1
|
Knabe M, Maselli R, Cesbron-Metivier E, Hollerbach S, Petruzziello L, Prat F, Khara HS, Pioche M, Hartmann D, Cesaro P, Barbaro F, Berger A, Spada C, Diehl DL, May A, Ponchon T, Repici A, Costamagna G. Endoscopic powered resection device for residual colonic lesions: the first multicenter, prospective, international clinical study. Gastrointest Endosc 2024; 99:778-786. [PMID: 38042207 DOI: 10.1016/j.gie.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic resection is standard treatment for adenomatous colorectal lesions. Depending on lesion morphology and resection technique, recurrence can occur. Scarred adenomas are challenging to resect and may require surgical management. This study evaluated the safety and effectiveness of an endoscopic powered resection (EPR) system for scarred adenomatous colorectal lesions. METHODS This single-arm, prospective, multicenter study was conducted from January 2018 to January 2021 at 12 sites. Patients with persistent flat or sessile colorectal lesions were enrolled. Primary end points were technical success (the ability of the device to resect the lesion[s] without use of other resection devices without device-related serious adverse events [AEs]) and safety (the occurrence of AEs through 90 days). Secondary end points included endoscopic confirmation of resection completeness, occurrence of colon stenosis, disease persistence, and diagnostic value of resected specimens. RESULTS Sixty-five patients were in the intention-to-treat/safety analysis population. Primary analysis was performed on 45 per-protocol (PP) patients with 48 lesions. All PP patients were solely treated by using the EPR device. Technical success was achieved in 44 (98%) patients. Three (5%) serious AEs occurred: 2 delayed self-limited bleeds and 1 perforation. Nonserious AEs included 4 (6%) cases of mild intraprocedural bleeding. Completeness of resection and histopathologic diagnosis of tissue specimens were achieved in all patients. Twenty-one (46.7%) patients had disease persistence after the first treatment, and there was no colon stenosis. CONCLUSIONS EPR is safe and effective for benign, persistent, large (>20 mm), scarred colorectal adenomas and should be considered as an alternative treatment in lieu of surgery. A persistence rate of 46.7% indicates that >1 treatment is necessary for effective endoscopic treatment. (Clinical trial registration number: NCT04203667.).
Collapse
Affiliation(s)
- Mate Knabe
- Centrum Gastroenterology Bethanien (CGB), Bethanien Hospital Frankfurt, Germany.
| | - Roberta Maselli
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology Humanitas Research Hospital, Milano, Italy
| | | | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italia
| | - Frédéric Prat
- Endoscopy Unit, Beaujon Hospital, Publique des Hôpitaux de Paris, Clichy, France
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Dirk Hartmann
- Department of General Internal Medicine, Diabetology, Gastroenterology and Oncology, Katholisches Klinikum Mainz, Mainz, Germany
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italia
| | - Arthur Berger
- CHU Bordeaux, Department of Gastroenterology and Digestive Endoscopy, Univ. Bordeaux, Bordeaux, France
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italia
| | - David L Diehl
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Andrea May
- Department of Gastroenterology, Oncology and Pneumology, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology Humanitas Research Hospital, Milano, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italia
| |
Collapse
|
2
|
Rodríguez de Santiago E, van Tilburg L, Deprez PH, Pioche M, Pouw RE, Bourke MJ, Seewald S, Weusten BLAM, Jacques J, Leblanc S, Barreiro P, Lemmers A, Parra-Blanco A, Küttner-Magalhães R, Libânio D, Messmann H, Albéniz E, Kaminski MF, Mohammed N, Ramos-Zabala F, Herreros-de-Tejada A, Huchima Koecklin H, Wallenhorst T, Santos-Antunes J, Cunha Neves JA, Koch AD, Ayari M, Garces-Duran R, Ponchon T, Rivory J, Bergman JJGHM, Verheij EPD, Gupta S, Groth S, Lepilliez V, Franco AR, Belkhir S, White J, Ebigbo A, Probst A, Legros R, Pilonis ND, de Frutos D, Muñoz González R, Dinis-Ribeiro M. Western outcomes of circumferential endoscopic submucosal dissection for early esophageal squamous cell carcinoma. Gastrointest Endosc 2024; 99:511-524.e6. [PMID: 37879543 DOI: 10.1016/j.gie.2023.10.042] [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] [Received: 07/24/2023] [Revised: 09/12/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS Circumferential endoscopic submucosal dissection (cESD) in the esophagus has been reported to be feasible in small Eastern case series. We assessed the outcomes of cESD in the treatment of early esophageal squamous cell carcinoma (ESCC) in Western countries. METHODS We conducted an international study at 25 referral centers in Europe and Australia using prospective databases. We included all patients with ESCC treated with cESD before November 2022. Our main outcomes were curative resection according to European guidelines and adverse events. RESULTS A total of 171 cESDs were performed on 165 patients. En bloc and R0 resections rates were 98.2% (95% confidence interval [CI], 95.0-99.4) and 69.6% (95% CI, 62.3-76.0), respectively. Curative resection was achieved in 49.1% (95% CI, 41.7-56.6) of the lesions. The most common reason for noncurative resection was deep submucosal invasion (21.6%). The risk of stricture requiring 6 or more dilations or additional techniques (incisional therapy/stent) was high (71%), despite the use of prophylactic measures in 93% of the procedures. The rates of intraprocedural perforation, delayed bleeding, and adverse cardiorespiratory events were 4.1%, 0.6%, and 4.7%, respectively. Two patients died (1.2%) of a cESD-related adverse event. Overall and disease-free survival rates at 2 years were 91% and 79%. CONCLUSIONS In Western referral centers, cESD for ESCC is curative in approximately half of the lesions. It can be considered a feasible treatment in selected patients. Our results suggest the need to improve patient selection and to develop more effective therapies to prevent esophageal strictures.
Collapse
Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, CIBEREHD, Universidad de Alcalá, Madrid, Spain.
| | - Laurelle van Tilburg
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stefan Seewald
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jeremie Jacques
- Service d'Hépato-Gastro-Entérologie CHU Dupuytren, Limoges, France
| | - Sara Leblanc
- Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Pedro Barreiro
- Gastroenterology Department of Centro Hospitalar Lisboa Ocidental, Advanced Endoscopy Center of Hospital Lusíadas, Lisboa, Portugal
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | | | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal; MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Helmut Messmann
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra Navarrabiomed, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Michal F Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Noor Mohammed
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom
| | - Felipe Ramos-Zabala
- Gastroenterology Department, Hospital Universitario HM Montepríncipe, Grupo HM Hospitales, Boadilla del Monte, Madrid, Spain
| | - Alberto Herreros-de-Tejada
- Puerta de Hierro University Hospital Majadahonda IDIPHISA Instituto de Investigacion Segovia Arana, Majadahonda, Spain
| | | | | | - João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - João A Cunha Neves
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, CIBEREHD, Universidad de Alcalá, Madrid, Spain; Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Myriam Ayari
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Rodrigo Garces-Duran
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Eva P D Verheij
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUmc, Cancer Center Amsterdam, The Netherlands
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stefan Groth
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | | | - Ana Rita Franco
- Gastroenterology Department of Centro Hospitalar Lisboa Ocidental, Advanced Endoscopy Center of Hospital Lusíadas, Lisboa, Portugal
| | - Sanaa Belkhir
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan White
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Alanna Ebigbo
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
| | - Romain Legros
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nastazja Dagny Pilonis
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Diego de Frutos
- Puerta de Hierro University Hospital Majadahonda IDIPHISA Instituto de Investigacion Segovia Arana, Majadahonda, Spain
| | | | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal; MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Masgnaux LJ, Grimaldi J, Rivory J, Ponchon T, Yzet C, Wallenhorst T, Lupu A, Lafeuille P, Legros R, Rostain F, Jacques J, Pioche M. Endoscopic submucosal dissection assisted by adaptive traction: results of the first 54 procedures. Endoscopy 2024; 56:205-211. [PMID: 37311544 DOI: 10.1055/a-2109-4350] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/15/2023]
Abstract
BACKGROUND : Good submucosal exposure is key to successful endoscopic submucosal dissection (ESD) and can be achieved with various traction devices. Nevertheless, these devices have a fixed traction force that tends to decrease as the dissection progresses. In contrast, the ATRACT adaptive traction device increases traction during the procedure. METHODS : In this retrospective analysis of prospectively collected data (from a French database), we analyzed ESD procedures performed with the ATRACT device between April 2022 and October 2022. The device was used consecutively whenever possible. We collected details of lesion characteristics, procedural data, histologic outcomes, and clinical consequences for the patient. RESULTS : 54 resections performed in 52 patients by two experienced operators (46 procedures) and six novices (eight procedures) were analyzed. The ATRACT devices used were the ATRACT-2 (n = 21), the ATRACT 2 + 2 (n = 30), and the ATRACT-4 (n = 3). Four adverse events were observed: one perforation (1.9 %), which was closed endoscopically, and three delayed bleeding events (5.5 %). The R0 rate was 93 %, resulting in curative resection in 91 % of cases. CONCLUSION: ESD using the ATRACT device is safe and effective in the colon and rectum, but can also be used to assist with procedures in the upper gastrointestinal tract. It may be particularly useful in difficult locations.
