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Balducci D, Archimbaud C, Ratone JP, Dahel Y, Hoibian S, Caillol F, Giovannini M. An unusual complication following endoscopic ultrasound-directed transgastric ERCP in a patient with a history of bariatric surgery. Endoscopy 2024; 56:E325. [PMID: 38594002 PMCID: PMC11003799 DOI: 10.1055/a-2291-9505] [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: 04/11/2024]
Affiliation(s)
- Daniele Balducci
- Endoscopy Unit, Institut Paoli-Calmettes, Marseille, France
- Clinic of Gastroenterology, Hepatology, and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Yanis Dahel
- Endoscopy Unit, Institut Paoli-Calmettes, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit, Institut Paoli-Calmettes, Marseille, France
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Corre F, Albouys J, Tran VT, Lepilliez V, Ratone JP, Coron E, Lambin T, Rahmi G, Karsenti D, Canard JM, Chabrun E, Camus M, Wallenhorst T, Chevaux JB, Schaefer M, Gerard R, Rouquette A, Terris B, Coriat R, Jacques J, Barret M, Pioche M, Chaussade S, Cappelle E. Impact of surgery after endoscopically resected high-risk T1 colorectal cancer: results of an emulated target trial. Gastrointest Endosc 2024; 99:408-416.e2. [PMID: 37793506 DOI: 10.1016/j.gie.2023.09.027] [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: 05/05/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS We aimed to compare the long-term outcomes of patients with high-risk T1 colorectal cancer (CRC) resected endoscopically who received either additional surgery or surveillance. METHODS We used data from routine care to emulate a target trial aimed at comparing 2 strategies after endoscopic resection of high-risk T1 CRC: surgery with lymph node dissection (treatment group) versus surveillance alone (control group). All patients from 14 tertiary centers who underwent an endoscopic resection for high-risk T1 CRC between March 2012 and August 2019 were included. The primary outcome was a composite outcome of cancer recurrence or death at 48 months. RESULTS Of 197 patients included in the analysis, 107 were categorized in the treatment group and 90 were categorized in the control group. From baseline to 48 months, 4 of 107 patients (3.7%) died in the treatment group and 6 of 90 patients (6.7%) died in the control group. Four of 107 patients (3.7%) in the treatment group experienced a cancer recurrence and 4 of 90 patients (4.4%) in the control group experienced a cancer recurrence. After balancing the baseline covariates by inverse probability of treatment weighting, we found no significant difference in the rate of death and cancer recurrence between patients in the 2 groups (weighted hazard ratio, .95; 95% confidence interval, .52-1.75). CONCLUSIONS Our study suggests that patients with high-risk T1 CRC initially treated with endoscopic resection may not benefit from additional surgery.
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Affiliation(s)
- Félix Corre
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Viet-Thi Tran
- Paris Cité University and Sorbonne Paris Nord University, INSERM, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | | | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland; Digestive Diseases Institute, University Hospital of Nantes, Nantes, France
| | - Thomas Lambin
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Marine Camus
- Department of Endoscopy, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | | | - Marion Schaefer
- Department of Gastroenterology, Brabois University Hospital, Nancy, France
| | - Romain Gerard
- Department of Gastroenterology, Claude Huriez Hospital, Lille, France
| | - Alexandre Rouquette
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Paris Cité University, Paris, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stanislas Chaussade
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
| | - Elisabeth Cappelle
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Cité University, Paris, France
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Caillol F, Godat S, Solovyev A, Harouchi A, Oumrani S, Marx M, Hoibian S, Dahel Y, Ratone JP, Giovannini M. EUS-BD for calibration of benign stenosis of the bile duct in patients with altered anatomy or inaccessible papilla. Endosc Int Open 2024; 12:E377-E384. [PMID: 38464978 PMCID: PMC10919993 DOI: 10.1055/a-2261-2968] [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: 10/14/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Background and study aims In cases of inaccessible papilla, EUS-guided biliary drainage (EUS-BD) has been described as an alternative to calibrate benign biliary stenosis. However, few studies are available. Patients and methods This tw-center, retrospective study was designed to evaluate technical success and clinical success at 1 year. All patients who underswent EUS-BD without the rendezvous technique used for calibration of benign biliary stenosis were included from 2016 to 2022. Patients underwent EUS-hepaticogastrostomy (EUS-HGS) during the first session. Then, HGS was used to access the bile duct, allowing calibration of the stenosis: Dilation of the biliary stenosis and placement of double pigtail stents through the stenosis for 1 year. Results Thirty-six patients were included. Technical success was 89% (32/36), with four failures to cross the stenosis but EUS-HGS was performed in 100% of the cases. Nine patients were excluded during calibration because of oncological relapse in six and complex stenosis in three. Three patients had not yet reached 1 year of follow-up. Twenty patients had a calibration for at least 1 year. Clinical success after stent placement was considered in all cases after 1 year of follow-up. Thirteen patients underwent stent removal and no relapse occurred after 435 days of follow-up (SD=568). Global morbidity was 41.7% (15/36) with only one serious complication (needing intensive care), including seven cases of cholangitis due to intrabiliary duct obstruction and five stent migrations. No deaths were reported. Conclusions EUS-BD for calibration in case of benign biliary stenosis is an option. Dedicated materials are needed to decrease morbidity.
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Affiliation(s)
- Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Sébastien Godat
- gastroentérologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alexey Solovyev
- Statistics Unit, Paoli-Calmettes Institute, Marseille, France
| | - Amina Harouchi
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Sarra Oumrani
- Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Mariola Marx
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
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Marx M, Caillol F, Godat S, Poizat F, Oumrani S, Ratone JP, Hoibian S, Dahel Y, Oziel-Taieb S, Niccoli P, Ewald J, Mitry E, Giovannini M. Outcome of nonfunctioning pancreatic neuroendocrine tumors after initial surveillance or surgical resection: a single-center observational study. Ann Gastroenterol 2023; 36:686-693. [PMID: 38023974 PMCID: PMC10662066 DOI: 10.20524/aog.2023.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background Current guidelines consider observation a reasonable strategy for G1 or G2 nonfunctional pancreatic neuroendocrine tumors (nf pNETs) ≤2 cm. We aimed to characterize their natural behavior and confront the data with the outcomes of patients undergoing upfront surgery. Methods Data from patients with histologically confirmed nf pNETs ≤2 cm, managed at a single tertiary referral center between 2002 and 2020, were retrospectively reviewed. Results Thirty-nine patients (mean age 62.1 years, 56% male) with 43 lesions (mean size 12.7±3.9 mm; 32 grade 1 [G1] and 7 grade 2 lesions [G2]) were managed by careful surveillance. Progression was observed in 15 lesions (35%; mean follow up 47 months). Six patients (18%) underwent secondary surgery because of an increase in tumor size or dilation of the main pancreatic duct; 3 of them had lymph node metastasis in the resected specimen. Surgery was followed by pancreatic fistula in 2/6 patients, 1 of whom died. Fourteen patients (mean age 59 years, 64.3% female, mean size of lesions 11.4±3.1 mm) underwent pancreatic surgery immediately after diagnosis. The surgery-associated complication rate was 57.1% (8/14). Of the 14 patients, 13 remained recurrence free (mean follow up 67 months). Recurrent metastatic disease was observed 3 years after pancreaticoduodenectomy (R0, 15 mm G2 lesion, 0 N+/8 N) in 1 patient. Conclusions The behavior of small nf pNETs is difficult to predict, as there is evidence for malignant behavior in a subgroup of patients, even after surgical treatment. Optimal management remains challenging, as pancreatic surgery is associated with significant morbidity.
