasive pit pattern.
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Affiliation(s)
- Heithem Soliman
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Bertrand Brieau
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Marie-Anne Guillaumot
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Sarah Leblanc
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Maximilien Barret
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France.,INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris-France
| | - Marine Camus
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Marie Dior
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Benoit Terris
- Pathology Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Romain Coriat
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France.,INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris-France
| | - Frédéric Prat
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France.,INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris-France
| | - Stanislas Chaussade
- Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France
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Camus M, Napoléon B, Vienne A, Le Rhun M, Leblanc S, Barret M, Chaussade S, Robin F, Kaddour N, Prat F. Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy: a multicenter prospective study. Gastrointest Endosc 2018; 88:511-518. [PMID: 29660322 DOI: 10.1016/j.gie.2018.04.2332] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 12/18/2017] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endobiliary dysplasia may persist after endoscopic papillectomy. Intraductal radiofrequency ablation (ID-RFA) is a potential alternative to complementary surgery. The aim of this study was to evaluate the efficacy and safety of ID-RFA for the treatment of adenomatous intraductal residue after endoscopic papillectomy. METHODS A prospective open-label multicenter study included patients with histologically proven endobiliary adenoma remnant (ductal extent <20 mm) after endoscopic papillectomy for ampullary tumor. RFA (effect 8, power 10 W, 30 seconds) was performed during ERCP. Biliary ± pancreatic stent was placed at the end of the procedure. Endpoints were (1) the rate of residual neoplasia (ie, low-grade dysplasia [LGD], high-grade dysplasia [HGD], or invasive carcinoma) at 6 and 12 months, (2) rate of surgery, and (3) adverse events. RESULTS Twenty patients (67 ± 11 years of age, 12 men) were included. The endobiliary adenoma was in LGD in 15 patients and HGD in 5 patients. All underwent 1 successful ID-RFA session with biliary stent placement and recovered uneventfully. Five (25%) received a pancreatic stent. The rates of residual neoplasia were 15% and 30% at 6 and 12 months, respectively. Only 2 patients (10%) were referred for surgery. Eight patients (40%) experienced at least 1 adverse event between ID-RFA and 12 months of follow-up. No major adverse event occurred. HGD at inclusion was associated with higher dysplasia recurrence at 12 months (P = .01). CONCLUSIONS ID-RFA of residual endobiliary dysplasia after endoscopic papillectomy can be offered as an alternative to surgery, with a 70% chance of dysplasia eradication at 12 months after a single session and a good safety profile. Patient follow-up remains warranted after ID-RFA. (Clinical trial registration number: NCT02825524.).
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Affiliation(s)
- Marine Camus
- Université Paris 5, INSERM U1016, Institut Cochin, Paris, France
| | | | - Ariane Vienne
- Ramsay Générale de Santé, Hôpital Privé d'Antony, Antony, Paris, France
| | - Marc Le Rhun
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - Sarah Leblanc
- Université Paris 5, INSERM U1016, Institut Cochin, Paris, France
| | | | | | - Françoise Robin
- ARC SFED, Hépato-Gastroentérologie, HCL, Hôpital Edouard Herriot, Lyon, France
| | | | - Frederic Prat
- Université Paris 5, INSERM U1016, Institut Cochin, Paris, France; Service de Gastroentérologie, Hôpital Cochin, Assistance publique hôpitaux de Paris, Paris, France
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Oumrani S, Barret M, Beuvon F, Leblanc S, Chaussade S, Prat F. Salvage endoscopic submucosal dissection for esophageal adenocarcinoma arising during radiofrequency ablation. Ann Gastroenterol 2018; 31:522-524. [PMID: 29991901 PMCID: PMC6033755 DOI: 10.20524/aog.2018.0261] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/26/2018] [Indexed: 11/11/2022] Open
Abstract
Radiofrequency ablation is a recommended treatment option for residual Barrett's esophagus after endoscopic resection of a visible lesion. We herein report 3 cases of esophageal adenocarcinoma arising during the course of radiofrequency ablation, all of which were successfully resected by endoscopic submucosal dissection. Partial or suboptimal response to radiofrequency ablation or early recurrence of Barrett's mucosa after radiofrequency ablation should raise suspicion for adenocarcinoma and lead to consideration of en bloc resection by endoscopic submucosal dissection.