Collapse
Affiliation(s)
- Louis-Jean Masgnaux
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean Grimaldi
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, Pontchaillou University Hospital, Rennes, France
| | - Alexandru Lupu
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
4
|
Vauquelin B, Quénéhervé L, Pioche M, Barret M, Wallenhorst T, Chabrun E, Coron E, Roman S, Mion F, Chaussade S, Ponchon T, Olivier R, Rivière P, Zerbib F, Berger A. Factors associated with early failure of peroral endoscopic myotomy in achalasia. Gastrointest Endosc 2024; 99:349-357.e3. [PMID: 37806398 DOI: 10.1016/j.gie.2023.10.025] [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] [Received: 05/01/2023] [Revised: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Achalasia can be treated very effectively with peroral endoscopic myotomy (POEM), but factors associated with early failure remain to be determined, especially in European cohorts. METHODS All consecutive adult patients who underwent a first POEM to treat primary achalasia were included in this multicenter retrospective study. Early failure was defined by an Eckardt score (ES) >3 at 3 months after POEM. When evaluating factors predictive of early failure, 2 cohorts were considered: one consisted of the total population, for whom only basic variables were collected, and the other a cohort built for a case-control study that included matched early-failure and early-success patients (ratio, 1:2). RESULTS Among 746 patients, the early failure rate was 9.4%. Predictive factors were age ≤45 years (P = .019), achalasia types I and III (P < .001), and the development of a severe adverse event during the procedure (P = .023). In the case-control study, the only additional independent risk factor for early failure was a high pre-POEM ES (P = .001). Only the retrosternal pain subscore was significantly associated with the early failure rate. CONCLUSION The early failure rate of POEM used to treat primary achalasia is <10%. Younger age, type I/III achalasia, and a high pre-POEM ES were significantly associated with failure.
Collapse
Affiliation(s)
- Blandine Vauquelin
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France
| | - Mathieu Pioche
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | - Edouard Chabrun
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Sabine Roman
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - François Mion
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Thierry Ponchon
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Raphael Olivier
- Department of Gastroenterology, Nantes University Hospital, Nantes, France
| | - Pauline Rivière
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Frank Zerbib
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Arthur Berger
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France.
| |
Collapse
|
5
|
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.
Collapse
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.)
| |
Collapse
|
6
|
Michoud C, Erard D, Valette PJ, Bertrand G, Ponchon T, Milot L, Dumortier J. A biliary cast syndrome requiring liver transplantation: an original sequence. J Gastrointestin Liver Dis 2023; 32:565-566. [PMID: 38147616 DOI: 10.15403/jgld-5082] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Claire Michoud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France. .
| | - Domitille Erard
- Hospices civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépatologie, Lyon.
| | - Pierre-Jean Valette
- Université Claude Bernard Lyon 1, Lyon; Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération de Radiologie, Lyon, France.
| | - Gaspard Bertrand
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France.
| | - Thierry Ponchon
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon; Université Claude Bernard Lyon 1, Lyon;.
| | - Laurent Milot
- Université Claude Bernard Lyon 1, Lyon; Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération de Radiologie, Lyon, France.
| | - Jerome Dumortier
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon; Université Claude Bernard Lyon 1, Lyon;.
| |
Collapse
|
7
|
Ghuysen S, Lupu A, Rivory J, Saurin JC, Rostain F, Ponchon T, Pioche M. Endoscopic transgastric extraction of a prophylactic pancreatic single-pigtail plastic stent that had previously migrated into the caudal part of the Wirsung duct. Endoscopy 2023; 55:E532-E533. [PMID: 36931296 PMCID: PMC10023251 DOI: 10.1055/a-2032-3272] [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: 03/19/2023]
Affiliation(s)
| | | | - Jérôme Rivory
- Endoscopy Unit, Edouard Herriot Hospital, Lyon France
| | | | | | | | | |
Collapse
|
8
|
Saito Y, Sakamoto T, Dekker E, Pioche M, Probst A, Ponchon T, Messmann H, Dinis-Ribeiro M, Matsuda T, Ikematsu H, Saito S, Wada Y, Oka S, Sano Y, Fujishiro M, Murakami Y, Ishikawa H, Inoue H, Tanaka S, Tajiri H. First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial. Dig Endosc 2023. [PMID: 37702082 DOI: 10.1111/den.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/10/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Narrow-band imaging (NBI) contributes to real-time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. METHODS This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non-JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white-light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. RESULTS In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high-grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. CONCLUSION The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity.
Collapse
Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- University of Tsukuba, Ibaraki, Japan
| | - Evelien Dekker
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andreas Probst
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Helmut Messmann
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Toho University, Tokyo, Japan
| | | | | | | | - Shiro Oka
- Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | - Shinji Tanaka
- Hiroshima University, Hiroshima, Japan
- JA Onomichi General Hospital, Hiroshima, Japan
| | | |
Collapse
|
9
|
Thiveaud D, Durand F, Hajjar J, Le Dinh E, Metz V, Napoleon B, Plessis C, Prat F, Vanbiervliet G, Durand-Zaleski I, Ponchon T. Costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope. Endosc Int Open 2023; 11:E873-E879. [PMID: 37942444 PMCID: PMC10629588 DOI: 10.1055/a-2153-7016] [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: 12/20/2022] [Accepted: 07/21/2023] [Indexed: 11/10/2023] Open
Abstract
Background and study aims The costs of reusable endoscope reprocessing have been evaluated, yet external validity of the findings remains challenging. The aim of this study was to assess the costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope per endoscopic retrograde cholangiopancreatography (ERCP) in France. Study findings exclude the costs of infection, downtime due to breakdown, reprocessing single-use material disposal, and device disposal, all of which should also be considered. Materials and methods The study encompassed both observational and theoretical approaches. Observational data were collected in four hospitals, from December 2019 to December 2020, with an ad hoc survey, based on 2016 and 2018 national guidelines for duodenoscope reprocessing. Costs were modeled, using the same guidelines, assuming a mean workload of 223 ERCP/duodenoscope/year. Results The mean observed cost of purchase, maintenance, microbiological control, reprocessing (human resources and consumables), and overhead (additional 35%) with a reusable duodenoscope was €80.23 (standard deviation €3.77) per ERCP. The corresponding mean theoretical cost was €182.71 for manual reprocessing without endoscope drying cabinet (EDC), €191.36 for manual reprocessing with EDC, €235.25 for automated endoscope reprocessing (AER) without EDC, and €253.62 for AER with EDC. Conclusions Because procedures, equipment, volume activity, number of duodenoscopes, human resources, and internal work organizations are hospital-dependent, observed costs varied between hospitals. Theoretical costs were higher than observed costs, showing that the theoretical approach is not sufficient. Hypotheses to explain the difference between the two approaches include failing to measure some costs in the survey and challenges in guideline implementation.
Collapse
Affiliation(s)
| | - Fanny Durand
- Pôle Thoraco-Abdomen, CHU Limoges, Limoges, France
| | - Joseph Hajjar
- Medical Officer of Health and Epidemiologist, Honorary Hospital Practitioner, Pau, France
| | | | - Vanessa Metz
- Pharmacy, Hopital Europeen Marseille, Marseille, France
| | | | | | | | | | | | - Thierry Ponchon
- Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
10
|
Bretthauer M, Mori Y, Zessner-Spitzenberg J, Kaminski MF, Siersema PD, Ponchon T, Messmann H, Gralnek IM, Bisschops R, Hassan C. Gastrointestinal endoscopy devices and the European Union Medical Device Regulation: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55:578-581. [PMID: 37080238 DOI: 10.1055/a-2052-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Gastrointestinal endoscopy is largely dependent on medical devices. The European Union (EU) has recently introduced stricter rules and regulations for the approval of medical devices. This has consequences both for endoscopists and for patients. The new regulations increase the need for clinical trials and observational studies for new and current devices used in endoscopy to ensure clinical benefit and reduce patient harm. European endoscopy environments should facilitate industry-sponsored clinical trials and registry studies to meet the demand for robust data on endoscopic devices as required in the new legislation. The European Society of Gastrointestinal Endoscopy (ESGE) will play an active role in the establishment of the new system.The EU is establishing independent expert panels for device regulation in gastroenterology and hepatology, including endoscopy, that are charged with assessing the requirements for device testing. The ESGE encourages endoscopists with expertise in the technical and clinical performance of endoscopy devices to apply for expert panel membership. The ESGE has provided information for interested endoscopists on the ESGE website. Private European companies called "notified bodies" are entitled to conduct device approval for the EU. The ESGE will actively engage with these notified bodies for topics related to the new endoscopy device approval process to ensure continued access to high quality endoscopy devices for endoscopists in Europe.
Collapse
Affiliation(s)
- Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Michal F Kaminski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| |
Collapse
|
11
|
Stephant S, Jacques J, Brochard C, Legros R, Lepetit H, Barret M, Lupu A, Rostain F, Rivory J, Ponchon T, Pioche M, Wallenhorst T. High proficiency of esophageal endoscopic submucosal dissection with a "tunnel + clip traction" strategy: a large French multicentric study. Surg Endosc 2023; 37:2359-2366. [PMID: 36229550 DOI: 10.1007/s00464-022-09689-7] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/25/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophageal endoscopic submucosal dissection (ESD) is the gold standard for the treatment of precancerous lesions or superficial esophageal cancers. This procedure is currently performed by expert endoscopists only, and poorly standardized. We aimed to assess the technical results and outcomes of a "tunnel + clip" strategy for esophageal ESD procedures performed by less experienced operators for the treatment of superficial neoplasms. METHODS All consecutive esophageal ESDs performed with the "tunnel + clip" technique for patients with early esophageal cancer in 3 centers were enrolled. Procedural characteristics, clinical outcomes, and complications were recorded. RESULTS Among 195 esophageal ESD procedures performed, early adenocarcinomas or high-grade dysplasia complicating Barrett's esophagus were predominant (132/195, 67.7%) compared with early squamous cell carcinomas (63/195, 32.3%). The en bloc, R0 and curative resection rates were 100% (195/195), 78.5% (153/195) and 67.2% (131/195), respectively. The mean rate of ESD was 29.7 mm2/min. One (0.5%) perprocedural perforation and 7 (3.6%) postprocedural bleedings occurred, all managed endoscopically. No delayed perforation occurred. Overall, 31 patients (31/195; 15.9%) of patients developed stenosis. CONCLUSIONS The "tunnel + clip" strategy is safe, and allows to achieve high en bloc, R0 and curative resection rates. This standardized procedure could be used by physicians with little experience and might help spreading esophageal ESD in Western countries.