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Affiliation(s)
- Mariola Marx
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Mariola Marx, Sébastien Godat, Sarra Oumrani)
| | - Fabrice Caillol
- Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini)
| | - Sébastien Godat
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Mariola Marx, Sébastien Godat, Sarra Oumrani)
| | | | - Sarra Oumrani
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Mariola Marx, Sébastien Godat, Sarra Oumrani)
| | - Jean-Philippe Ratone
- Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini)
| | - Solène Hoibian
- Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini)
| | - Yanis Dahel
- Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini)
| | - Sandrine Oziel-Taieb
- Department of Medical Oncology (Sandrine Oziel-Taieb, Patricia Niccoli, Emmanuel Mitry)
| | - Patricia Niccoli
- Department of Medical Oncology (Sandrine Oziel-Taieb, Patricia Niccoli, Emmanuel Mitry)
| | - Jacques Ewald
- Department of Surgery (Jacques Ewald), Paoli-Calmettes Institute, Marseille, France
| | - Emmanuel Mitry
- Department of Medical Oncology (Sandrine Oziel-Taieb, Patricia Niccoli, Emmanuel Mitry)
| | - Marc Giovannini
- Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini)
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Ratone JP, Archimbaud C, Solovyev A, Zemmour C, Pesenti C, Hoibian S, Dahel Y, Marx M, De Chaisemartin C, Chanez B, Meillat H, Lelong B, Poizat F, Caillol F, Giovannini M. Piecemeal Resection for Large Colorectal Adenomas Remains Essential in 2022: A Single-Center Experience in a Tertiary French Center. J Gastrointestin Liver Dis 2023; 32:315-322. [PMID: 37774222 DOI: 10.15403/jgld-4719] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND AIMS Colorectal lesions measuring greater than 20 mm are unsuitable for en bloc endoscopic mucosal resection (EMR): piecemeal EMR (PM-EMR) and endoscopic submucosal dissection (ESD) are needed. The European Society of Gastrointestinal Endoscopy (ESGE) recommends ESD only for microinfiltrative lesions, although Japanese teams perform en bloc ESD for all lesions. We report the outcomes obtained in our endoscopy unit for these lesions and assess the hybrid "knife-assisted piecemeal EMR" (KAPM-EMR) technique. The main aim was to assess the short-term outcomes (C1). The secondary objectives were to evaluate the long-term results (C2), adverse event rate and management of recurrence. METHODS We retrospectively analyzed data from patients treated by PM-EMR, KAPM-EMR and ESD for a colorectal lesion measuring greater than 20 millimeters using prospective inclusion over four years. RESULTS Data from 167 patients (median age: 70) with a median follow-up of 15.1 months were analyzed after excluding 95 patients. A total of 131 lesions were removed by PM-EMR, 24 by KAPM-EMR and 12 by ESD; 146/167 (87.4%) patients were considered in remission at C1. Recurrence was treated by endoscopy in 20/21 patients (95%); 86/89 (96.6%) were in remission at C2. A total of 16/167 patients developed adverse events, all of whom except one were endoscopically managed. KAPM-EMR was associated with a higher perforation risk (p=0.037). No differences in postoperative bleeding were found among the three groups (p=0.576). CONCLUSIONS Piecemeal resection remains an effective and safe technique for large colorectal adenomas. KAPM-EMR may be useful but should be applied with caution due to the risk of perforation.
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Affiliation(s)
| | | | - Alexey Solovyev
- Paoli-Calmettes Institute, Dept Clin Res and Invest, Biostat and Methodolo Unit, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
| | - Christophe Zemmour
- Paoli-Calmettes Institute, Dept Clin Res and Invest, Biostat and Methodolo Unit, Marseille, France.
| | | | - Solène Hoibian
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Yanis Dahel
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Mariola Marx
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | | | - Brice Chanez
- Paoli-Calmettes Institute, Digestive Oncology Unit, Marseille, France.
| | - Hélène Meillat
- Paoli-Calmettes Institute, Surgical Unit, Marseille, France.
| | - Bernard Lelong
- Paoli-Calmettes Institute, Surgical Unit, Marseille, France.
| | - Flora Poizat
- Paoli-Calmettes Institute, Pathology Unit, Marseille, France.
| | - Fabrice Caillol
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Marc Giovannini
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
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Williet N, Caillol F, Karsenti D, Abou-Ali E, Camus M, Belle A, Chaput U, Levy J, Ratone JP, Tournier Q, Grange R, Le Roy B, Becq A, Phelip JM. The level of glucose in pancreatic cyst fluid is more accurate than carcinoembryonic antigen to identify mucinous tumors: A French multicenter study. Endosc Ultrasound 2023; 12:377-381. [PMID: 37795349 PMCID: PMC10547248 DOI: 10.1097/eus.0000000000000024] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 06/01/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Objectives Pancreatic cyst fluid level of glucose is a promising marker to identify mucinous from nonmucinous tumors, but the glucose assay has not yet been recommended. The objective of this study is to compare the diagnostic performances of pancreatic cyst fluid level of glucose and carcinoembryonic antigen (CEA). Methods In this French multicenter study, data of consecutive patients who underwent fine-needle aspiration of pancreatic cyst with intracyst glucose assay between 2018 and 2022 were retrospectively reviewed. The area under the receiver operating characteristic curve (AUROC) of glucose and corresponding sensitivity (Se), specificity (Sp), accuracy (Acc), positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared with those of CEA. The best threshold of glucose was identified using the Youden index. Results Of the 121 patients identified, 81 had a definitive diagnosis (46 mucinous, 35 nonmucinous tumors) and were included for analysis. An intracystic glucose level <41.8 mg/dL allowed identification of mucinous tumors with better diagnostic performances (AUROC, 93.6%; 95% confidence interval, 87.2%-100%; Se, 95.3%; Sp, 91.2%; Acc, 93.5%; PPV, 93.2%; NPV, 93.9%) compared with CEA level >192 ng/mL (AUROC, 81.2%; 95% confidence interval, 71.3%-91.1%; Se, 41.7%; Sp, 96.9%; Acc, 67.6%; PPV, 93.8%; NPV, 59.6%) (P = 0.035). Combining values of glucose and CEA did not offer additional benefit in terms of diagnosis. Conclusion Our results confirm previously published data and support the use of pancreatic cyst fluid glucose for the identification of mucinous tumors when the definitive diagnosis remains uncertain.
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Affiliation(s)
- Nicolas Williet
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - David Karsenti
- Digestive Endoscopy Unit, Clinique de Paris-Bercy, Charenton-le-Pont, France
| | - Einas Abou-Ali
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Camus
- Department of Endoscopy, Saint-Antoine Hospital, Paris, France
| | - Arthur Belle
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulriikka Chaput
- Department of Endoscopy, Saint-Antoine Hospital, Paris, France
| | - Jonathan Levy
- Hepatogastroenterology Department, Clinique des Cèdres, Ramsay Santé, Cornebarrieu, France
| | | | - Quentin Tournier
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Étienne, Saint-Priest-En-Jarez, France
| | - Bertrand Le Roy
- Department of Digestive and oncologic surgery, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Aymeric Becq
- Department of Gastroenterology, Henri-Mondor University Hospital, AP-HP, EA7375, Université Paris Est Créteil, Créteil, France
| | - Jean-Marc Phelip
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
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Caillol F, Ratone JP, Marx M, Dahel Y, Hoibian S, Provansal M, Giovannini M. Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia. Endoscopy 2022; 55:E199-E200. [PMID: 36368666 PMCID: PMC9829772 DOI: 10.1055/a-1965-3599] [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: 11/13/2022]
Affiliation(s)
- Fabrice Caillol
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | | | - Mariola Marx
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | | | - Marc Giovannini
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
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Marx M, Caillol F, Autret A, Ratone JP, Zemmour C, Boher JM, Pesenti C, Bories E, Barthet M, Napoléon B, Giovannini M. EUS-guided hepaticogastrostomy in patients with obstructive jaundice after failed or impossible endoscopic retrograde drainage: A multicenter, randomized phase II Study. Endosc Ultrasound 2022; 11:495-502. [PMID: 36537387 PMCID: PMC9921974 DOI: 10.4103/eus-d-21-00108] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Background and Objectives Over the last two decades, EUS-guided hepaticogastrostomy (EUS-HGS) has emerged as a therapeutic alternative for patients with biliary obstruction and failed ERCP. Percutaneous transhepatic biliary drainage (PTBD) as the gold standard is associated with relevant morbidity and need for re-intervention. The aim of our work was to evaluate in a phase II study the safety and efficacy profile of EUS-HGS. A PTBD arm was considered a control group. Patients and Methods We conducted a prospective, randomized, noncomparative phase II study in three French tertiary centers involving patients with benign or malignant obstructive jaundice after failure of ERCP. Patients were randomized to either PTBD or EUS-HGS. Results Fifty-six patients (mean age 64 years) have been included between 2011 and 2015. Twenty-one underwent PTBD and thirty-five were drained using EUS-HGS. An interim analysis after the inclusion of 41 patients revealed an unexpected high 30-day morbidity rate for PTBD (13 out of 21 patients), justifying to stop randomization and inclusion in this control arm in 2013. The primary objective was reached with 10 out of the 35 EUS-HGS patients (28.6%) having observed complications (90%-level bilateral exact binomial confidence interval [CI] [16.4%-43.6%], left-sided exact binomial test to the objectified 50% unacceptable rate P = 0.0083). Both methods achieved comparable technical success rate (TSR) and clinical success rate (CSR) (TSR: PTBD 100% vs. EUS-HGS 94.3%, P = 0.28; CSR: PTBD 66.7% vs. EUS-HGS 80%, P = 0.35). Long-term follow-up showed EUS-HGS patients being at lower risk for re-intervention (relative risk = 0.47, 95% CI [0.27-0.83]). Conclusion In cases of ERCP failure, EUS-HGS is a valuable alternative for biliary drainage with a high TSR and CSR. PTBD is associated with an unacceptable 30-day morbidity rate, whereas EUS-HGS seems to have a decent safety profile, suggesting that it may be the treatment of choice in appropriately selected patients.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France,Address for correspondence Dr. Mariola Marx, Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France. E-mail:
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Aurélie Autret
- Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Jean Marie Boher
- Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Marc Barthet
- Division of Gastroenterology and Hepatology, Hôpital Nord, Marseille, France
| | - Bertrand Napoléon
- Division of Gastroenterology and Hepatology, Hôpital Jean Mermoz, Lyon, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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Marx M, Caillol F, Sfumato P, Romero J, Ratone JP, Pesenti C, Godat S, Hoibian S, Dahel Y, Boher JM, Giovannini M. EUS-guided hepaticogastrostomy in the management of malignant biliary obstruction: Experience and learning curve in a tertiary referral center. Dig Liver Dis 2022; 54:1236-1242. [PMID: 35680522 DOI: 10.1016/j.dld.2022.05.008] [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] [Received: 12/13/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND EUS-guided hepaticogastrostomy (EUS-HGS) is a recognized second-line strategy for biliary drainage when endoscopic retrograde cholangiopancreatography fails or is impossible. Substantial technical and procedural progress in performing EUS-HGS has been achieved. The present study wanted to analyze whether growing experience in current practice has changed patient outcomes over time. METHODS We retrospectively analyzed data from patients with malignant biliary obstruction treated by EUS-HGS between 2002 and 2018 at a tertiary referral center. RESULTS A total of 205 patients were included (104 male; mean age 68 years). Clinical success was achieved in 93% of patients with available 30-days follow-up (153), and the rate of procedure-related morbidity and mortality after one month was 18% and 5%, respectively. The cumulative sum (CUSUM) learning curve suggests a slight improvement in the rate of early complications during the second learning phase (23% vs 32%; P = 0.14; including death for any cause and intensive care). However, a significant threshold of early complications could not be determined. Recurrent biliary stent occlusion is the main cause for endoscopic reintervention (47/130; 37%). CONCLUSION The rate of procedure-related complications after EUS-HGS has improved over time. However, the overall morbidity rate remains high, emphasizing the importance of dedicated expertise, appropriate patient selection and multidisciplinary discussion.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland.
