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de Ponthaud C, Daire E, Pioche M, Napoléon B, Fillon M, Sauvanet A, Gaujoux S. Cystic dystrophy in heterotopic pancreas. J Visc Surg 2023; 160:108-117. [PMID: 36966112 DOI: 10.1016/j.jviscsurg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.
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Affiliation(s)
- C de Ponthaud
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France
| | - E Daire
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - M Pioche
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - B Napoléon
- Gastroenterology department, Jean Mermoz hospital, Lyon, France
| | - M Fillon
- Radiology department, la Croix Rousse hospital, Lyon, France
| | - A Sauvanet
- Pancreatic and hepatobiliary surgery department, Beaujon hospital, AP-HP, Clichy, France; University of Paris, France
| | - S Gaujoux
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France.
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Alvarez-Sánchez MV, Luna OB, Oria I, Marchut K, Fumex F, Singier G, Salgado A, Napoléon B. Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study. J Gastrointest Surg 2018; 22:1213-1220. [PMID: 29532359 DOI: 10.1007/s11605-018-3731-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
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Affiliation(s)
- María Victoria Alvarez-Sánchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain.
| | - O B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - I Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - K Marchut
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - F Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - G Singier
- Department of Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - A Salgado
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - B Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Mohammedi I, Fumex F, Vial V, Leclercq P, Napoléon B. [End-tidal carbon dioxine is increasing during CO(2) insufflation in endoscopy]. Ann Fr Anesth Reanim 2010; 29:497. [PMID: 20547032 DOI: 10.1016/j.annfar.2010.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Legoux J, Rougier P, Pienkowski P, Faroux R, Napoléon B, Rosmorduc O, Cadiot G, Ricard F, Michel P, Bedenne L. The role of French gastroenterologists (GE) in digestive oncology: Results of a national survey (FFCD, FSMAD, AFEF, ANGH, CREGG, SFED, SNFGE). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- V Lépilliez
- Service d'hépatogastroentérologie, hôpital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex, France.
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Gincoul R, Pujol B, Dumortier J, Scoazec JY, Hervieu V, Crombe-Ternamian A, Pilleul F, Napoléon B, Ponchon T. [Bile duct involvement in autoimmune pancreatitis: classification and treatment]. Gastroenterol Clin Biol 2008; 32:914-921. [PMID: 18472376 DOI: 10.1016/j.gcb.2007.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Autoimmune pancreatitis is a rare disease characterized by inflammation of the pancreatic parenchyma, irregular narrowing of the pancreatic duct, periductal lymphoplasmacytic infiltration and fibrosis at histological examination, the presence of autoantibodies and hypergammaglobulinemia, as well as the possible association of cholangitis and other autoimmune diseases. There is a favorable response to steroid therapy. We report the case of a patient with autoimmune pancreatitis with bile duct involvement and peripheral eosinophilia, requiring long-term immunosuppressant treatment. The diagnosis of a diffuse form of AIP was made without direct histological evidence and based on indirect imaging, clinical and laboratory findings in an autoimmune context. The histological and imaging studies of bile duct involvement and the favourable response to steroids were additional arguments.
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Affiliation(s)
- R Gincoul
- Service d'hépatogastroentérologie, pavillon H, hôpital Edouard-Herriot, Lyon cedex 03, France.
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Ciocîrlan M, Chemali M, Lapalus MG, Lefort C, Souquet JC, Napoléon B, Ponchon T. Esophageal varices and early esophageal cancer: can we perform endoscopic mucosal resection (EMR)? Endoscopy 2008; 40 Suppl 2:E91. [PMID: 18633900 DOI: 10.1055/s-2007-995571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- M Ciocîrlan
- Hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France.
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Barthet M, Napoléon B, Palazzo L, Chemali M, Letard JC, Laugier R, Arpurt JP, Boyer J, Boustière C, Canard JM, Cassigneul J, Dalbiès PA, Escourrou J, Gay G, Ponchon T, Richard-Molard B, Sautereau D, Tucat G, Vedrenne B. Management of cystic pancreatic lesions found incidentally. Endoscopy 2007; 39:926-8. [PMID: 17968813 DOI: 10.1055/s-2007-966786] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Boyer J, Laugier R, Chemali M, Arpurt JP, Boustière C, Canard JM, Dalbies PA, Gay G, Escourrou J, Napoléon B, Palazzo L, Ponchon T, Richard-Mollard B, Sautereau D, Tucat G, Vedrenne B. French Society of Digestive Endoscopy SFED guideline: monitoring of patients with Barrett's esophagus. Endoscopy 2007; 39:840-2. [PMID: 17703397 DOI: 10.1055/s-2007-966653] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Graber I, Dumas R, Filoche B, Boyer J, Coumaros D, Lamouliatte H, Legoux JL, Napoléon B, Ponchon T. The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy 2007; 39:784-7. [PMID: 17703386 DOI: 10.1055/s-2007-966594] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Société Française d'Endoscopie Digestive (SFED). PATIENTS AND METHODS A total of 51 patients were selected (mean age 72), the majority (69%) having pancreatic adenocarcinoma. Palliative treatment was chosen because of irresectability (61.2%), inoperability (18.4%), or both (20.4 %). Enteral Wallstent prostheses were used, and the patients were followed up on day 3, after 1 month, and then every month, with weight measurement, and symptomatic and laboratory evaluation. RESULTS One prosthesis was sufficient in 46 patients. Stent positioning and deployment were correct in 50/51 patients (98%). Twenty patients also underwent biliary stenting in addition to the duodenal stenting. On day 3, 43 patients (84%) were able to tolerate soft solids or a full diet. Six complications were attributed to stenting: three intestinal hemorrhages, two cases of peritonitis due to bowel perforation, and one case of septicemia, and these led to five deaths (mortality 9.8%). Stent dysfunction was observed in 12 cases (23.5%) after a mean delay of 75 days, comprising 11-malignant obstructions and one migration: a new stent was inserted inside the first one and was effective in eight cases; and no treatment was given in the other four patients because of their clinical state. The median survival was 71.5 days. CONCLUSIONS Palliative endoscopic treatment of malignant duodenal stenosis using metallic prostheses is highly feasible, even with associated biliary stenting. Symptomatic improvement is fast. However, the mortality and the obstruction rate are high, suggesting that a prospective trial comparing this treatment with surgery is still required.