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Affiliation(s)
- Sarra Oumrani
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (Sarra Oumrani, Maximilien Barret, Sarah Leblanc, Stanislas Chaussade, Frédéric Prat), Paris, France
| | - Maximilien Barret
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (Sarra Oumrani, Maximilien Barret, Sarah Leblanc, Stanislas Chaussade, Frédéric Prat), Paris, France.,Paris-Descartes University (Maximilien Barret, Frédéric Beuvon, Stanislas Chaussade, Frédéric Prat), Paris, France
| | - Frédéric Beuvon
- Paris-Descartes University (Maximilien Barret, Frédéric Beuvon, Stanislas Chaussade, Frédéric Prat), Paris, France.,Department of Pathology, Cochin Hospital (Frédéric Beuvon), Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (Sarra Oumrani, Maximilien Barret, Sarah Leblanc, Stanislas Chaussade, Frédéric Prat), Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (Sarra Oumrani, Maximilien Barret, Sarah Leblanc, Stanislas Chaussade, Frédéric Prat), Paris, France.,Paris-Descartes University (Maximilien Barret, Frédéric Beuvon, Stanislas Chaussade, Frédéric Prat), Paris, France
| | - Frédéric Prat
- Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (Sarra Oumrani, Maximilien Barret, Sarah Leblanc, Stanislas Chaussade, Frédéric Prat), Paris, France.,Paris-Descartes University (Maximilien Barret, Frédéric Beuvon, Stanislas Chaussade, Frédéric Prat), Paris, France
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Hammoudi N, Brieau B, Barret M, Bordacahar B, Leblanc S, Coriat R, Chaussade S, Prat F. Mirizzi's syndrome in Roux-en-Y bypass patient successfully treated with cholangioscopically-guided laser lithotripsy via percutaneous gastrostomy. Endosc Int Open 2018; 6:E826-E829. [PMID: 29978001 PMCID: PMC6032633 DOI: 10.1055/a-0609-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022] Open
Abstract
Obesity and bariatric surgery are major risk factors in gallstone disease. In patients with a past history of Roux-en-Y gastric bypass, Mirizzi's syndrome is a challenging endoscopic situation because of the modified anatomy. Here we report the first case of a patient with a Roux-en-Y gastric bypass treated by intracorporeal lithotripsy with a digital single-operator cholangioscope following an endoscopic retrograde cholangiopancreatography (ERCP) using a percutaneous gastrostomy access.
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Affiliation(s)
- Nassim Hammoudi
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Bertrand Brieau
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Corresponding author Bertrand Brieau, MD Service de gastroentérologie et endoscopie digestiveHôpital CochinUniversité Paris Descartes27 rue du Faubourg Saint Jacques75014 ParisFrance+33-1-58411930
| | - Maximilien Barret
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Benoit Bordacahar
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Sarah Leblanc
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Romain Coriat
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Stanislas Chaussade
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frédéric Prat
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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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.
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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.
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Gaujoux S, Genc S, Leblanc S, Dousset B, Prat F. Insulinoma enucleation after echoendoscopic fiducial placement. Gastrointest Endosc 2018; 87:615-616. [PMID: 28807758 DOI: 10.1016/j.gie.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/04/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne, Paris, France; INSERM Unité 1016, Centre National de la Recherche Scientifique, Institut Cochin, Paris, France
| | - Seray Genc
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne, Paris, France; INSERM Unité 1016, Centre National de la Recherche Scientifique, Institut Cochin, Paris, France
| | - Frédéric Prat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
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