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Dept. Clin Res and Invest, Biostat and Methodolo Unit, Paoli-Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Juan Romero
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | | | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Sébastien Godat
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Solène Hoibian
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Jean Marie Boher
- Dept. Clin Res and Invest, Biostat and Methodolo Unit, Paoli-Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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10
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Marx M, Godat S, Caillol F, Poizat F, Ratone JP, Pesenti C, Schoepfer A, Hoibian S, Dahel Y, Giovannini M. Management of non-functional pancreatic neuroendocrine tumors by endoscopic ultrasound-guided radiofrequency ablation: Retrospective study in two tertiary centers. Dig Endosc 2022; 34:1207-1213. [PMID: 34963025 DOI: 10.1111/den.14224] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/11/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, there has been growing interest in investigating endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for the management of small non-functional pancreatic neuroendocrine tumors (nf pNETs). PATIENTS AND METHODS A bicentric retrospective study was performed that included patients with histologically confirmed nf pNETs who were consecutively treated by EUS-RFA between December 2015 and March 2021 at two tertiary referral centers. RESULTS In 27 patients (mean age 65.0 years, 52% male), EUS-RFA was successfully performed. All patients had sporadic G1 lesions (mean size 14.0 ± 4.6 mm, 7% uncinated process, 22% head, 11% body, 19% body/tail junction, and 41% tail). Overall, 9/27 lesions (33%) were cystic. The mean hospital stay was 3.2 days. Complete treatment response was confirmed in 25/27 patients (93%) on cross-sectional imaging (mean follow-up 15.7 ± 12.2 months, range 2-41 months). Two patients had two EUS-RFA sessions until complete necrosis was observed. Periprocedural acute pancreatitis occurred in 4/27 (14.8%), three of them were treated by endoscopic cystogastrostomy (11.1%). One patient underwent secondary surgery. The histopathology of the resected specimen revealed 3 mm of residual tumor tissue. CONCLUSION EUS-RFA seems to be a promising treatment strategy for the management of small nf pNETs with excellent efficacy. Further evidence focusing on long-term survival, safety profile and recurrence is needed.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sébastien Godat
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fabrice Caillol
- Division of, Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Flora Poizat
- Division of, Pathology, Paoli-Calmettes Institute, Marseille, France
| | | | - Christian Pesenti
- Division of, Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Solène Hoibian
- Division of, Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Division of, Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Division of, Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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11
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Ratone JP, Caillol F, Marx M, Hoibian S, Dahel Y, Giovannini M, Devière J. A novel case of biliary common bile duct reconstruction by the rendezvous technique using endoscopic cholangioscopy and percutaneous cholangioscopy. Endoscopy 2022; 54:E950-E951. [PMID: 35863339 PMCID: PMC9736840 DOI: 10.1055/a-1883-9446] [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)
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Mariola Marx
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Jacques Devière
- Department of Gastroenterology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
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12
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Marx M, Trosic-Ivanisevic T, Caillol F, Demartines N, Schoepfer A, Pesenti C, Ratone JP, Robert M, Giovannini M, Godat S. EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers. Gastrointest Endosc 2022; 95:1256-1263. [PMID: 34902374 DOI: 10.1016/j.gie.2021.11.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 05/20/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, and preserving surgery is the treatment of choice. EUS-guided radiofrequency ablation (EUS-RFA) is a novel and promising technique that induces tissue necrosis of localized lesions. This article presents a preliminary clinical experience in treating pancreatic insulinomas <2 cm by EUS-RFA, focusing on safety and efficacy. METHODS The clinical course of patients with pancreatic insulinoma treated by EUS-RFA at 2 tertiary referral centers was analyzed. RESULTS Between November 2017 and December 2020, 7 patients were included (6 women; mean age, 66 years). EUS-RFA was feasible in all patients with immediate hypoglycemia relief after only 1 single treatment session; 6 of 7 achieved complete response by cross-sectional imaging and remained asymptomatic (median follow-up, 21 months; range, 3-38). Three patients had minor adverse events. One elderly patient developed a large retrogastric collection 15 days after treatment and died 1 month after EUS-RFA. CONCLUSIONS Management of pancreatic neuroendocrine tumors <2 cm by EUS-RFA seems to be effective with an acceptable safety profile. However, further evidence focusing on long-term survival and recurrence is needed.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology, Paoli Calmettes Institute, Marseille, France
| | | | - Fabrice Caillol
- Division of Gastroenterology, Paoli Calmettes Institute, Marseille, France
| | | | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Christian Pesenti
- Division of Gastroenterology, Paoli Calmettes Institute, Marseille, France
| | | | - Maxime Robert
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Marc Giovannini
- Division of Gastroenterology, Paoli Calmettes Institute, Marseille, France
| | - Sébastien Godat
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
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13
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Caillol F, Meunier E, Zemmour C, Ratone JP, Guiramand J, Pesenti C, Hoibian S, Dahel Y, Marx M, Poizat F, Giovannini M. Correction: Efficiency of an endoscopic resection strategy in the management of submucosal tumors less than 20 mm in size and located in the upper gastrointestina. Endosc Int Open 2022; 10:C4. [PMID: 35492381 PMCID: PMC9050466 DOI: 10.1055/a-1828-5001] [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: 11/04/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1783-8675.].
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Affiliation(s)
- Fabrice Caillol
- Endoscopic Unit, Paoli Calmettes Institute, Marseille, France,Corresponding author Fabrice Caillol Paoli Calmettes Institute, Endoscopic Unit232 bd Ste Marguerite13009 MarseilleFrance
| | - Elise Meunier
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | | | | | | | | | - Solene Hoibian
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Mariola Marx
- 56181Endoscopy, Paoli-Calmettes Institute, Marseille, France
| | - Florat Poizat
- Pathology unit, Paoli Calmette Institute, Marseille, France
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14
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Caillol F, Meunier E, Zemmour C, Ratone JP, Guiramand J, Hoibian S, Dahel Y, Poizat F, Giovannini M. Efficiency of an endoscopic resection strategy for management of submucosal tumors < 20 mm in the upper gastrointestinal tract. Endosc Int Open 2022; 10:E347-E353. [PMID: 35433227 PMCID: PMC9010088 DOI: 10.1055/a-1783-8675] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background and study aims The histologic diagnosis of submucosal tumors (SMTs) < 20 mm is challenging. Monitoring is the main option offered, but compliance is debatable. Endoscopic resection (ER) of malignant SMTs or those with an uncertain diagnosis is an alternative that has already been reported about and proposed in our center. The aims of this study were to confirm the safety of this resection strategy and to perform long-term follow-up of malignant SMTs after resection. Patients and methods All patients who underwent ER for SMTs < 2 cm in a single center between 2007 and 2019 were included retrospectively. Patients were classified into two groups according to the need for postresection follow-up: benign SMTs (B-SMTs) and follow-up SMTs (FU-SMTs). Results One hundred and one patients were included. The mean tumor size was 16.7 mm. In total, 92 of 101 SMTs had an uncertain diagnosis. Macroscopic resection was completed for 95 SMTs (93.1 %), with en bloc resection in 94 (92.1%). The morbidity rate was 3 %, with no mortality. A total of 84 of 101 SMTs (84 %) were B-SMTs and did not need monitoring, and 17 SMTs (19.7 %) were FU-SMTs (8 gastrointestinal stromal tumors, 6 neuroendocrine tumors, and 3 others). No relapse was reported in the FU-SMT group, with a median follow-up duration of 33 months [4-127] (61 months [17-127] for the gastrointestinal stroma tumor group). Conclusions The study results suggest ER is a potentially reliable and effective strategy for upper gastrointestinal tract SMTs < 20 mm. Although the strategy needs further validation in advanced care units, it could eliminate the need for long-term monitoring, therefore targeting such follow-up efforts to patients with FU-SMTs.