Collapse
Affiliation(s)
- Sophie Stephant
- Service Des Maladies de L'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou CHU Pontchaillou, 35033 Rennes Cedex, Rennes, France
| | - Jérémie Jacques
- Service d'Hépato-Gastro-Entérologie, CHU Dupuytren, 2 Avenue Martin Luther-King, 87042, Limoges, France
| | - Charlène Brochard
- Service Des Maladies de L'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou CHU Pontchaillou, 35033 Rennes Cedex, Rennes, France.
- Services d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France.
| | - Romain Legros
- Service d'Hépato-Gastro-Entérologie, CHU Dupuytren, 2 Avenue Martin Luther-King, 87042, Limoges, France
| | - Hugo Lepetit
- Service d'Hépato-Gastro-Entérologie, CHU Dupuytren, 2 Avenue Martin Luther-King, 87042, Limoges, France
| | - Maximilien Barret
- Service de Gastroentérologie, Hopital Cochin, Assistance Publique Hôpitaux de Paris, Et Université de Paris, Paris, France
| | - Alexandru Lupu
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Florian Rostain
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Jérôme Rivory
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Thierry Ponchon
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Mathieu Pioche
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Timothée Wallenhorst
- Service Des Maladies de L'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, 2 rue Henri le Guillou CHU Pontchaillou, 35033 Rennes Cedex, Rennes, France
| |
Collapse
|
12
|
Carnovali M, Spada C, Uebel P, Bocus P, Cannizzaro R, Cavallaro F, Cesana BM, Cesaro P, Costamagna G, Di Paolo D, Ferrari AP, Hinkel C, Kashin S, Massella A, Melnikova E, Orsatti A, Ponchon T, Prada A, Radaelli F, Sferrazza S, Soru P, Testoni PA, Tontini GE, Vecchi M, Fiori G. Factors influencing the presence of potentially explosive gases during colonoscopy: Results of the SATISFACTION study. Clin Transl Sci 2023; 16:759-769. [PMID: 36799346 PMCID: PMC10176010 DOI: 10.1111/cts.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
This study tested the hypothesis that bowel preparation with mannitol should not affect the colonic concentration of H2 and CH4 . Therefore, the SATISFACTION study, an international, multicenter, randomized, parallel-group phase II-III study investigated this issue. The phase II dose-finding part of the study evaluated H2 , CH4 , and O2 concentrations in 179 patients randomized to treatment with 50 g, 100 g, or 150 g mannitol. Phase III of the study compared the presence of intestinal gases in 680 patients randomized (1:1) to receive mannitol 100 g in single dose or a standard split-dose 2 L polyethylene glycol (PEG)-Asc preparation (2 L PEG-Asc). Phase II results showed that mannitol did not influence the concentration of intestinal gases. During phase III, no patient in either group had H2 or CH4 concentrations above the critical thresholds. In patients with H2 and/or CH4 levels above detectable concentrations, the mean values were below the risk thresholds by at least one order of magnitude. The results also highlighted the effectiveness of standard washing and insufflation maneuvers in removing residual intestinal gases. In conclusion, bowel cleansing with mannitol was safe as the concentrations of H2 and CH4 were the same as those found in patients prepared with 2 L PEG-Asc. In both groups, the concentrations of gases were influenced more by the degree of cleansing achieved and the insufflation and washing maneuvers performed than by the preparation used for bowel cleansing. The trial protocol was registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT04759885) and with EudraCT (eudract_number: 2019-002856-18).
Collapse
Affiliation(s)
| | - Cristiano Spada
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - Peter Uebel
- Praxis für Gastroenterologie und Fachärztliche Innere Medizin, Im Haus der Gesundheit, Ludwigshafen am Rhein, Germany
| | - Paolo Bocus
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Renato Cannizzaro
- Department of Clinical Oncology, Experimental Gastrointestinal Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Endoscopy Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Mario Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Paola Cesaro
- U.O. Endoscopia Digestiva, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica S. Cuore, Rome, Italy
| | | | | | - Carsten Hinkel
- Praxis für Gastroenterologie und Fachärztliche Innere Medizin, Im Haus der Gesundheit, Ludwigshafen am Rhein, Germany
| | - Sergey Kashin
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | - Arianna Massella
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Thierry Ponchon
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
| | - Alberto Prada
- Servizio Gastroenterologia ed Endoscopia Digestiva, Istituto Auxologico Italiano, Milan, Italy
| | | | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Pietro Soru
- Divisione di Endoscopia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Pier Alberto Testoni
- Unità di Gastroenterologia ed Endoscopia Digestiva, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Giancarla Fiori
- Divisione di Endoscopia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | | |
Collapse
|
13
|
Lafeuille P, Poincloux L, Rouquette O, Yzet C, Ponchon T, Rivory J, Pioche M. Refractory aortoesophageal fistulas after aortic stenting successfully closed using endoscopic submucosal dissection with clip closure. Endoscopy 2022; 55:E292-E293. [PMID: 36460037 PMCID: PMC9831779 DOI: 10.1055/a-1974-9737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Pierre Lafeuille
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Laurent Poincloux
- Department of Endoscopy and Hepatogastroenterology, Clermont-Ferrand University Hospital, Université Clermont Auvergne, Inserm, 3iHP, Clermont-Ferrand, France
| | - Olivier Rouquette
- Department of Endoscopy and Hepatogastroenterology, Clermont-Ferrand University Hospital, Université Clermont Auvergne, Inserm, 3iHP, Clermont-Ferrand, France
| | - Clara Yzet
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
14
|
Yzet C, Lupu A, Forté E, Dubois R, Cercueil E, Ponchon T, Pioche M. Endoscopic ultrasound-guided bile duct reconstruction after complete section following a car crash in a 5-year-old child with complete situs inversus. Endoscopy 2022; 55:E282-E283. [PMID: 36460043 PMCID: PMC9831771 DOI: 10.1055/a-1974-8974] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Clara Yzet
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Lupu
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Forté
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Rémi Dubois
- Pediatric Surgery Unit, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Eloïse Cercueil
- Pediatric Intensive Care Unit, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
15
|
Hastier-De Chelle A, Onana-Ndong P, Olivier R, Bentellis I, Pioche M, Rivory J, Gonzalez JM, Bailly L, Piche T, Ponchon T, Brochard C, Coron E, Barthet M, Vanbiervliet G. Impact of antibiotic prophylaxis and conditioning modalities in per-oral endoscopic myotomy for esophageal motor disorders. Scand J Gastroenterol 2022; 57:1522-1530. [PMID: 35850618 DOI: 10.1080/00365521.2022.2097892] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS No recommendation regarding antibiotic prophylaxis and preparation modalities are available for patients with esophageal motor disorders who benefit from Per-Oral Endoscopic Myotomy (POEM). The aim of our study was to evaluate their impact on the POEM's safety. PATIENTS AND METHODS This study was a comparative and multicentric retrospective analysis of a database prospectively collected. Patients over 18 years old with esophageal motor disorders confirmed by prior manometry, who underwent POEM were included. The primary endpoint was the occurrence of adverse events, as classified by Cotton, based on whether or not antibiotic prophylaxis was administered. RESULTS A total of 226 patients (median age 52.9 ± 19.12 years [18-105], 116 women [51.3%]) were included. The indication for POEM was mainly type 2 achalasia (n = 135, 60.3%). Antibiotic prophylaxis was administered to 170 patients (75.2%) during 3.93 ± 3.46 days [1-21]. The overall adverse events rate was 9.3% (n = 21). Antibiotic prophylaxis was associated with the occurrence of adverse events (p = .003), but had no impact on their severity (p = .238). Antibiotic prophylaxis didn't influence the effectiveness of POEM (1 [0-4] vs 1 [0-9], p = .231). The use of a liquid diet in the 48 h prior to the procedure was significantly associated with a lower adverse events rate (3.1% vs 6.19%, p = .0002). CONCLUSION The antibiotic prophylaxis during POEM does not prevent adverse events, had no impact on their severity and the efficacy of the procedure. A liquid diet before the procedure should be systematically proposed.