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Affiliation(s)
- I Graber
- Service d'Hépatogastroentérologie, Hôpital E. Herriot, Lyon, France.
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Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoléon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 2007; 39:24-9. [PMID: 17252456 DOI: 10.1055/s-2006-945182] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED BACK AND STUDY AIMS: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. PATIENTS AND METHODS A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasas or mucosal (m) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. RESULTS There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91%). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26%). The 5-year survival rate was 95%. CONCLUSIONS EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.
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Affiliation(s)
- M Ciocirlan
- Gastroenterology and Hepatology Centre, Fundeni Clinical Institute, Bucharest, Romania.
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Napoléon B, Boneu B, Maillard L, Samama CM, Schved JF, Gay G, Ponchon T, Sautereau D, Canard JM. Guidelines of the French Society for Digestive Endoscopy (SFED). Endoscopy 2006; 38:632-8. [PMID: 16586249 DOI: 10.1055/s-2006-925086] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 12/10/2022]
Affiliation(s)
- B Napoléon
- Société Française d'Endoscopie Digestive (SFED), Lyon, France.
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Affiliation(s)
- B Napoléon
- Clinique Sainte-Anne Lumière, 85 Cours Albert Thomas 69003 Lyon, France.
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Saurin JC, Chavaillon A, Napoléon B, Descos F, Bory R, Berger F, Ponchon T. Long-term follow-up of patients with endoscopic treatment of sporadic adenomas of the papilla of vater. Endoscopy 2003; 35:402-6. [PMID: 12701011 DOI: 10.1055/s-2003-38767] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [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: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Knowledge about the long-term outcome of patients after endoscopic treatment of ampullary adenomas remains poor, although surgical series have suggested that the initial endoscopic evaluation of these diseases might overlook cancer foci developed in adenomas. The aim of this study was to evaluate retrospectively the long-term outcome in patients with ampullary adenomas treated endoscopically, with a focus on the possible development of cancer. PATIENTS AND METHODS The study included 24 patients (median age 59 years, range 34 - 84) with macroscopically benign adenomas of the papilla of Vater treated using mainly laser photodestruction between 1983 and 1996. Medical, endoscopic, surgical, and histological reports were reviewed. Patients and general practitioners were contacted to determine patient outcome when endoscopic follow-up had been discontinued. RESULTS Endoscopic remission (macroscopic and histological) was achieved in 16 patients (66.6 %) with one recurrence (6.2 %) during a mean endoscopic follow-up of 66 months (4-168 months). Endoscopic treatment was discontinued in five (20.8 %) patients (with minimal residual adenoma and advanced age and/or severe unrelated disease), and failed in three patients (12.5 %) (failure of Nd:YAG laser in one case, severe pancreatitis and pancreatic duct ingrowth in one case each). After a mean clinical follow-up of 81 months (8-172 months), two patients (8.3 %) had undergone pancreaticoduodenectomy; eight (33.3 %) had died from unrelated diseases; and 14 (58.3 %) were alive and asymptomatic without any evidence of ampullary cancer. CONCLUSIONS Long-term follow-up revealed no case of advanced ampullary cancer and suggested that endoscopic treatment was satisfactory for the large majority of patients with ampullary adenomas.
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Affiliation(s)
- J-C Saurin
- Fédération des Spécialités Digestives, Pavillon I, Hôpital E. Herriot, Lyon, Lyon, France.