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Affiliation(s)
- Fabrice Caillol
- Endoscopy Department, Paoli Calmettes Institute, Marseille, France
| | - Elise Meunier
- Endoscopy Department, Paoli Calmettes Institute, Marseille, France
| | | | | | - Jerome Guiramand
- Surgery Department, Paoli Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Department, Paoli Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Department, Paoli Calmettes Institute, Marseille, France
| | - Flora Poizat
- Pathology Department, Paoli Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Endoscopy Department, Paoli Calmettes Institute, Marseille, France
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15
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Meillat H, Niziers V, Zemmour C, Ewald J, Ratone JP, Dermeche S, Guiramand J. Correction to: Transhiatal esophagectomy as a treatment for locally advanced adenocarcinoma of the gastroesophageal junction: postoperative and oncologic results of a single-center cohort : THE for locally advanced GEJC. World J Surg Oncol 2022; 20:107. [PMID: 35365174 PMCID: PMC8976337 DOI: 10.1186/s12957-022-02577-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hélène Meillat
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
| | - Vincent Niziers
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Christophe Zemmour
- Department of Clinical Research & Investigation, Biostatistics & Methodology Unit, Paoli Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Jacques Ewald
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | | | - Slimane Dermeche
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Jérôme Guiramand
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
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16
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Leblanc J, Hoibian S, Boucraut A, Ratone JP, Stoffaes L, Dano D, Louvel-Perrot D, Chanez B, Chretien AS, Madroszyk A, Rochigneux P. Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report. Front Immunol 2022; 12:799666. [PMID: 34975913 PMCID: PMC8718638 DOI: 10.3389/fimmu.2021.799666] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/30/2021] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) reinvigorate the immune system to recognize and destroy tumor cells. Because of this biological mechanism, patients might develop autoimmune toxicities, notably in the digestive tract (most frequently, hepatitis or colitis). A 70-year-old man with relapsed mesothelioma was treated with nivolumab in 3rd line. He was hospitalized for watery and foul-smelling diarrhea. He underwent gastrointestinal endoscopy, showing duodenitis and villous atrophy and measurement of serum IgA antibodies to tissue transglutaminase (tTG-IgA+), leading to the diagnosis of ICI-induced celiac disease. He was treated with steroids, proton pump inhibitors, and a gluten-free diet. If ICI-induced celiac disease is rare in the literature, increasing reports suggest that celiac disease might represent an underestimated ICI toxicity. This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy.
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Affiliation(s)
- Julie Leblanc
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Solene Hoibian
- Gastroenterology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Agathe Boucraut
- Pathology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Jean-Philippe Ratone
- Gastroenterology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Louis Stoffaes
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Domitille Dano
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Delphine Louvel-Perrot
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Brice Chanez
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Anne-Sophie Chretien
- Team Immunity and Cancer, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, CNRS, UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Anne Madroszyk
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Philippe Rochigneux
- Medical Oncology Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France.,Team Immunity and Cancer, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, CNRS, UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
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17
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Rudler F, Caillol F, Ratone JP, Pesenti C, Valats JC, Soloveyv A, Giovannini M. EUS-guided drainage of the pancreatic duct for the treatment of postoperative stenosis of pancreatico-digestive anastomosis or pancreatic duct stenosis complicating chronic pancreatitis: Experience at a tertiary care center. Endosc Ultrasound 2022:336600. [PMID: 35083983 PMCID: PMC9526096 DOI: 10.4103/eus-d-21-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and Objectives For the treatment of pancreatic duct stenosis due to chronic pancreatitis (CP) or postoperative (PO) stenosis, endoscopic procedures are usually the first choice. In cases of failure of the recommended treatment by ERCP, anastomosis between the Wirsung duct and the stomach or duodenum can be performed under EUS guidance. The objective of this retrospective study was to compare the outcomes of pancreatico-gastric or pancreaticoduodenal anastomosis under EUS for PO stenosis versus CP stenosis. Subjects and Methods This was a retrospective, single-center, consecutive case study of patients who underwent EUS-guided Wirsungo-gastric/bulbar anastomosis. Results Forty-three patients were included. Twenty-one patients underwent treatment for PO stenosis, and 22 patients underwent treatment for CP stenosis. The technical success rate was 95.3% (41/43), with 100% in cases of PO stenosis and 90.9% in cases of CP stenosis. The clinical success rate was 72.5% (29/40): 75% (15/20) in cases of PO stenosis and 70% (14/20) in cases of CP stenosis. The overall morbidity rate was 34.9% (15/43). The main complication was postprocedural pain, occurring in 20.9% (9/443) of patients. The rate of stent migration or obstruction was 27.9% (12/43). There was no difference in patient outcomes or morbidity according to the etiology of the stenosis. The median follow-up duration in this study was 14 months. Conclusions EUS-guided Wirsungo-gastric/duodenal anastomosis is a feasible, minimally invasive, safe, and relatively effective procedure. The rates of technical success, clinical success, and complications were not different between patients with PO and CP stenosis. However, the follow-up period was too short to assess recurrent symptoms in these patients.
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18
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Chanez B, Caillol F, Ratone JP, Pesenti C, Rochigneux P, Pignot G, Thomassin J, Brunelle S, Walz J, Salem N, Giovannini M, Gravis G. Endoscopic Ultrasound-Guided Radiofrequency Ablation as an Future Alternative to Pancreatectomy for Pancreatic Metastases from Renal Cell Carcinoma: A Prospective Study. Cancers (Basel) 2021; 13:cancers13215267. [PMID: 34771431 PMCID: PMC8582413 DOI: 10.3390/cancers13215267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Glandular metastases and more precisely pancreatic metastases (PM) from renal cell carcinoma (mRCC) are associated with a long survival. Focal treatment in order to control oligo-metastatic disease and avoid systemic therapy is a standard in RCC. However, pancreatic radiofrequency ablation remains a marginal and under evaluated technic. Standard treatment remains pancreatectomy with hazardous outcomes. We report here the largest series of endoscopic radiofrequency ablation (EUS-RFA) on PM for patient treated at Institut Paoli-Calmettes for a mRCC. Patients with progressive PM was treated under general anesthesia with an ultrasound guided endoscopic radiofrequency ablation procedure then followed by CT-scan. We prospectively included 12 patients, median age was 70.5 years old and median size and number of PM at inclusion was 17 mm and 1 respectively. All 26 procedures performed went as planned and no immediate complications were experienced. After 27.7 months of follow-up, the 6- and 12-month focal control rates were 84% and 73% respectively. Two severe complications occurred after EUS-RFA but were totally resolved after specific treatment. In total, EUS-RFA is feasible and displayed an excellent focal control and should be integrated in the arsenal to treat PM from mRCC in order to spare systemic therapy and/or pancreatic surgery. Abstract Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare, are associated with favorable outcomes and are usually handled by surgery or VEGFR inhibitors, which both have side effects. Endoscopic Ultrasound (EUS)-guided radiofrequency ablation (RFA) is an innovative approach to treat focally deep metastases and could be a relevant technique to control PM from RCC. Methods: This monocentric, prospective study aimed to evaluate the safety and efficacy of EUS-RFA to treat PM. We included patients with confirmed and progressive PM from RCC. PM was ablated under general anesthesia with a linear EUS scope and a EUS-RFA 19-gauge needle electrode placed into the tumor. Results: Twelve patients from Paoli-Calmettes Institute were recruited between May 2017 and December 2019. Median age was 70.5 years (range 61–75), 50% were female, 100% were ECOG 0–1. At inclusion, mean PM size was 17 mm (range 3–35 mm); and all were progressive before EUS-RFA. Seven patients had EUS-RFA as the only treatment for RCC. We performed 26 EUS-RFA procedures and 21 PM was ablated. Median follow up was 27.7 months (range 6.4–57.1). For evaluable PM, the 6- and 12-month focal control rates were 84% and 73% respectively. One patient treated with TKI developed a paraduodenal abscess 2 months after EUS-RFA and another patient with biliary stent developed hepatic abscesses few days after EUS-RFA. No other severe side effects were experienced. Conclusions: in this series, which is the largest ever reported, we showed that EUS-RFA is feasible and yields an excellent local control rate for PM from mRCC. With manageable complications, it could be a valuable alternative to pancreatic surgery in well-selected patients.
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Affiliation(s)
- Brice Chanez
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Aix Marseille Université, 13010 Marseille, France
| | - Fabrice Caillol
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Jean-Philippe Ratone
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Christian Pesenti
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Philippe Rochigneux
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Aix Marseille Université, 13010 Marseille, France
| | - Géraldine Pignot
- Department of Urologic Surgery, Institut Paoli-Calmettes, 13009 Marseille, France; (G.P.); (J.W.)
| | - Jeanne Thomassin
- Department of Pathology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Jochen Walz
- Department of Urologic Surgery, Institut Paoli-Calmettes, 13009 Marseille, France; (G.P.); (J.W.)