Collapse
Affiliation(s)
| | - Philippe Onana-Ndong
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Raphaël Olivier
- Institut des maladies de l'appareil digestif, Hôpital Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Imad Bentellis
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Mathieu Pioche
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Jean Michel Gonzalez
- Gastro-entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, France
| | - Laurent Bailly
- Direction de L'Information Médicale, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Thierry Piche
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Thierry Ponchon
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Charlène Brochard
- Gastro-entérologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Emmanuel Coron
- Institut des maladies de l'appareil digestif, Hôpital Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marc Barthet
- Gastro-entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, France
| | - Geoffroy Vanbiervliet
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| |
Collapse
|
16
|
Lafeuille P, Yzet C, Benech N, Rostain F, Ponchon T, Rivory J, Pioche M. Histological R0 classification after colorectal endoscopic submucosal dissection: a gold standard with feet of clay. Endoscopy 2022; 54:E798-E799. [PMID: 35477121 PMCID: PMC9735293 DOI: 10.1055/a-1816-7853] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Pierre Lafeuille
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Clara Yzet
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Nicolas Benech
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
17
|
Karstensen JG, Ebigbo A, Desalegn H, Afihene M, Anigbo G, Antonelli G, Bhat P, Duduyemi B, Guy C, Ijoma U, Ponchon T, Rahmi G, Aabakken L, Hassan C. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy Cascade Guideline. Endosc Int Open 2022; 10:E1427-E1433. [PMID: 36397871 PMCID: PMC9666068 DOI: 10.1055/a-1964-7965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- John Gásdal Karstensen
- Gastro Unit, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alanna Ebigbo
- Central Clinic of Augsburg – Gastroenterology, Augsburg, Germany
| | - Hailemichael Desalegn
- St. Paul’s Hospital Millennium Medical College – Department of Internal Medicine, Addis Ababa, Ethiopia
| | - Mary Afihene
- Kwame Nkrumah University of Science and Technology – Department of Medicine, Kumasi, Ghana
| | - Gideon Anigbo
- Enugu State University Teaching Hospital – Department of Medicine, Enugu, Nigeria
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Rome, Italy,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Purnima Bhat
- Australian National University Medical School, Canberra, Australia,Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australia
| | - Babatunde Duduyemi
- Department of Pathology, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Claire Guy
- Technische Universität München (TUM), Munich, Germany
| | - Uchenna Ijoma
- University of Nigeria Teaching Hospital – Gastroenterology Unit, Department of Medicine, Enugu, Nigeria
| | - Thierry Ponchon
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Gabriel Rahmi
- Gastroenterology, Georges-Pompidou European Hospital, Paris, France
| | - Lars Aabakken
- Dept of transplantation medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway,Faculty of Medicine, University of Oslo, Norway
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,IRCCS Humanitas Research Hospital - Department of Gastroenterology, Milan, Italy
| | | |
Collapse
|
18
|
Pioche M, Masgnaux LJ, Rivory J, Ponchon T, Wallenhorst T, Legros R, Jacques J. Endoscopic submucosal dissection in the colon with adaptive traction device: resection strategy and device setup. Endoscopy 2022; 55:E171-E172. [PMID: 36307083 PMCID: PMC9829756 DOI: 10.1055/a-1959-2010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Mathieu Pioche
- 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
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, Pontchaillou University Hospital, Rennes, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| |
Collapse
|
19
|
Lafeuille P, Rivory J, Lambin T, Bonniaud P, Ponchon T, Rostain F, Pioche M. A very rare case of submucosal invasive duodenal adenocarcinoma in a patient with a history of radiation therapy. Endoscopy 2022; 54:E544-E545. [PMID: 34781370 DOI: 10.1055/a-1682-6865] [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: 12/10/2022]
Affiliation(s)
- Pierre Lafeuille
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Paul Bonniaud
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
20
|
Lafeuille P, Yzet C, Bonniaud P, Rostain F, Ponchon T, Rivory J, Pioche M. Use of a bougie-shaped cap for dilation with direct visual control for an esophageal stricture induced by radiation therapy. Endoscopy 2022; 55:E18-E19. [PMID: 36113487 PMCID: PMC9812673 DOI: 10.1055/a-1929-9317] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Pierre Lafeuille
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Clara Yzet
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Paul Bonniaud
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
21
|
Grimaldi J, Rivory J, Lambin T, Lafeuille P, Jacques J, Ponchon T, Pioche M. Endoscopic submucosal dissection with early multitraction placed before circumferential incision allows excellent exposure but with a risk of catching the muscularis propria. Endoscopy 2022; 54:E510-E511. [PMID: 34655057 DOI: 10.1055/a-1655-8226] [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: 12/10/2022]
Affiliation(s)
- Jean Grimaldi
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lambin
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
22
|
Lambin T, Rivory J, Adham M, Rostain F, Ponchon T, Lafeuille P, Pioche M. Endoscopic biliary access after pancreaticoduodenectomy following Imanaga's procedure. Endoscopy 2022; 54:E360-E361. [PMID: 34374050 DOI: 10.1055/a-1540-6827] [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: 12/10/2022]
Affiliation(s)
- Thomas Lambin
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mustapha Adham
- Digestive Surgery Unit, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Pierre Lafeuille
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| |
Collapse
|
23
|
Lafeuille P, Wallenhorst T, Lupu A, Jacques J, Lambin T, Camus M, Yzet C, Ponchon T, Rostain F, Rivory J, Subtil F, Pioche M. Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy. Endoscopy 2022; 54:700-705. [PMID: 34500487 DOI: 10.1055/a-1641-7938] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Gastrointestinal (GI) fistula is a life-threatening condition and a therapeutic challenge. Endoscopic approaches include mucosal abrasion, clip closure, or stent diversion, with moderate success rates in the long term. We assessed whether fistula endoscopic submucosal dissection with clip closure (FESDC) could lead to complete resolution of fistulas even after failure of previous endoscopic therapy. METHODS Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. The primary outcome was long-term (> 3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with FESDC success. RESULTS 23 patients (13 refractory 57 %) were included. Tight immediate sealing was achieved in 19 patients (83 %; 95 % confidence interval [CI] 61 %-95 %). Long-term closure was achieved in 14 patients (61 %; 95 %CI 39 %-80 %), with median follow-up of 20 months. Complications occurred in two patients (9 %). Previous local malignancy (P = 0.08) and radiotherapy (P = 0.047) were associated with a higher risk of failure. CONCLUSION This novel FESDC strategy was demonstrated to be safe and feasible for permanent endoscopic closure of GI fistulas. Further studies are warranted to determine the place of this technique in the management of chronic GI fistula.
Collapse
Affiliation(s)
- Pierre Lafeuille
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Timothée Wallenhorst
- Department of Gastroenterology and Endoscopy, Pontchaillou University Hospital, Rennes, France
| | - Alexandru Lupu
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Jérémie Jacques
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Thomas Lambin
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Marine Camus
- Department of Gastroenterology and Endoscopy, Saint Antoine Hospital, Paris, France
| | - Clara Yzet
- Department of Gastroenterology and Endoscopy, Amiens University Hospital, Amiens, France
| | - Thierry Ponchon
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
24
|
Uedo N, Ponchon T. Methods to obtain informed consent in medical and biological research involving human subject: application to studies on digestive endoscopy. Endosc Int Open 2022; 10:E719-E720. [PMID: 35692923 PMCID: PMC9187373 DOI: 10.1055/a-1776-7801] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Thierry Ponchon
- Digestive Diseases Department, Lyon University Hospital, France.
| |
Collapse
|
25
|
Lambin T, Schaefer M, Lafeuille P, Rostain F, Rivory J, Pioche M, Ponchon T. Endoscopic esophagogastric anastomosis using a lumen-apposing metal stent to manage an anastomotic leakage after esophagectomy. Endoscopy 2022; 54:E320-E321. [PMID: 34243200 DOI: 10.1055/a-1529-5035] [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: 12/10/2022]
Affiliation(s)
- Thomas Lambin
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Marion Schaefer
- Gastroenterology Unit, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Pierre Lafeuille
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| |
Collapse
|
26
|
Figueiredo M, Yzet C, Lafeuille P, Ponchon T, Jacques J, Rivory J, Pioche M. Endoscopic mucosal resection with a magnetic traction system: a new strategy to facilitate complete resection. Endoscopy 2022; 54:E820-E821. [PMID: 35561985 PMCID: PMC9735300 DOI: 10.1055/a-1826-2394] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mariana Figueiredo
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Clara Yzet
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Pierre Lafeuille
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Hôpital Dupuytren, Limoges, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavillon L, Hôpital Edouard Herriot, Lyon, France
| |
Collapse
|
27
|
Affiliation(s)
- Thomas Lambin
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, LabTAU, Lyon, France
| | - Pierre Lafeuille
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Rivory
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Laura Calavas
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepato-Gastroenterology, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, LabTAU, Lyon, France
| |
Collapse
|
28
|
Bertrand G, Rivory J, Robert M, Saurin JC, Pelascini É, Monneuse O, Gruner L, Poncet G, Valette PJ, Gimonet H, Rostain F, Ber CÉ, Bouffard Y, Boibieux A, Ciochina M, Landel V, Boyer H, Jacques J, Ponchon T, Pioche M. Digestive perforations related to endoscopy procedures: a local management charter based on local evidence and experts' opinion. Endosc Int Open 2022; 10:E328-E341. [PMID: 35433214 PMCID: PMC9010098 DOI: 10.1055/a-1783-8424] [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: 03/18/2021] [Accepted: 10/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Perforations are a known adverse event of endoscopy procedures; a proposal for appropriate management should be available in each center as recommended by the European Society of Gastrointestinal Endoscopy. The objective of this study was to establish a charter for the management of endoscopic perforations, based on local evidence. Patients and methods Patients were included if they experienced partial or complete perforation during an endoscopic procedure between 2008 and 2018 (retrospectively until 2016, then prospectively). Perforations (size, location, closure) and management (imagery, antibiotics, surgery) were analyzed. Using these results, a panel of experts was asked to propose a consensual management charter. Results A total of 105 patients were included. Perforations occurred mainly during therapeutic procedures (91, 86.7%). Of the perforations, 78 (74.3 %) were diagnosed immediately and managed during the procedure; 69 of 78 (88.5 %) were successfully closed. Closures were more effective during therapeutic procedures (60 of 66, 90.9 %) than during diagnostic procedures (9 of 12, 75.0 %, P = 0.06). Endoscopic closure was effective for 37 of 38 perforations (97.4 %) < 0.5 cm, and for 26 of 34 perforations (76.5 %) ≥ 0.5 cm ( P < 0.05). For perforations < 0.5 cm, systematic computed tomography (CT) scan, antibiotics, or surgical evaluation did not improve the outcome. Four of 105 deaths (3.8 %) occurred after perforation, one of which was attributable to the perforation itself. Conclusions Detection and closure of perforations during endoscopic procedure had a better outcome compared to delayed perforations; perforations < 0.5 cm had a very good prognosis and CT scan, surgeon evaluation, or antibiotics are probably not necessary when the endoscopic closure is confidently performed. This work led to proposal of a local management charter.