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Napoléon B, Dumortier J, Keriven-Souquet O, Pujol B, Ponchon T, Souquet JC. Do normal findings at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone? A prospective follow-up study of 238 patients. Endoscopy 2003; 35:411-5. [PMID: 12701013 DOI: 10.1055/s-2003-38778] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Biliary endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiography (ERC) are equally accurate for the diagnosis of common bile duct (CBD) stone. The aim of this prospective 1-year follow-up study was to determine whether normal findings at initial EUS obviated the need for ERC. PATIENTS AND METHODS During a 17-month period, all patients referred for biliary EUS because of suspicion of CBD stone, in whom EUS findings were normal were included in the study. Early (1-month) and late (1-year) follow-up details were obtained by mail or telephone. The clinical course and need for ERC were recorded. RESULTS 238 patients were enrolled. During follow-up, 59 (25 %) patients underwent cholecystectomy, with (n=31) or without (n=28) cholangiography, and 30 patients underwent ERC (13 %). CBD stone was found in 14 (6 %) patients. Of these 30 patients, ERC was done in 15 cases in the first week after EUS, because of persistent suspicion of a CBD stone which was found in 10 patients. The 15 late ERC procedures (carried out more than 1 week after EUS) revealed only one CBD stone. The negative predictive value of EUS for the diagnosis of CBD stones was 95.4 %. CONCLUSIONS Patients with suspicion of CBD stones but normal EUS findings have a low risk of needing ERC in a 1-year period.
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Affiliation(s)
- B Napoléon
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
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Napoléon B. [Echoendoscopy and biliary disease]. Gastroenterol Hepatol 2002; 25:35-41. [PMID: 11835871 DOI: 10.1016/s0210-5705(02)70238-0] [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] [Indexed: 11/23/2022]
Affiliation(s)
- B Napoléon
- Service de Gastro-entérologie, Hopital Edouard Herriot, Lyon, France
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Canard JM, Gorce D, Napoléon B, Richard-Molard B, Caucanas JP, Dalbiès P, Revol C, Letard JC, Le Bourgeois P, Clanet J, Vandromme L, Greff M, Lugand JJ, Levy P, Lapuelle J. Fleet® phospho soda: pour une meilleure acceptabilité de la préparation colique avant coloscopie. Etude comparative randomisée menée en simple aveugle versus polyéthylène glycol. ACTA ACUST UNITED AC 2001. [DOI: 10.1007/bf03022144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Napoléon B. [Endosonography-guided puncture: useful or dangerous?]. Gastroenterol Clin Biol 1999; 23:459-62. [PMID: 10429847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Affiliation(s)
- T Ponchon
- Digestive Disease Dept., E. Herriot Hospital, Lyon, France
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Napoléon B. Role of endoscopic ultrasound in the diagnosis of cholestasis. Endoscopy 1998; 30 Suppl 1:A116-9. [PMID: 9765101 DOI: 10.1055/s-2007-1001490] [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: 12/10/2022]
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Burtin P, Napoléon B. [Standardization of echo-endoscopic examinations in digestive cancerology. Club Français d'Echo-Endoscopie Digestive]. Gastroenterol Clin Biol 1995; 19:7-14. [PMID: 7720994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P Burtin
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers
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Abstract
Endoscopic ultrasonography is the best available method for the locoregional staging of esophageal carcinoma. Its main limitations are represented by a) tumor stenosis, b) distinguishing between malignant and benign lymph nodes, and c) distinguishing between mucosal and submucosal cancer. In untreated esophageal carcinoma, three main groups can be distinguished, based on clinical and morphological evaluation (endoscopy, abdominal ultrasound and CT). EUS is not useful when palliative treatment aiming to relieve dysphagia is the only treatment. In tumors with a superficial pattern at endoscopy, EUS is necessary to distinguish T1 from more invasive tumors, but endoscopic treatment (photodynamic therapy, strip biopsy) is indicated only in nonsurgical patients. In the last, and largest, group of tumors with no clear surgical contraindication, EUS is necessary when surgery is not the only treatment considered. EUS staging then improves patient management (surgery alone, surgery with preoperative treatment, or nonsurgical treatment; type of surgery). Moreover, it provides a good evaluation of the prognosis, and allows better follow-up after nonsurgical treatment.
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Affiliation(s)
- J C Souquet
- Federation of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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Napoléon B, Berger F, Espinouse D, Dechavanne M, Mion F, Vignal J, Descos L. [IgM kappa gastric plasmacytoma]. Gastroenterol Clin Biol 1989; 13:938-41. [PMID: 2515089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A case of gastric plasmacytoma in a 50-year old woman was reported. Immunofluorescent and immunoperoxidase studies were performed. Polyclonal antibodies reactive with immunoglobulin chains and a panel of 14 monoclonal antibodies reactive with B and T cells, and epithelial cells were used. These studies showed that the tumor cells produced IgM Kappa molecules whereas no monotypic immunoglobulin could be detected in the serum and urine. On the other hand the tumor cells had the immunologic phenotype of plasma cells. This helps diagnosis: some lymphomas with plasmocytic differentiation could also produce a monotypic immunoglobulin. Treatment using a combination of surgery, radio and polychimiotherapy was effective, leading to complete remission.
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Affiliation(s)
- B Napoléon
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Lyon-Sud, Pierre-Bénite
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