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, 13009 Marseille, France;
| | - Marc Giovannini
- Department of Gastroenterology and Endoscopy, Institut Paoli-Calmettes, 13009 Marseille, France; (F.C.); (J.-P.R.); (C.P.); (M.G.)
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (B.C.); (P.R.)
- Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR7258, Institut Paoli-Calmettes, 13009 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-37-36
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19
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Rony M, Ratone JP, Walz J, Pignot G, Caillol F, Pesenti C, Guerin M, Dermeche S, Brunelle S, Salem N, Vicier C, Rybikowski S, Maubon T, Fakhfakh S, Tejeda M, Giovannini M, Gravis G. Corrigendum: Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review. Front Oncol 2021; 11:710477. [PMID: 34195098 PMCID: PMC8237751 DOI: 10.3389/fonc.2021.710477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maelle Rony
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Jean-Philippe Ratone
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Jochen Walz
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Geraldine Pignot
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Fabrice Caillol
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Christian Pesenti
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Mathilde Guerin
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | - Slimane Dermeche
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | - Serge Brunelle
- Paoli-Calmettes Institute, Department of Radiology, Marseille, France
| | - Naji Salem
- Paoli-Calmettes Institute, Department of Radiotherapy, Marseille, France
| | - Cecile Vicier
- Paoli-Calmettes Institute, Department of Medical Oncology, Marseille, France
| | | | - Thomas Maubon
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Sami Fakhfakh
- Paoli-Calmettes Institute, Department of Urology, Marseille, France
| | - Manuel Tejeda
- Paoli-Calmettes Institute, Department of Informatics, Marseille, France
| | - Marc Giovannini
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Gwenaelle Gravis
- Paoli-Calmettes Institute, Department of Medical Oncology, Aix-Marseille University, Inserm, CNRS, CRCM, Marseille, France
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20
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Hoibian S, Ratone JP, Gonzalez JM, Bories E, Pesenti C, Caillol F, Grimaud JC, Giovannini M, Barthet M. Endoscopic mucosal resection of sporadic duodenal nonampullary adenoma: outcomes of 130 patients with a long-term follow up in two tertiary French centers. Ann Gastroenterol 2021; 34:169-176. [PMID: 33654355 PMCID: PMC7903584 DOI: 10.20524/aog.2021.0581] [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: 06/24/2020] [Accepted: 09/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background The long-term outcomes and safety of endoscopic mucosal resection (EMR) of sporadic duodenal adenoma (SDA), and the management of adverse events need to be confirmed. Methods A bicentric retrospective study was performed including all patients who underwent EMR for SDAs from 2003-2016. The primary aim was to evaluate the efficiency of EMR for SDA. The secondary objectives were to assess safety, recurrence management, predictive factors for treatment success, and adverse events. Results One hundred thirty patients (134 procedures) were included (median age 65 years, 49.3% male). The mean SDA size was 20.7 (range 5-50) mm. Of the SDAs, 58.2% were category 3 of the Vienna classification, 35.8% were category 4, and 5.9% were category 5. The median follow up was 25.0 (range 2-120) months. Complete mucosal resection was achieved for 129/134 lesions (96.2%), with en bloc resection in 59/134 (44%). Recurrence occurred in 28.6% of cases (30/105 procedures). Recurrence was successfully treated by new endoscopic procedures in 72.2% (13/18) and by surgery in 27.8% (5/18). Delayed bleeding occurred in 13.4% of cases (18/134) and was successfully managed endoscopically. The perforation rate was 3.7% (5/134); perforations were managed without surgery in 60% (3/5 patients) of cases. Conclusions Endoscopic treatment of SDA appears to be effective and relatively safe in tertiary centers. All bleeding complications were endoscopically controlled, and perforation was rare. Recurrence was frequent but could be managed endoscopically. EMR is confirmed as a first-line treatment in cases of SDA, and surgery is useful only if repeated EMRs fail.
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Affiliation(s)
- Solène Hoibian
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet).,Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Philippe Ratone
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Michel Gonzalez
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
| | - Erwan Bories
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Christian Pesenti
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Charles Grimaud
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Marc Barthet
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
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21
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Winkler J, Caillol F, Ratone JP, Bories E, Pesenti C, Giovannini M. Feasibility of EUS-guided hepaticogastrostomy for inoperable malignant hilar biliary strictures. Endosc Ultrasound 2021; 10:51-56. [PMID: 33402550 PMCID: PMC7980690 DOI: 10.4103/eus.eus_68_20] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) has emerged as a complementary technique for primary drainage or as a rescue technique after failed endoscopic retrograde cholangiography. The objective of this study was to demonstrate the feasibility of EUS-BD for malignant hilar stenosis (MHS), both as an initial and rescue procedure. Patients and Methods This study was a retrospective work based on a prospective registry of patients with malignant drainage stenosis of the hilum. For this analysis, only patients who underwent EUS-BD drainage were included. The drainage procedure could be performed by EUS-BD alone or in combination with another technique, for initial drainage or reintervention. Results Between January 2015 and September 2018, 20 patients were included. The mean patient age was 68 years. Seven patients had primary liver tumors and 13 had obstructions caused by metastasis. Four patients had Type II stenosis, 7 had Type IIIA, 2 had Type IIIb, and 7 had Type IV stenosis. Sixteen patients underwent EUS-guided hepaticogastrostomy (EUS-HGS) for initial drainage and four as reintervention. For initial drainage, 2 patients underwent EUS-HGS alone and 14 underwent EUS-HGS in combination with another technique: 11 combined with endoscopic retrograde cholangiopancreatography (ERCP), 2 with percutaneous transhepatic drainage, and 1 with ERCP and percutaneous transhepatic drainage. The technical success rate for EUS-HGS in the drainage of MHS was 100%, and the clinical success rate was 95%. The mean percentage of liver drained was 84%, with an average 1.7 endoscopic sessions and an average 2.7 protheses. The early complication rate was 35% and the mortality rate was 5%. Five EUS-HGS/ERCP combination drainage procedures were performed in one session and six were performed in two sessions with similar complication rates and percentages of liver segments drained. Conclusion EUS-BD is a feasible and safe technique for initial drainage and for reintervention procedures. The EUS-HGS/ERCP combination seemed to be useful in cases of complex stenosis and could be performed during the same session or in two sessions.
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Affiliation(s)
- Jérôme Winkler
- Department of Endoscopy, Institut Paoli-Calmette, Marseille, France
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli-Calmette, Marseille, France
| | | | - Erwan Bories
- Department of Endoscopy, Institut Paoli-Calmette, Marseille, France
| | | | - Marc Giovannini
- Department of Endoscopy, Institut Paoli-Calmette, Marseille, France
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22
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Hoibian S, Giovannini M, Autret A, Pesenti C, Bories E, Ratone JP, Dahel Y, Dermeche S, Meillat H, Guiramand J, Caillol F. Preoperative EUS evaluation of the response to neoadjuvant therapy for gastric and esophagogastric junction cancer is correlated with survival: A single retrospective study of 97 patients. Endosc Ultrasound 2021; 10:103-110. [PMID: 33666179 PMCID: PMC8098840 DOI: 10.4103/eus-d-20-00073] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: The European Society for Medical Oncology suggests performing EUS staging for esophagogastric junction and gastric cancers to further assess the T and N stages. The use of EUS after neoadjuvant therapy (NT) is still under debate. We aimed to evaluate the contribution of EUS after NT to staging, therapeutic choices, and prognosis prediction. Subjects and Methods: In 97 patients with esophagogastric junction and gastric cancers who received NT (chemotherapy or radiochemotherapy) followed by carcinologic surgery, EUS was performed before (uT, uN) and after (yuT, yuN) NT. We compared the results of EUS staging after NT (yuT and yuN) and final histology (ypT and ypN). We analyzed the correlation between overall survival (OS), disease-free survival (DFS), and the objective and subjective responses to NT evaluated by EUS (comparison of uT and yuT and uN and yuN with OS and DFS). Results: EUS staging detected metastasis that went undetected by computed tomography in 16% of metastatic patients. The accuracy between EUS after NT and postoperative pathological findings was 44.4% (34.2%; 54.7%) for T stage and 49.3% (37.5%; 61.1%) for N stage. On multivariate analysis, OS had significantly correlated with the objective response to NT. In the case of a response to NT, the median OS was 64.77 months, and in the case of stable disease, the median OS was 22.9 months (P = 0.01). Conclusion: EUS after NT can be used for staging. Despite its moderate accuracy, the evaluation of the response to NT by EUS seems to be correlated with patient prognosis.