Collapse
Affiliation(s)
- Gaspard Bertrand
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Jérôme Rivory
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Maud Robert
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Jean-Christophe Saurin
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Élise Pelascini
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Olivier Monneuse
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive d’Urgence, Lyon, France
| | - Laurent Gruner
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive d’Urgence, Lyon, France
| | - Gilles Poncet
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Pierre-Jean Valette
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon France
| | - Hélène Gimonet
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon France
| | - Florian Rostain
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Charles-Éric Ber
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Anesthésie, Section Endoscopie, Lyon, France
| | - Yves Bouffard
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Anesthésie, Section Endoscopie, Lyon, France
| | - André Boibieux
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Pathologies Infectieuses, Lyon, France
| | - Marina Ciochina
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Verena Landel
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l’Innovation, Lyon, France
| | - Hélène Boyer
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l’Innovation, Lyon, France
| | - Jérémie Jacques
- Hôpital Dupuytren, Service de Gastroentérologie, Limoges, France
| | - Thierry Ponchon
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France,Hôpital Dupuytren, Service de Gastroentérologie, Limoges, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| |
Collapse
|
29
|
Dellestable C, Lambin T, Rivory J, Saurin JC, Jacques J, Ponchon T, Pioche M. Esophageal lumen recreated with a self-expanding metal stent in a deep submucosal tunnel: a successful way to treat a refractory stricture. Endoscopy 2022; 54:E139-E140. [PMID: 33862652 DOI: 10.1055/a-1418-7727] [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: 12/10/2022]
Affiliation(s)
- Caroline Dellestable
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | | | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| |
Collapse
|
30
|
Brule C, Pioche M, Albouys J, Rivory J, Geyl S, Legros R, Rostain F, Dahan M, Lepetit H, Sautereau D, Ponchon T, Auditeau E, Jacques J. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment classification for identification of large laterally spreading lesions lacking submucosal carcinomas: A prospective study of 663 lesions. United European Gastroenterol J 2022; 10:80-92. [PMID: 35089651 PMCID: PMC8830277 DOI: 10.1002/ueg2.12194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Optical diagnosis is necessary when selecting the resection modality for large superficial colorectal lesions. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment (CONECCT) encompasses overt (irregular pit or vascular pattern) and covert (macroscopic features) signs of carcinoma in an all‐in‐one classification using validated criteria. The CONECCT IIC subtype corresponds to adenomas with a high risk of superficial carcinoma that should be resected en bloc with free margins. Methods This prospective multicentre study investigated the diagnostic accuracy of the CONECCT classification for predicting submucosal invasion in colorectal lesions >20 mm. Optical diagnosis before en bloc resection by endoscopic submucosal dissection (ESD) was compared with the final histological diagnosis. Diagnostic accuracy for the CONECCT IIC subtype was compared with literature‐validated features of concern considered to be risk factors for submucosal invasion (non‐granular large spreading tumour [NG LST], macronodule >1 cm, SANO IIIA area, and Paris 0‐IIC area). Results Six hundred 63 lesions removed by ESD were assessed. The en bloc, R0, and curative resection rates were respectively 96%, 85%, and 81%. The CONECCT classification had a sensitivity (Se) of 100%, specificity (Sp) of 26.2%, positive predictive value of 11.6%, and negative predictive value (NPV) of 100% for predicting at least submucosal adenocarcinoma. The sensitivity of CONECCT IIC (100%) to predict submucosal cancer was superior to all other criteria evaluated. COlorectal NEoplasia Endoscopic Classification to Choose the Treatment IIC lesions constituted 11.5% of all submucosal carcinomas. Conclusion The CONECCT classification, which combines covert and overt signs of carcinoma, identifies with very perfect sensitivity (Se 100%, NPV 100%) the 30% of low‐risk adenomas in large laterally spreading lesions treatable by piecemeal endoscopic mucosal resection or ESD according to expertise without undertreatment. However, the low specificity of CONECCT leads to a large number of potentially not indicated ESDs for suspected high‐risk lesions.
Collapse
Affiliation(s)
- Clementine Brule
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jeremie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jerome Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sophie Geyl
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Martin Dahan
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Hugo Lepetit
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Denis Sautereau
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emilie Auditeau
- Department of Epidemiology, Dupuytren University Hospital, Limoges, France
| | - Jeremie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Taveira F, Hassan C, Kaminski MF, Ponchon T, Benamouzig R, Bugajski M, de Castelbajac F, Cesaro P, Chergui H, Goran L, Minelli Grazioli L, Janičko M, Januszewicz W, Lamonaca L, Lenz J, Negreanu L, Repici A, Spada C, Spadaccini M, State M, Szlak J, Veseliny E, Dinis-Ribeiro M, Areia M. The Colon Endoscopic Bubble Scale (CEBuS): a two-phase evaluation study. Endoscopy 2022; 54:45-51. [PMID: 33285583 DOI: 10.1055/a-1331-4325] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND To date, no scale has been validated to assess bubbles associated with bowel preparation. This study aimed to develop and assess the reliability of a novel scale - the Colon Endoscopic Bubble Scale (CEBuS). METHODS This was a multicenter, prospective, observational study with two online evaluation phases of 45 randomly distributed still colonoscopy images (15 per scale grade). Observers assessed images twice, 2 weeks apart, using CEBuS (CEBuS-0 - no or minimal bubbles, covering < 5 % of the surface; CEBuS-1 - bubbles covering 5 %-50 %; CEBuS-2 - bubbles covering > 50 %) and reporting the clinical action (do nothing; wash with water; wash with simethicone). RESULTS CEBuS provided high levels of agreement both in evaluation Phase 1 (4 experts) and Phase 2 (6 experts and 13 non-experts), with almost perfect intraobserver reliability: kappa 0.82 (95 % confidence interval 0.75-0.88) and 0.86 (0.85-0.88); interobserver agreement - intraclass correlation coefficient (ICC) 0.83 (0.73-0.89) and 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement among experts vs. non-experts: kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was ICC 0.63 (0.43-0.78) in Phase 1 and 0.77 (0.68-0.84) in Phase 2. Absolute agreement on clinical action per scale grade was 85 % (82-88) for CEBuS-0, 21 % (16-26) for CEBuS-1, and 74 % (70-78) for CEBuS-2. CONCLUSION CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.
Collapse
Affiliation(s)
- Filipe Taveira
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Thierry Ponchon
- Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Robert Benamouzig
- Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
| | - Marek Bugajski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | | | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Hasnae Chergui
- Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
| | - Loredana Goran
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | | | - Martin Janičko
- 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Wladyslaw Januszewicz
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Laura Lamonaca
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Jamila Lenz
- Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Lucian Negreanu
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy
| | - Monica State
- Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania
| | - Jakub Szlak
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eduard Veseliny
- 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Mário Dinis-Ribeiro
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| |
Collapse
|
33
|
Napoléon B, Gonzalez JM, Grandval P, Lisotti A, Laquière AE, Boustière C, Barthet M, Prat F, Ponchon T, Donatelli G, Vanbiervliet G. Evaluation of the performances of a single-use duodenoscope: Prospective multi-center national study. Dig Endosc 2022; 34:215-221. [PMID: 33666280 DOI: 10.1111/den.13965] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A single-use duodenoscope (SUD) has been recently developed to overcome issues with endoscopic retrograde cholangiopancreatography (ERCP)-related cross-infections. The aim was to evaluate SUD safety and performance in a prospective multi-centre study. METHODS All consecutive patients undergoing ERCP in six French centers were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators' satisfaction based on a VAS 0-10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID-RCB: 2020-A00346-33). External companies collected the database and performed statistical analysis. RESULTS Sixty patients (34 females, median age 65.5 years old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty-seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (one duodenal stricture, one ampullary infiltration, and one tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators' satisfaction was 9 (7-9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an adverse event. None was SUD-related. CONCLUSIONS The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.
Collapse
Affiliation(s)
- Bertrand Napoléon
- Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Jean-Michel Gonzalez
- Service de Gastro-entérologie, Hôpital Nord, Aix Marseille Université, Marseille, France
| | - Philippe Grandval
- Digestive Endoscopy and Gastroenterology Department, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Andrea Lisotti
- Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.,Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Arthur E Laquière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Christian Boustière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Marc Barthet
- Service de Gastro-entérologie, Hôpital Nord, Aix Marseille Université, Marseille, France
| | - Frédéric Prat
- Service d'Endoscopie, GHU AP-HP Nord, Université de Paris et Inserm, Paris, France
| | - Thierry Ponchon
- Hepato-Gastroenterology Department, Edouard Herriot University Hospital, Lyon, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | | |
Collapse
|
34
|
Ponchon T, Hassan C. Advanced diagnostic endoscopy for colorectal tumors: Challenges that need to be solved in the years to come. Endosc Int Open 2021; 9:E1865-E1867. [PMID: 34917452 PMCID: PMC8670999 DOI: 10.1055/a-1552-3346] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thierry Ponchon
- Digestive Diseases Department, Lyon University Hospital, France
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| |
Collapse
|
35
|
Rivory J, Menassel B, Lambin T, Rostain F, Milot L, Ponchon T, Pioche M. Percutaneous cholangioscopy to remove endovascular coils that had migrated into the bile duct after right hepatic artery pseudoaneurysm embolization. Endoscopy 2021; 53:E448-E449. [PMID: 33540444 DOI: 10.1055/a-1322-1942] [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: 12/10/2022]
Affiliation(s)
- Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Badis Menassel
- Department of Radiology, Pavillon B, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Florian Rostain
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Laurent Milot
- Department of Radiology, Pavillon B, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France.,Inserm U1032 LabTau, Lyon, France
| |
Collapse
|
36
|
AbiMansour JP, Ichkhanian Y, Minami H, Familiari P, Landi R, Costamagna G, Seewald S, Callahan ZM, Ujiki MB, Pioche M, Ponchon T, Roman S, Cho JY, Yoo IK, Sippey M, Marks JM, Eleftheriadis N, Khumbari V, Gutierrez OIB, Khashab MA. Durability of per-oral endoscopic myotomy beyond 6 years. Endosc Int Open 2021; 9:E1595-E1601. [PMID: 34790520 PMCID: PMC8589554 DOI: 10.1055/a-1553-9846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia. Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated. Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years ( P < 0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5 %). Type I achalasia (OR 10.8, P = 0.04) was found to be associated with clinical failure on logistic regression analysis. Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastroesophageal reflux post-procedure which persist at long-term follow-up.