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Affiliation(s)
- Solène Hoibian
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Aurélie Autret
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Christian Pesenti
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Erwan Bories
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | | | - Yanis Dahel
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Slimane Dermeche
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Hélène Meillat
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Jérôme Guiramand
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
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Debourdeau A, Caillol F, Zemmour C, Winkler JP, Decoster C, Pesenti C, Ratone JP, Boher JM, Giovannini M. Endoscopic management of concomitant biliary and duodenal malignant obstruction: Impact of the timing of drainage for one vs. two procedures and the modalities of biliary drainage. Endosc Ultrasound 2021; 10:124-133. [PMID: 33818527 PMCID: PMC8098836 DOI: 10.4103/eus-d-20-00159] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives Concomitant biliary and duodenal malignant obstruction are a severe condition mainly managed by duodenal and biliary stenting, which can be performed simultaneously (SAMETIME) or in two distinct procedures (TWO-TIMES). We conducted a single-center retrospective study to evaluate the feasibility of a SAMETIME procedure and the impact of endoscopic ultrasound (EUS)-hepaticogastrostomy in double malignant obstructions. Patients and Methods From January 1, 2011, to January 1, 2018, patients with concomitant malignant bilioduodenal obstruction treated endoscopically were included. The primary endpoint was hospitalization duration. The secondary endpoints were bilioduodenal reintervention rates, adverse event rates, and overall survival. Patients were divided into groups for statistical analysis: (i) divided according to the timing of biliary drainage: SAMETIME vs. TWO-TIMES group, (ii) divided based on the biliary drainage method: EUS-HG group underwent hepaticogastrostomy, while DUODENAL ACCESS group underwent endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic drainage (PCTD) or EUS-guided choledocoduodenostomy (EUS-CD). Results Thirty-one patients were included (19 women, median age = 71 years). Stenosis was mainly related to pancreatic cancer (17 patients, 54.8%). Sixteen patients were in the SAMETIME group, and 15 were in the TWO-TIMES group. Biliary drainage was performed by EUS-HG in 11 (35.%) patients, PCTD in 11 (35.%), ERCP in 8 (25.8%) and choledoduodenostomy in 1. Thirty patients died during follow-up. The median survival was 77 days (9% confidence interval [37-140]). The mean hospitalization duration was lower in the SAMETIME group: 7.5 vs. 12.6 days, P = 0.04. SAMETIME group patients tended to have a lower complication than TWO-TIMES (26.7% vs. 56.3%, P = 0.10). The EUS-HG group tended to have a lower complication rate (5% vs. 18.2%, P = 0.07) and less biliary endoscopic revision (30% vs. 9.1%, P = 0.37) than DUODENAL ACCESS. Conclusions SAMETIME drainage is associated with a lower hospital stay without increased morbidity. EUS-HG could provide better access because it did not exhibit a higher complication rate and showed a tendency toward better patency and fewer complications.
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Affiliation(s)
- Antoine Debourdeau
- Endoscopy Unit, Paoli Calmette Institute, Marseille; Gastroenterology and Hepatology Unit, CHU, Montpellier University, Montpellier, France
| | | | | | - Jérome Polypo Winkler
- Endoscopy Unit, Paoli Calmette Institute; Gastroenterology and Hepatology Unit, Assistance Publique Hopitaux Marseille AP-HM, Aix Marseille University, Marseille, France
| | - Claire Decoster
- Endoscopy Unit, Paoli Calmette Institute; Gastroenterology and Hepatology Unit, Assistance Publique Hopitaux Marseille AP-HM, Aix Marseille University, Marseille, France
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24
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Ratone JP, Caillol F, Zemmour C, Bories E, Pesenti C, Godat S, Hoibian S, De Chaisemartin C, Meillat H, Lelong B, Poizat F, Giovannini M. Is Piecemeal Endoscopic Resection Acceptable for Early Colorectal Cancers in Certain Situations? A Single-Center French Study. J Gastrointestin Liver Dis 2020; 29:353-360. [PMID: 32919419 DOI: 10.15403/jgld-1568] [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] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/18/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The use of endoscopic treatment for early colorectal cancer (ECC) is increasing. The European guidelines suggest performing piecemeal endoscopic resection (pmR) for benign lesions and en bloc resection for ECC, especially for patients with favorable lymph node involvement risk evaluations. However, en bloc resections for lesions larger than two centimeters require invasive endoscopic techniques. Our retrospective single-center study aimed to determine the clinical impact of performing pmR for ECC rather than traditional en bloc resection. METHODS A single-center study was performed between January 2012 and September 2017. All ECC patients were included. The main objective was to evaluate the number of patients who potentially underwent unnecessary surgery due to piecemeal resection. The secondary endpoints were as follows: disease-free survival (DFS), defined as the time from pmR to endoscopic failure (local recurrence not treatable by endoscopy), complication rate, number of patients who did not undergo surgery by default, and factors predictive of outcomes and complications. RESULTS One hundred and forty-six ECC endoscopically treated patients were included. In total, 85 patients were excluded (71 who underwent en bloc resection, 14 with pending follow-up). Data from 61 patients (33 women and 28 men) were analyzed. Two patients underwent potentially unnecessary surgery [3.28% (0.9%- 11.2%)]. The DFS rate was 87% (75%-93%) at 6 months and 85% [72%-92%] at 12 months. The median follow- up time was 16.5 months (12.4-20.9). Three patients (4.9%) had complications. One patient did not undergo surgery by default. A Paris classification of 0-2c (HR=9.3 (2.4-35.9), p<0.001) and Vienna classification of 5 [HR=16.3 (3.3-80.4), p<0.001] were factors associated with poor DFS. CONCLUSION Performing pmR in place of en bloc resection for ECC had a limited impact on patients. If the pathology (especially deep margins) is analyzable, careful monitoring could be acceptable in ECC patients who undergo pmR.
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Affiliation(s)
| | - Fabrice Caillol
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Christophe Zemmour
- Paoli-Calmettes Institute, Dept. Clin Res and Invest, Biostat and Methodolo Unit, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.
| | - Erwan Bories
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | | | - Sébastien Godat
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Solene Hoibian
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | | | - Hélène Meillat
- Paoli-Calmettes Institute, Surgery Unit, Marseille, France.
| | - Bernard Lelong
- Paoli-Calmettes Institute, Surgery Unit, Marseille, France.
| | - Flora Poizat
- Paoli-Calmette Institute, Pathology Unit, Marseille, France.
| | - Marc Giovannini
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
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25
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Forté E, Petit B, Walter T, Lépilliez V, Vanbiervliet G, Rostain F, Barsic N, Albeniz E, Gete GG, Gabriel JCM, Cuadrado-Tiemblo C, Ratone JP, Jacques J, Wallenhorst T, Subtil F, Albouys J, Giovannini M, Chaussade S, Landel V, Ponchon T, Saurin JC, Barret M, Pioche M. Risk of neoplastic change in large gastric hyperplastic polyps and recurrence after endoscopic resection. Endoscopy 2020; 52:444-453. [PMID: 32120411 DOI: 10.1055/a-1117-3166] [Citation(s) in RCA: 14] [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: 12/16/2022]
Abstract
BACKGROUND Gastric hyperplastic polyps (GHPs) have a risk of neoplastic transformation reaching 5 %. Current endoscopic resection techniques appear suboptimal with a high risk of local recurrence. This study assessed the outcomes of endoscopic resection for GHPs and identified risk factors for recurrence and neoplastic transformation. METHODS This retrospective, multicenter, European study included adult patients with at least one GHP ≥ 10 mm who underwent endoscopic resection and at least one follow-up endoscopy. Patients with recurrent GHPs or hereditary gastric polyposis were excluded. All data were retrieved from the endoscopy, pathology, and hospitalization reports. RESULTS From June 2007 to August 2018, 145 GHPs in 108 patients were included. Recurrence after endoscopic resection was 51.0 % (74 /145) in 55 patients. R0 resection or en bloc resection did not impact the risk of polyp recurrence. In multivariate analysis, cirrhosis was the only risk factor for recurrence (odds ratio [OR] 4.82, 95 % confidence interval [CI] 1.33 - 17.46; P = 0.02). Overall, 15 GHPs (10.4 %) showed neoplastic transformation, with size > 25 mm (OR 10.24, 95 %CI 2.71 - 38.69; P < 0.001) and presence of intestinal metaplasia (OR 5.93, 95 %CI 1.56 - 22.47; P = 0.01) being associated with an increased risk of neoplastic transformation in multivariate analysis. CONCLUSIONS Results confirmed the risk of recurrence and neoplastic transformation of large GHPs. The risk of neoplastic change was significantly increased for lesions > 25 mm, with a risk of high grade dysplasia appearing in polyps ≥ 50 mm. The risk of recurrence was high, particularly in cirrhosis patients, and long-term follow-up is recommended in such patients.