Collapse
Affiliation(s)
- Jad P. AbiMansour
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology Nagasaki University Hospital Nagasaki, Japan
| | - Pietro Familiari
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Stefan Seewald
- Center of Gastroenterology Hirslanden Private Clinic Group Zürich, Switzerland
| | | | - Michael B. Ujiki
- Department of Surgery NorthShore University HealthSystem Evanston, USA
| | - Mathieu Pioche
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Thierry Ponchon
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Sabine Roman
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Megan Sippey
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Jeffrey M. Marks
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | - Vivek Khumbari
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | | | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| |
Collapse
|
37
|
Johnson G, Webster G, Boškoski I, Campos S, Gölder SK, Schlag C, Anderloni A, Arnelo U, Badaoui A, Bekkali N, Christodoulou D, Czakó L, Fernandez Y Viesca M, Hritz I, Hucl T, Kalaitzakis E, Kylänpää L, Nedoluzhko I, Petrone MC, Poley JW, Seicean A, Vila J, Arvanitakis M, Dinis-Ribeiro M, Ponchon T, Bisschops R. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2021; 53:1071-1087. [PMID: 34311472 DOI: 10.1055/a-1537-8999] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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] [Indexed: 02/08/2023]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should be competent in gastroscopy prior to commencing training. Formal training courses and the use of simulation in training are recommended. 2: Trainees should keep a contemporaneous logbook of their procedures, including key performance indicators and the degree of independence. Structured formative assessment is encouraged to enhance feedback. There should be a summative assessment process prior to commencing independent practice to ensure there is robust evidence of competence. This evidence should include a review of a trainee's procedure volume and current performance measures. A period of mentoring is strongly recommended in the early stages of independent practice. 3: Specifically for ERCP, all trainees should be competent up to Schutz level 2 complexity (management of distal biliary strictures and stones > 10 mm), with advanced ERCP requiring a further period of training. Prior to independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 300 cases, a native papilla cannulation rate of ≥ 80 % (90 % after a period of mentored independent practice), complete stones clearance of ≥ 85 %, and successful stenting of distal biliary strictures of ≥ 90 % (90 % and 95 % respectively after a mentored period of independent practice). 4: The progression of EUS training and competence attainment should start from diagnostic EUS and then proceed to basic therapeutic EUS, and finally to advanced therapeutic EUS. Before independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 250 cases (75 fine-needle aspirations/biopsies [FNA/FNBs]), satisfactory visualization of key anatomical landmarks in ≥ 90 % of cases, and an FNA/FNB accuracy rate of ≥ 85 %. ESGE recognizes the often inadequate quality of the evidence and the need for further studies pertaining to training in advanced endoscopy, particularly in relation to therapeutic EUS.
Collapse
Affiliation(s)
| | | | - Ivo Boškoski
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sara Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Stefan Karl Gölder
- Department of Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Andrea Anderloni
- Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Urban Arnelo
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Abdenor Badaoui
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Noor Bekkali
- John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Dimitrios Christodoulou
- Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina, Greece
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Michael Fernandez Y Viesca
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Istvan Hritz
- Centre for Therapeutic Endoscopy, 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, IKEM, Prague, Czech Republic
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece.,Digestive Disease Center, University Hospital of Copenhagen/Herley, University of Copenhagen, Copenhagen, Denmark
| | - Leena Kylänpää
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ivan Nedoluzhko
- Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow, Russia
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Jan-Werner Poley
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Juan Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Leuven, Belgium
| |
Collapse
|
38
|
Benech N, Vinet O, Gaudin JL, Benamouzig R, Dray X, Ponchon T, Galmiche JP, Sacher-Huvelin S, Samaha E, Saurin JC. Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort. Endosc Int Open 2021; 9:E1542-E1548. [PMID: 34540548 PMCID: PMC8445686 DOI: 10.1055/a-1526-0923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/04/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) has been proposed as an alternative to colonoscopy for screening patients at average risk of colorectal cancer (CRC). A prospective national cohort was developed to assess relevance of CCE in real-life practice and its short- and long-term impacts on clinical management. Patients and methods All patients who underwent a CCE in France were prospectively enrolled from January 2011 to May 2016 and reached annually by phone until May 2017. All CCE and colonoscopy reports were systematically collected. Results During the study period, 689 CCEs were analyzed from 14 medical centers. Median follow-up time was 35 months [IQR: 12-50]. Indication for CCE was mainly for elderly patients (median age: 70 years, IQR: [61-79]) due to anesthetic or colonoscopy contraindication (n = 307; 44.6 %). Only 337 CCEs (48.9 %) were both complete and with adequate bowel preparation. Advanced neoplasia (adenoma with high-grade dysplasia or CRC) was diagnosed following 32 CCEs (4.6 %). Among patients who underwent colonoscopy or therapeutic surgery following CCE, 18.8 % of all advanced neoplasias (6/32) had not been diagnosed by CCE mainly due to technical issues. Performing a colonoscopy in the case of significant polyps or insufficient bowel cleansing or after an incomplete CCE allowed the diagnosis of 96.9 % of all identified advanced neoplasias (31/32). Conclusions Outside the scope of academic trials, improvement is needed to increase the reliability of CCE as less than half were considered optimal i. e. complete with adequate bowel cleansing. Most of missed colonic advanced neoplasia were due to incomplete CCE with distal neoplasia location.
Collapse
Affiliation(s)
- Nicolas Benech
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Vinet
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Louis Gaudin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Robert Benamouzig
- Service de Gastro-entérologie, Hôpital d’Avicenne, Assistance Publique- Hôpitaux de Paris, Bobigny, France
| | - Xavier Dray
- Centre d’Endoscopie digestive, Hôpital Saint-Antoine, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Thierry Ponchon
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Elia Samaha
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Saurin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | |
Collapse
|
39
|
Bordillon P, Pioche M, Wallenhorst T, Rivory J, Legros R, Albouys J, Lepetit H, Rostain F, Dahan M, Ponchon T, Sautereau D, Loustaud-Ratti V, Geyl S, Jacques J. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021; 94:333-343. [PMID: 33548280 DOI: 10.1016/j.gie.2021.01.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colonic endoscopic submucosal dissection (ESD) is particularly challenging and limited to a few expert centers. We recently conducted a pilot study on improvement of colonic ESD with systematic use of a countertraction device (double-clip traction with rubber band [DCT-ESD]). METHODS A French prospective multicenter study was conducted between March 2017 and September 2019, including all consecutive cases of naive colonic ESD. Since the first case of DCT-ESD in March 2017, all cases of colonic ESD have been performed using the DCT-ESD strategy in the 3 centers involved in the study. RESULTS Five hundred ninety-nine lesions with a mean size of 53 mm were included in this study, resected by 5 operators in 3 centers. The en bloc, R0, and curative resection rates were 95.7%, 83.5%, and 81.1%, respectively. The adverse event rates were 4.9% for perforation and 4.2% for postprocedure bleeding. Between 2017 and 2019, the rates of R0 and curative resections increased significantly from 74.7% in 2017 to 88.4% in 2019 (P = .003) and from 72.6% in 2017 to 86.3% in 2019 (P = .004), respectively. Procedure duration and speed of resection were 62.4 minutes and 39.4 mm2/minute, respectively. No differences were noted between operators. CONCLUSION DCT-ESD is a safe and reproducible technique, with results comparable with those of the large Japanese teams with speed of resection twice as high as previously reported studies. The DCT strategy is promising, cheap, and seems to be reproducible. Physicians performing colonic ESD should be aware of this promising tool to improve their results in ESD.
Collapse
Affiliation(s)
- Pierre Bordillon
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | | | - Jérôme Rivory
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Romain Legros
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jérémie Albouys
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Hugo Lepetit
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Florian Rostain
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Martin Dahan
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Thierry Ponchon
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Denis Sautereau
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | - Sophie Geyl
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jérémie Jacques
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| |
Collapse
|
40
|
Meunier C, Jacques J, Rivory J, Lambin T, Walter T, Ponchon T, Pioche M. Diagnostic endoscopic submucosal dissection with targeted tunnel to reach the suspect area first in order to diagnose muscular invasion and differentiate T1b from T2 cancers. Endoscopy 2021; 53:870-871. [PMID: 33032350 DOI: 10.1055/a-1268-7057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Camille Meunier
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lambin
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Walter
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
41
|
Nakata K, Pioche M, Kuribayashi S, Tanaka H, Uehara D, Nagai K, Lambin T, Ponchon T, Uraoka T. The feasibility of a fully synthetic and self-assembled peptide solution as submucosal injection material: a preliminary animal study. Scand J Gastroenterol 2021; 56:984-989. [PMID: 34181504 DOI: 10.1080/00365521.2021.1934727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM An injection solution is required to create a submucosal cushion (SMC) for safe endoscopic resection procedures. The aim of this preliminary animal study was to clarify the safety and efficacy of a novel fully synthetic and self-assembled peptide (FSSP) solution as a submucosal injection material (SMIM). METHOD To compare the submucosal-lifting properties, 0.3% FSSP, Eleview®, sodium hyaluronate acid solution (SHA) and normal saline (NS) were randomly injected using an injection needle into the submucosa of exposed stomach and colon in five living dogs in a blind fashion. The mean height, and volume of SMCs were measured using a digital caliper immediately and 10, 20, 30, and 40 min after injecting each solution. All resected specimens were examined histopathologically. RESULTS In both the colon and stomach, ANOVA for repeated measures showed the significant interaction between time and solution for the time-dependent change in the height. In the colon, FSSP created significantly higher SMC than NS 20 min after injection (p = .0015) and Eleview® and NS 40 min after injection (p = .0009 and p = .0002). Furthermore, FSSP and SHA tended to maintain height and volume when compared to the other two solutions. In the stomach, FSSP and SHA tended to maintain height and volume when compared to the other two solutions. There were no significant differences between the histopathological finding and the injecting solutions used. CONCLUSION FSSP seems to be useful as a SMIM for endoscopic resection especially in the colon. Further studies are needed prior to clinical use of FSSP.