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Affiliation(s)
- Emmanuel Forté
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Bérénice Petit
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Thomas Walter
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Lépilliez
- Hôpital Privé Jean Mermoz, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Geoffroy Vanbiervliet
- Hôpital Archet, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Nice, France
| | - Florian Rostain
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
| | - Neven Barsic
- Department of Gastroenterology and Hepatology, Sisters of Charity University Hospital, Zagreb, Croatia
| | - Eduardo Albeniz
- Complejo Hospitalario de Navarra, Endoscopy Unit and Gastroenterology Department, Pamplona, Spain.,Navarrabiomed Biomedical Research Center, University of Navarra, IdiSNA, Pamplona, Spain
| | - Gonzalo Gonzalez Gete
- Complejo Hospitalario de Navarra, Endoscopy Unit and Gastroenterology Department, Pamplona, Spain.,Navarrabiomed Biomedical Research Center, University of Navarra, IdiSNA, Pamplona, Spain
| | - Jose Carlos Marín Gabriel
- "12 de Octubre" University Hospital, Digestive Disease and Endoscopy Unit, "i+12" Research Institute, Madrid, Spain
| | - Cristina Cuadrado-Tiemblo
- "12 de Octubre" University Hospital, Digestive Disease and Endoscopy Unit, "i+12" Research Institute, Madrid, Spain
| | - Jean-Philippe Ratone
- Institut Paoli-Calmettes, Service d'Oncologie et d'Endoscopie Digestives, Marseille, France
| | - Jérémie Jacques
- Centre Hospitalier Universitaire Dupuytren, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Limoges, France
| | - Timothée Wallenhorst
- Hôpital Pontchaillou, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Rennes, France
| | - Fabien Subtil
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jérémie Albouys
- Centre Hospitalier Universitaire Dupuytren, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Limoges, France
| | - Marc Giovannini
- Institut Paoli-Calmettes, Service d'Oncologie et d'Endoscopie Digestives, Marseille, France
| | - Stanislas Chaussade
- Hôpital Cochin AP-HP, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Paris, France
| | - Véréna Landel
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Thierry Ponchon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Saurin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Maximilien Barret
- Hôpital Cochin AP-HP, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Paris, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Lyon, France
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Chanez B, Caillol F, Ratone JP, Bories E, Pesenti C, Pignot G, Brunelle S, Walz J, Thomassin J, Salem N, Giovannini M, Gravis G. Endoscopic Ultra Sound-guided RadioFrequency Ablation (EUSRFA) as focal treatment for pancreatic metastases from renal cell carcinoma: A monocentric experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
695 Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare but associated with long survival. The usual management of PM is surgery or tyrosine kinase inhibitor (TKI) with sides effects. Endoscopic radiofrequency ablation (EUSRFA) is an innovative approach to focally treat deep metastasis and could be a relevant technic to control PM from RCC. Methods: This analysis addressed the local control and toxicity in patients treated by EUSRFA for progressive PM from RCC. EUSRFA was done with a linear EUS scope and a 19 G needle delivering short ablation time. Response was assessed by CT-scan using both size and contrast enhancement of the PM treated every 2 to 3 months. Results: 8 pts from Paoli-Calmettes Institute (France) were treated between May 2017 and August 2019. Age was 70.5y [61-75], 5/8 female, ECOG 0-1 (100%). The median time from diagnosis to PM was 14.5 years [9.35-22.18], median number of PM was 2 [1-3], 6/8 was documented by histology and all were classified as progressive before EUSRFA. PM localizations was: head in 40%, body 40% and average size was 14 mm [4 - 35]. 75% of pts (6/8) had other mRCC spread, 5/8 had received systemic treatment and 2 were on therapy at EUSRFA time. 3 pts had EUSRFA as the only treatment for RCCm. We performed 18 EUSRFA procedures over 16 PM. Patient received in median 2 EUSRFA sessions [1-3]. Follow up of 22.4 months [2.3-42.6], 50% of treated PM was evaluated as complete response, 17.5% as partial response and 20% as stable disease at the last CT-scan evaluation. 2 pts were considered as progressive disease and PM focal control was 87.5%. One patient treated with TKI during EURFA developed a paraduodenal abscess 2 months after EUSRFA. Another patient with biliary prothesis developed hepatic abscesses few days after EUSRFA. No other acute side effects were experienced. Interestingly, all PM treated with diameter of < 20mm was locally control versus only 75% of PM> 20mm. Conclusions: Though larger studies have to corroborate our data, EUSRFA is feasible and displays a good local control for PM. It could be a valuable option, less morbid than pancreas resection, for well selected patients with progressive PM.
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Affiliation(s)
- Brice Chanez
- APHM, Service de Neuro-Oncologie, CHU Timone, Marseille, France
| | | | | | | | | | - Geraldine Pignot
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Jochen Walz
- Institut Paoli-Calmettes, Chirurgie Oncologique 2, Marseille, France
| | | | - Naji Salem
- Institut Paoli Calmettes, Marseille, France
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Ratone JP, Caillol F, Zemmour C, Bories E, Pesenti C, Lestelle V, Godat S, Hoibian S, Proux A, Capodano G, Giovannini M. Outcomes of duodenal stenting: Experience in a French tertiary center with 220 cases. Dig Liver Dis 2020; 52:51-56. [PMID: 31401023 DOI: 10.1016/j.dld.2019.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/19/2019] [Accepted: 06/30/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic stenting for malignant gastroduodenal outlet obstruction (MGOO) is described as ineffective and not long-lasting despite a few favorable studies. This study aimed to evaluate the clinical outcomes of a large series of patients in a tertiary center. METHODS A single-center retrospective study was performed using data collected from all patients who received palliative duodenal self-expandable metal stents between January 2011 and December 2016. The primary endpoints were patient diet after the first duodenal procedure (Gastric Outlet Obstruction Scoring System, GOOSS) and clinical success. The secondary endpoints were the median patency duration (calculated according to the Kaplan-Meier method) and the cumulative incidence of reintervention. RESULTS Two-hundred twenty patients were included. The increase in the GOOSS score was significant (p < 0.001), and the clinical success rate was 86.3%. The median estimated patency duration was 9.0 months [6.5-29.1]. Patients with pancreatic adenocarcinoma had significantly longer patency durations (p = 0.02). The estimated cumulative probability of a second duodenal procedure after 4 months was 13%. CONCLUSIONS In this large series of patients who underwent duodenal stenting for MGOO, we observed significant changes in GOOSS scores, a relatively long patency duration compared to findings in previous series, and a low probability of subsequent duodenal procedures, primarily due to a low median overall survival time (4 months).
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Affiliation(s)
| | - Fabrice Caillol
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Christophe Zemmour
- Inst Paoli Calmettes, Dept Clin Res & Invest, Biostat & Methodolo Unit, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
| | - Erwan Bories
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | | | | | - Sébastien Godat
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Solène Hoibian
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Aurélien Proux
- Paoli-Calmettes Institute, Palliative Unit, Marseille, France.
| | | | - Marc Giovannini
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
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Abstract
Hepaticogastrostomy (HGS) has been reported for the management of palliative malignant hilar stricture and involves draining the left liver as rescue therapy. For the management of this complex stenosis, another new option for draining the right liver under EUS guidance was introduced. Ten publications involving 38 patients have been reported in the literature, in which the following two main techniques have been described: direct puncture of the right liver from the bulbus and the bridge technique allowing the drainage of the right liver across the left liver through HGS. In this review, we describe the techniques used and the potential advantages and complications of these procedures. Although this kind of drainage is demanding and probably limited to specific patients, EUS-biliary drainage of the right liver seems feasible with acceptable complications.
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Affiliation(s)
- Fabrice Caillol
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Mathieu Rouy
- Surgery Unit, Paoli Calmettes Institute, Marseille, France
| | | | | | - Marc Giovannini
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
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Gonzalez JM, Lorenzo D, Ratone JP, Culetto A, Maire F, Levy P, Giovannini M, Barthet M. Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study. Endosc Int Open 2019; 7:E1130-E1134. [PMID: 31475230 PMCID: PMC6715559 DOI: 10.1055/a-0841-3385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/10/2018] [Accepted: 12/27/2018] [Indexed: 01/15/2023] Open
Abstract
Abstract
Introduction Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) require follow-up to detect worrisome features (WF). Data are missing about endoscopic pancreatic sphincterotomy (PS) for symptomatic IPMN.
Patients and methods This was a retrospective multicenter study in four expert centers. Patients treated with endoscopic PS for symptomatic (painful) BD-IPMN without WF were included. Age, sex, follow-up time, characteristics of IPMNs and endoscopic retrograde cholangiopancreatographies (ERCPs), and indications for surgery were recorded.
Results In total, 21 patients were included (median age 68 years, range 45 – 87 years). The median number of cysts was 2 (range 1 – 10), located in the head (59 %), body/tail (17 %), or multifocal (24 %). ERCP including PS was completed in all of the cases, with biliary sphincterotomy in 33 %. Clinical efficacy after one session was 81 % (17/21). Among the failures, one had a second successful PS and three were operated. The final efficacy was 86 % (18/21). Seven patients were operated after a mean of 19 months: four for WF, three for pain. The histopathology showed four low grade dysplasia, one high grade dysplasia, and two no dysplasia. No adenocarcinoma occurred during a follow-up of 99 months (range 14 – 276 months).
Conclusions Endoscopic PS for symptomatic IPMN without WF is effective in more than 80 % of cases, without increasing the risk for adenocarcinoma.