Collapse
Affiliation(s)
- Ko Nakata
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirohito Tanaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Daisuke Uehara
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazue Nagai
- Research and Education Center of Health Sciences School of Health Sciences, Gunma University, Maebashi, Japan
| | - Thomas Lambin
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
42
|
Héroin L, Rivory J, Ponchon T, Legros R, Albouys J, Chaussade S, Gronier O, Reimund JM, Fabacher T, Sautereau D, Dumeirain F, Pioche M, Jacques J. Video clips compared with high-definition still images for characterization of colorectal neoplastic lesions: a randomized comparative prospective study. Endosc Int Open 2021; 9:E1255-E1263. [PMID: 34447873 PMCID: PMC8383078 DOI: 10.1055/a-1487-5628] [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: 12/17/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Accurate real-time characterization of colorectal neoplastic lesions (CNLs) during colonoscopy is important for deciding appropriate treatment. No studies have evaluated whether still images or video clips are better for characterization. We compared histological predictions and size estimations of CNLs between two groups of gastroenterologists: one viewing still images and the other viewing video clips. Materials and methods Participants were shown 20 CNLs as either 3-5 still images or a video clip. Three endoscopy experts obtained the images using high-definition white light and virtual chromoendoscopy without magnification. Stratified randomization was performed according to experience. For each lesion, participants assessed the size and histological subtype according to the CONECCT classification (hyperplastic polyp [IH], sessile serrated lesion [IS], adenoma [IIA], high-risk adenoma or superficial adenocarcinoma [IIC], or deeply invasive adenocarcinoma [III]). The correct histological status and size were defined by the pathology reports or combined criteria between histology and expert opinion for high-risk adenoma or superficial adenocarcinoma (CONECCT IIC). Results 332 participants were randomized and 233 performed the characterization. Participants comprised 118 residents, 75 gastroenterologists, and 40 endoscopy experts; 47.6 % were shown still images and 52.4 % viewed video clips. There was no statistically significant difference between the two groups in histological prediction, our primary end point. However, the lesion size was better assessed using still images than video clips ( P = 0.03). Conclusions Video clips did not improve the histological prediction of CNLs compared with still images. Size was better assessed using still images.
Collapse
Affiliation(s)
- Lucile Héroin
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Jérémie Albouys
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | | | - Olivier Gronier
- Endoscopy and Gastroenterology Unit, Clinique Sainte Barbe, Groupe Hospitalier Saint-Vincent, Strasbourg, France
| | - Jean-Marie Reimund
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thibaut Fabacher
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Denis Sautereau
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Franck Dumeirain
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | | |
Collapse
|
43
|
Barret M, Chaussade S, Boustière C, Canard JM, Schott AM, Ponchon T, Rahmi G, Cellier C. Diagnostic yield of esophagogastroduodenoscopy in France. Clin Res Hepatol Gastroenterol 2021; 45:101540. [PMID: 33036954 DOI: 10.1016/j.clinre.2020.08.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Large scale data on esophagogastroduodenoscopy (EGD) in Western countries are scarce. We conducted a prospective study on the diagnostic yield of upper gastrointestinal endoscopy in France. PATIENTS AND METHODS An online questionnaire was sent to all French gastroenterologists practicing endoscopy. Data from EGDs performed during one week were collected. A statistical extrapolation of the results to a whole year was performed. RESULTS 342 gastrointestinal endoscopists, representative of the population of French gastroenterologists, provided data on 2735 EGDs, corresponding to 1 006 316 (95%CI=937 080-1 075 552) procedures for the entire year. 1770 (64.7%) EGDs were performed under sedation or general anesthesia, and 930 (34%) were associated with a colonoscopy. 896 (32.8%) EGDs were normal. Hiatal hernia and esophagitis were the most frequent esophageal diagnoses, in 496 (18.1%) and 374 (13.7%) cases, respectively. Barrett's esophagus was diagnosed in 109 (4%) patients. Among gastric lesions, endoscopic gastritis was reported in 572 (20.9%) patients; ulcer, polyps, and suspected malignancy in 78 (2.9%), 62 (2.3%), and 19 (0.7%), respectively. 1597 (58.4%) EGDs included mucosal biopsies, and 141 (5.1%) were associated with a therapeutic procedure. CONCLUSIONS We report nationwide prospective data on upper gastrointestinal endoscopy practice in France. Our data suggest that about 300 000 normal EGDs each year in France could potentially be avoided by a diagnostic strategy relying on upper GI capsule endoscopy, providing significant relief on healthcare practitioners.
Collapse
Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, and University of Paris, France.
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, and University of Paris, France
| | | | | | - Anne-Marie Schott
- Pôle Information Médicale Évaluation Recherche (IMER), Université Claude Bernard-Lyon 1, Lyon, France
| | - Thierry Ponchon
- Department of Gastroenterology Edouard Herriot Hospital and Université Claude Bernard-Lyon 1, Lyon, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Digestive Endoscopy, George Pompidou European Hospital and University of Paris, France
| | - Christophe Cellier
- Department of Gastroenterology and Digestive Endoscopy, George Pompidou European Hospital and University of Paris, France
| | | |
Collapse
|
44
|
Gruner M, Denis A, Masliah C, Amil M, Metivier-Cesbron E, Luet D, Kaasis M, Coron E, Le Rhun M, Lecleire S, Antonietti M, Legoux JL, Lefrou L, Renkes P, Tarreirias AL, Balian P, Rey P, Prost B, Cellier C, Rahmi G, Samaha E, Fratte S, Guerrier B, Landel V, Touzet S, Ponchon T, Pioche M. Narrow-band imaging versus Lugol chromoendoscopy for esophageal squamous cell cancer screening in normal endoscopic practice: randomized controlled trial. Endoscopy 2021; 53:674-682. [PMID: 32698233 DOI: 10.1055/a-1224-6822] [Citation(s) in RCA: 22] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics). METHODS This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. RESULTS 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol (P = 0.002). CONCLUSIONS As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia.
Collapse
Affiliation(s)
- Mélissa Gruner
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Angélique Denis
- Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
| | - Claude Masliah
- Gastroenterology Division, Clinique Mutualiste de l'Estuaire, Saint Nazaire, France
| | - Morgane Amil
- Gastroenterology Division, Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | - Dominique Luet
- Gastroenterology Division, Centre Hospitalo-Universitaire Larrey, Angers, France
| | - Medhi Kaasis
- Gastroenterology Division, Centre Hospitalier de Cholet, Cholet, France
| | - Emmanuel Coron
- Hepatogastroenterology Department, Hotel Dieu, Nantes, France
| | - Marc Le Rhun
- Hepatogastroenterology Department, Hotel Dieu, Nantes, France
| | - Stéphane Lecleire
- Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
| | - Michel Antonietti
- Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
| | - Jean-Louis Legoux
- Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
| | - Laurent Lefrou
- Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
| | - Pascal Renkes
- Gastroenterology Division, Hôpital Clinique Claude Bernard, Metz, France
| | | | | | - Philippe Rey
- Gastroenterology Division, Hôpital d'Instruction des Armées, Legouest, Metz, France
| | - Bénédicte Prost
- Gastroenterology Division, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Christophe Cellier
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Gabriel Rahmi
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Elia Samaha
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Serge Fratte
- Gastroenterology Division, Centre Hospitalier Régional, Belfort, France
| | - Béatrice Guerrier
- Gastroenterology Division, Centre Hospitalier Bourg en Bresse, Bourg en Bresse, France
| | - Verena Landel
- Direction Recherche Clinique et Innovations, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Touzet
- Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTAU, Lyon, France
| | - Mathieu Pioche
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTAU, Lyon, France
| |
Collapse
|
45
|
Ramchandani M, Lakhtakia S, Costamagna G, Tringali A, Püspöek A, Tribl B, Dolak W, Devière J, Arvanitakis M, van der Merwe S, Laleman W, Ponchon T, Lepilliez V, Gabbrielli A, Bernardoni L, Bruno MJ, Poley JW, Arnelo U, Lau J, Roy A, Bourke M, Kaffes A, Neuhaus H, Peetermans J, Rousseau M, Reddy DN. Fully Covered Self-Expanding Metal Stent vs Multiple Plastic Stents to Treat Benign Biliary Strictures Secondary to Chronic Pancreatitis: A Multicenter Randomized Trial. Gastroenterology 2021; 161:185-195. [PMID: 33741314 DOI: 10.1053/j.gastro.2021.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Benign biliary strictures (BBS) are complications of chronic pancreatitis (CP). Endotherapy using multiple plastic stents (MPS) or a fully covered self-expanding metal stent (FCSEMS) are acceptable treatment options for biliary obstructive symptoms in these patients. METHODS Patients with symptomatic CP-associated BBS enrolled in a multicenter randomized noninferiority trial comparing 12-month treatment with MPS vs FCSEMS. Primary outcome was stricture resolution status at 24 months, defined as absence of restenting and 24-month serum alkaline phosphatase not exceeding twice the level at stenting completion. Secondary outcomes included crossover rate, numbers of endoscopic retrograde cholangiopancreatography (ERCPs) and stents, and stent- or procedure-related serious adverse events. RESULTS Eighty-four patients were randomized to MPS and 80 to FCSEMS. Baseline technical success was 97.6% for MPS and 98.6% for FCSEMS. Eleven patients crossed over from MPS to FCSEMS, and 10 from FCSEMS to MPS. For MPS vs FCSEMS, respectively, stricture resolution status at 24 months was 77.1% (54/70) vs 75.8% (47/62) (P = .008 for noninferiority intention-to-treat analysis), mean number of ERCPs was 3.9 ± 1.3 vs 2.6 ± 1.3 (P < .001, intention-to-treat), and mean number of stents placed was 7.0 ± 4.4 vs 1.3 ± .6 (P < .001, as-treated). Serious adverse events occurred in 16 (19.0%) MPS and 19 (23.8%) FCSEMS patients (P = .568), including cholangitis/fever/jaundice (9 vs 7 patients respectively), abdominal pain (5 vs 5), cholecystitis (1 vs 3) and post-ERCP pancreatitis (0 vs 2). No stent- or procedure-related deaths occurred. CONCLUSIONS Endotherapy of CP-associated BBS has similar efficacy and safety for 12-month treatment using MPS compared with a single FCSEMS, with FCSEMS requiring fewer ERCPs over 2 years. (ClinicalTrials.gov, Number: NCT01543256.).
Collapse
Affiliation(s)
| | | | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andreas Püspöek
- Centre for Endoscopic Research Therapeutics and Training (CERTT), St. John's Hospital, Eisenstadt, Austria
| | | | | | | | | | | | - Wim Laleman
- University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Laura Bernardoni
- Università degli Studi Verona Policlinico G.B. Rossi, Verona, Italy
| | | | | | - Urban Arnelo
- CLINTEC, Division of Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - James Lau
- Prince of Wales Hospital, New Territories, Hong Kong
| | - André Roy
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michael Bourke
- Western Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Arthur Kaffes
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Horst Neuhaus
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Joyce Peetermans
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Matthew Rousseau
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | | |
Collapse
|
46
|
Mercier C, Pioche M, Albuisson E, Ponchon T, Gonzalez JM, Barthet M, Boytchev I, Vanbiervliet G, Fortier Beaulieu C, Prat F, Belle A, Branche J, Grandval P, Valats JC, Rudler F, Wallenhorst T, Koch S, Comte A, Williet N, Musquer N, Coron E, Derosiere A, Le Mouel JP, Schaefer M, Chabot C, Scheers I, Deprez PH, Chevaux JB. Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study. Endoscopy 2021; 53:586-594. [PMID: 32599632 DOI: 10.1055/a-1209-0155] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. METHODS All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. RESULTS 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 - 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 - 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. CONCLUSION Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.
Collapse
Affiliation(s)
- Clémence Mercier
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Nancy, Nancy, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Eliane Albuisson
- CHRU-Nancy, DRCI, Département MPI, Unité de Méthodologie, Data management et Statistique UMDS, Nancy, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Michel Gonzalez
- Department of Digestive Endoscopy, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Digestive Endoscopy, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Isabelle Boytchev
- Gastroenterology Department, Kremlin-Bicêtre University Hospital, Paris, France
| | | | | | - Frederic Prat
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Julien Branche
- Gastroenterology Department, Claude Huriez Hospital, Lille, France
| | - Phillipe Grandval
- Hepatogastroenterology Department, AP-HM, Hôpital La Timone, Marseille, France
| | | | - Franz Rudler
- Department of Endoscopy and Gastroenterology, Lapeyronie Hospital, Montpellier, France
| | - Timothee Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Stephane Koch
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Aurélie Comte
- Department of Pediatric Hepatology, Gastroenterology and Nutrition, CHU Besançon, Besançon, France
| | - Nicolas Williet
- Department of Hepato-gastro-enterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Nicolas Musquer
- Digestive Endoscopy Department, Nantes University Hospital, Nantes, France
| | - Emmanuel Coron
- Digestive Endoscopy Department, Nantes University Hospital, Nantes, France
| | - Aline Derosiere
- Department of Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Jean-Phillippe Le Mouel
- Department of Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| | - Caroline Chabot
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Nancy, Nancy, France
| | - Isabelle Scheers
- Department of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Baptiste Chevaux
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| |
Collapse
|
47
|
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: 13] [Impact Index Per Article: 4.3] [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: 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.
Collapse
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
| |
Collapse
|
48
|
Bhandari P, Longcroft-Wheaton G, Libanio D, Pimentel-Nunes P, Albeniz E, Pioche M, Sidhu R, Spada C, Anderloni A, Repici A, Haidry R, Barthet M, Neumann H, Antonelli G, Testoni A, Ponchon T, Siersema PD, Fuccio L, Hassan C, Dinis-Ribeiro M. Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update. Endoscopy 2021; 53:535-554. [PMID: 33822332 DOI: 10.1055/a-1397-3005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinical practice); (2) remains a priority (i. e. the above criterion was not met); (3) redefine the existing priority (i. e. the priority was too vague with the research question not clearly defined). RESULTS The previous ESGE research priorities document published in 2016 had 26 research priorities under seven domains. Our review of these priorities has resulted in seven priorities being removed from the list, one priority being partially removed, another seven being redefined to make them more precise, with eleven priorities remaining unchanged. This is a reflection of a rapid surge in endoscopic research, resulting in 27 % of research questions having already been answered and another 27 % requiring redefinition. CONCLUSIONS Our extensive review process has led to the removal of seven research priorities from the previous (2016) list, leaving 19 research priorities that have been redefined to make them more precise and relevant for researchers and funding bodies to target.
Collapse
Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | | | - Diogo Libanio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Eduardo Albeniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed-UPNA-IdiSNA, Pamplona, Spain
| | - Mathieu Pioche
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Digestive Endoscopy Unit, IRCSS Humanitas Research Hospital, Milan, Italy
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy.,Nuovo Regina Margherita Hospital, Rome, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| |
Collapse
|
49
|
Attar A, Branche J, Coron E, Privat J, Caillo L, Chevaux JB, Vuitton L, Amiot A, Belkhodja H, Dray X, Ponchon T, Bouhnik Y, Baumann C, Peyrin-Biroulet L. An Anti-migration Self-expandable and Removable Metal Stent for Crohn's Disease Strictures: A Nationwide Study From GETAID and SFED. J Crohns Colitis 2021; 15:521-528. [PMID: 33106876 DOI: 10.1093/ecco-jcc/jjaa208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS In Crohn's disease, strictures are frequent and may require surgical resection or endoscopic balloon dilation. An anti-migration, removable and shaped self-expandable metal stent is available. We evaluated its effectiveness and safety in a real-life setting. METHODS All centres were asked to collect retrospectively or prospectively all data on patients who had a stent for a stricture. The anti-migration stent [Hanarostent HRC-20-080-230-MITech, Seoul, South Korea] was maintained 7 days before its extraction during a second colonoscopy. Short- and long-term efficacy and safety outcomes were evaluated. RESULTS A total of 46 patients were enrolled. Strictures were anastomotic in 73.9% of cases. The median length of the stricture evaluated by cross-sectional imaging and during colonoscopy was 3.1 ± 1.7 and 2.7 ± 1.4 cm, respectively. Immediate success [no obstructive symptom at Day 30] was reported in 93.5% of cases (95% confidence interval [CI] = [86.3; 99.9]). Sixteen patients needed a new balloon dilation [n = 8] or surgery [n = 8]. The overall success rate [obstruction-free without any intervention] was 58.7% [n = 27] after a median follow-up of 26 months [8-41 months]. No perforation occurred and three migrations were observed [6.5%]. Perianal disease (hazard ratio [HR] = 0.1 [0.02; 0.58]) and discontinuation of an immunosuppressant (0.12 [0.02; 0.86]), were associated with a lower probability of success, whereas performing imaging (HR = 5.3 [1.2; 23.5]) before stent placement was associated with success. CONCLUSIONS The anti-migration stent is safe and effective in about half of patients, with no perforation reported in this study, and has an extremely low migration rate.
Collapse
Affiliation(s)
- Alain Attar
- Hépato-Gastro-Entérologie MICI Assistance Nutritive, Hôpital Beaujon, Clichy-La-Garenne, France
| | - Julien Branche
- Hépato-Gastro-Entérologie, Hôpital Huriez, Lille, France
| | - Emmanuel Coron
- Hépato-Gastro-Entérologie et Cancérologie Digestive, Hôpital Hôtel Dieu, Nantes, France
| | - Jocelyn Privat
- Hépato-Gastro-Entérologie, Centre Hospitalier de Vichy, Vichy, France
| | - Ludovic Caillo
- Hépato-Gastro-Entérologie, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
| | - Jean-Baptiste Chevaux
- Department of Gastroenterology, Nancy University Hospital, and Inserm U1256, Lorraine University, Vandoeuvre-Les-Nancy, France
| | - Lucine Vuitton
- Hépato Gastro-Entérologie, Hôpital Jean-Minjoz, Besançon, France
| | - Aurélien Amiot
- Hépato Gastro-Entérologie, Hôpital Henri Mondor, Créteil, France
| | - Hichem Belkhodja
- Hépato-Gastro-Entérologie, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Xavier Dray
- Sorbonne Université, Endoscopie Digestive, Hôpital Saint-Antoine AP-HP, Paris, France
| | - Thierry Ponchon
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Lyon, France
| | - Yoram Bouhnik
- Hépato-Gastro-Entérologie MICI Assistance Nutritive, Hôpital Beaujon, Clichy-La-Garenne, France
| | - Cédric Baumann
- Méthodologie, data management et statistique, Hôpital de Brabois, Nancy, France
| | | |
Collapse
|
50
|
Antonelli G, Karstensen JG, Bhat P, Ijoma U, Osuagwu C, Desalegn H, Abera H, Guy C, Vilmann P, Dinis-Ribeiro M, Ponchon T, Sabbagh LC, Pausawasdi N, Makharia G, Hassan C, Veitch A, Aabakken L, Ebigbo A. Erratum: Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings. Endosc Int Open 2021; 9:C4. [PMID: 33880396 PMCID: PMC8050563 DOI: 10.1055/a-1480-4036] [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] [Indexed: 11/29/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1400-9135.].
Collapse
Affiliation(s)
- Giulio Antonelli
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy,Department of Translational and Precision Medicine, “Sapienza” University of Rome, Italy,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), Rome, Italy
| | - John Gásdal Karstensen
- Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Purnima Bhat
- ANU Medical School/Canberra Hospital -Gastroenterology, Garran, Australia
| | - Uchenna Ijoma
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Chukwuemeka Osuagwu
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St. Paulʼs Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hanna Abera
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Claire Guy
- European Society of Gastrointestinal Endoscopy – Munich, Germany
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev – Herlev, Denmark
| | | | - Thierry Ponchon
- Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Luis Carlos Sabbagh
- Department of Gastroenterology, Reina Sofia and Colombia University Clinics, Bogota, Colombia
| | | | | | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, UK
| | - Lars Aabakken
- Department of Transplantation Medicine, Faculty of Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Alanna Ebigbo
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | | |
Collapse
|