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Affiliation(s)
- Jean-Michel Gonzalez
- Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France
| | - Diane Lorenzo
- Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France,APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
| | | | - Adrian Culetto
- CHU de Purpan, Department of Gastroenterology, Toulouse, France
| | - Frédérique Maire
- APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
| | - Philippe Levy
- APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
| | | | - Marc Barthet
- Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France
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Gravis G, Chanez B, Walz J, Ratone JP, Pignot G, Pesenti C, Thomassin J, Caillol F, Brunelle S, Salem N, Bories E, Giovannini M. Efficacy and safety of endoscopic radiofrequency ablation for metastatic pancreatic renal cell carcinoma: A monocentric experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16549] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Naji Salem
- Institut Paoli Calmettes, Marseille, France
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Ratone JP, Bories E, Caillol F, Pesenti C, Godat S, Sellier F, Hoibian S, Landon M, Servajean C, Cassan CD, Lestelle V, Casanova JP, Poizat F, Giovannini M. Impact of Full Spectrum Endoscopy® (Fuse®, EndoChoice®) on adenoma detection: a prospective French pilot study. Ann Gastroenterol 2017; 30:512-517. [PMID: 28845106 PMCID: PMC5566771 DOI: 10.20524/aog.2017.0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/12/2017] [Indexed: 12/18/2022] Open
Abstract
Background Currently, colonoscopy and polypectomy are the gold standard methods for the prevention of incident cases of colorectal cancer. The use of a new colonoscope (Fuse®, EndoChoice®) with a larger view of up to 330° appears to improve the adenoma detection rate (ADR). We performed a prospective observational study concerning this scope. The primary endpoint was potentially omitted adenomas (POA), i.e. adenomas seen on the side screens that will not appear on the central display during colonoscopy withdrawal without oriented movements. Secondary endpoints included our ADR, Fuse® impact on ADR, time to cecal intubation and withdrawal time. Methods We performed a single-center prospective study in one French center. We enrolled patients over 18 years of age between January 2015 and March 2016. Results We included 141 patients; 3 were excluded because their colonoscopies were incomplete. Our study included 78 men and 60 women (sex ratio 1.3). The mean age was 60.4 years. A total of 130 polyps were resected. In all, 88/130 were adenomas (68%) and 34/88 adenomas (39%) were POA. The mean time to cecum was 10 min, and the mean withdrawal time was 12 min. ADR was 35% for men and 31% for women. The estimated ADR without POA was 29% for men and 19% for women. Conclusions The Fuse® system appears to be safe and efficient. POA represented 39% of all adenomas. The impact of the panoramic view on the ADR was considered substantial. The main limitations are the lack of randomization and the absence of a control group.
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Affiliation(s)
- Jean-Philippe Ratone
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Sébastien Godat
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Floriane Sellier
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Marine Landon
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Cécilia Servajean
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Chiara De Cassan
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Valentin Lestelle
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Jean-Patrick Casanova
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
| | - Flora Poizat
- Pathology Unit (Flora Poizat), Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sébastien Godat, Floriane Sellier, Solene Hoibian, Marine Landon, Cécilia Servajean, Chiara De Cassan, Valentin Lestelle, Jean-Patrick Casanova, Marc Giovannini), Paoli-Calmettes Institute, Marseille, France
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Ratone JP, Bories E, Caillol F, Pesenti C, Godat S, Poizat F, Cassan CD, Giovannini M. Oral steroid prophylaxis is effective in preventing esophageal strictures after large endoscopic resection. Ann Gastroenterol 2016; 30:62-66. [PMID: 28042239 PMCID: PMC5198248 DOI: 10.20524/aog.2016.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/05/2016] [Indexed: 12/13/2022] Open
Abstract
Background Strictures are frequent complications of large endoscopic mucosal resections (EMR) and endoscopic submucosal dissections of the esophagus. Local or systemic steroid therapy has shown promise in the prevention of secondary stenosis. The aim of this study was to evaluate the safety and efficacy of systemic steroid therapy following endoscopic resection of at least hemi-circumferential esophageal mucosa. Methods This was a single-center retrospective study in a tertiary center. We evaluated patients who were treated with oral steroids between July 2013 and September 2015, after undergoing a large EMR for Barrett’s esophagus associated with dysplasia or carcinoma. The steroid protocol used was an initial dose of 30 mg prednisolone, tapered over 8 weeks. Exclusion criteria were a previous attempt at radiofrequency ablation or resection. Results Thirty-one patients (27 men) were analyzed: 13 with low-grade dysplasia Barrett’s esophagus, 16 with in situ adenocarcinoma, 1 with pT1SM1 adenocarcinoma, and 1 with pT1SM2 adenocarcinoma. Twenty-eight resections (28/31) were completed (R0) in 1-3 sessions (median 2), while 3 resections were R1. The median length of Barrett’s esophagus was C3M5 (range C0M2-C10M11) according to the Prague classification. The median follow up was 10 months (range 4-17), during which 4 patients (13%) developed a secondary stenosis. All stenoses were successfully treated by endoscopic dilation (range 1-4). No complications related to dilation or to the steroid therapy were observed. Conclusions Our rate of secondary stricture was lower than expected, given the rates of 17-88% in published studies. Systemic oral steroid therapy seems to be effective in reducing potential esophageal stenosis after EMR. Complementary randomized studies are required to confirm whether systemic steroids are an effective primary prophylaxis for esophageal stenosis.
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Affiliation(s)
- Jean-Philippe Ratone
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Erwan Bories
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Fabrice Caillol
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Christian Pesenti
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Sebastien Godat
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Flora Poizat
- Pathology Unit (Flora Poizat), Paoli-Calmettes Institute, Marseille, France
| | - Chiara De Cassan
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
| | - Marc Giovannini
- Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini)
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Abstract
BACKGROUND AND OBJECTIVE Pelvic abscesses are a well-known complication of intestinal diseases or abdominal surgery. We report our case series concerning transrectal drainage by endoscopic ultrasound (EUS). METHODS Between January 2010 and august 2014, seven patients received transrectal drainage by endoscopic ultrasound (EUS) were selected and analyzed. RESULTS Two pigtails was positioned under fluoroscopic and EUS control. The success rate was 100% and complication rate was 0%. The median time of hospitalization was 10 days [range 4-25]. CONCLUSIONS The technique appears to be safe and feasible in all etiologies. In our experience, we can considerate transrectal drainage by EUS like a first-line technique in experienced hands.
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Ratone JP, Caillol F, Bories E, Pesenti C, Godat S, Giovannini M. Hepatogastrostomy by EUS for malignant afferent loop obstruction after duodenopancreatectomy. Endosc Ultrasound 2015; 4:250-2. [PMID: 26374585 PMCID: PMC4568639 DOI: 10.4103/2303-9027.163017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
One of the most difficult biliary drainages is the recurrence and stenosis on afferent loop after surgery. We report an original case of hepaticogastrostomy (HGE) in a patient who had malignant stenosis of afferent loop after cephalic duodenopancreatectomy (CDP). After failure of the gastrointestinal stent, two metal self-expandable stents were placed by endoscopic ultrasound (EUS) after puncture of the dilated left hepatic duct. On clinical improvement and disappearance of jaundice, palliative chemotherapy was started.
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Bertrand J, Caillol F, Borentain P, Raoul JL, Heyries L, Bories E, Pesenti C, Ratone JP, Bernard JP, Gerolami R, Giovannini M. Percutaneous hepatic radiofrequency for hepatocellular carcinoma: results and outcome of 46 patients. Hepat Med 2015; 7:21-7. [PMID: 26056497 PMCID: PMC4445946 DOI: 10.2147/hmer.s67940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Radiofrequency ablation (RFA) is a curative option for hepatocellular carcinoma (HCC), the most common primary malignancy of the liver. This bicentric retrospective study includes 46 patients admitted for their first percutaneous RFA for HCC. Sixty-three nodules were treated, with an average size of 32.5 mm. Our study confirms the efficiency of this technique for attaining necrosis of HCC nodules, with few complications. Subgroup studies according to RFA mode (mono- or multipolar), etiology of cirrhosis (alcoholic or viral), and HCC size showed better efficiency for multipolar RFA when applied to small tumors and better survival when the cirrhosis was due to viral infection. However, we noted a high rate of local recurrence in our and other recent works compared to previous studies, probably due to improved imaging techniques. The main problem is still de novo intrahepatic recurrence in diseased livers.
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Affiliation(s)
- Julie Bertrand
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Patrick Borentain
- Department of Hepato-Gastroenterology, Conception Hospital, Marseille, France
| | - Jean-Luc Raoul
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Laurent Heyries
- Department of Hepato-Gastroenterology, Conception Hospital, Marseille, France
| | - Erwan Bories
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | | | | | - Jean-Paul Bernard
- Department of Hepato-Gastroenterology, Conception Hospital, Marseille, France
| | - René Gerolami
- Department of Hepato-Gastroenterology, Conception Hospital, Marseille, France
| | - Marc Giovannini
- Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
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