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Coron E, David G, Lecleire S, Jacques J, Le Sidaner A, Barrioz T, Coumaros D, Volteau C, Vedrenne B, Bichard P, Boustière C, Touchefeu Y, Brégeon J, Prat F, Le Rhun M. Antireflux versus conventional self-expanding metallic Stents (SEMS) for distal esophageal cancer: results of a multicenter randomized trial. Endosc Int Open 2016; 4:E730-6. [PMID: 27556085 PMCID: PMC4993873 DOI: 10.1055/s-0042-106960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Self-expanding metal stents (SEMS) are commonly used in the palliation of dysphagia in patients with inoperable esophageal carcinoma. However, they predispose to gastroesophageal reflux when deployed across the gastroesophageal junction. The aims of this study were to: 1) assess the influence of the antireflux valve on trans-prosthetic reflux (primary outcome); and 2) compare the results of SEMS with and without antireflux valve in terms of reflux symptoms, quality of life (QOL), improvement of dysphagia and adverse events (secondary outcomes). PATIENTS AND METHODS Thirty-eight patients were enrolled in nine centers. Carcinomas were locally advanced (47 %) or metastatic. After randomization, patients received either a covered SEMS with antireflux valve (n = 20) or a similar type of SEMS with no antireflux device but assigned to standard proton pump inhibitor therapy and postural advice (n = 18). Trans-prosthetic reflux was assessed at day 2 using a radiological score based on barium esophagography performed after Trendelenburg maneuver and graded from 0 (no reflux) to 12 (maximum). Monthly telephone interviews were conducted for Organisation Mondiale de la Santé (OMS) scoring from 0 (excellent) to 5 (poor), QOL assessment (based on the Reflux-Qual Simplifié scoring system) from 0 (poor) to 100 (excellent), dysphagia scoring from 0 (no dysphagia) to 5 (complete dysphagia) and regurgitation scoring from 0 (no regurgitation) to 16 (maximum). RESULTS No difference was noted in terms of age, sex, size of lesion, prosthesis length or need for dilation prior to SEMS placement. No difficulty in placing SEMS nor complications were noted. Radiological scores of reflux were found to be significantly lower in patients with an antireflux stent compared to the conventional stent and associated measures. The regurgitation scores were significantly decreased in patients with antireflux stents during the first 2 months after stent placement and thereafter, they were similar in the two groups. QOL and dysphagia were improved in both groups. Survival rates were comparable in the two groups. CONCLUSIONS No difference was observed between the two types of SEMS regarding the palliation of dysphagia and improvement of QOL. However, SEMS with an antireflux valve were more effective in preventing trans-prosthetic gastroesophageal reflux but at the cost of an increased likehood of minor adverse events (migrations and/or obstruction of the SEMS).
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Affiliation(s)
- E. Coron
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France,Corresponding author Pr Emmanuel Coron Institut des Maladies de l’Appareil DigestifCHU Hotel Dieu1 Place Alexis Ricordeau 44093 Nantes CedexFrance
| | - G. David
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - S. Lecleire
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Rouen, France
| | - J. Jacques
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Limoges, France
| | - A. Le Sidaner
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Limoges, France
| | - T. Barrioz
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Poitiers, France
| | - D. Coumaros
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Strasbourg, France
| | - C. Volteau
- Département de Biostatistiques, Centre Hospitalier Universitaire, Nantes, France
| | - B. Vedrenne
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Mulhouse, France
| | - P. Bichard
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Grenoble, France
| | - C. Boustière
- Service d’Hépatogastroentérologie, Hopital Saint-Joseph, Marseille, France
| | - Y. Touchefeu
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - J. Brégeon
- CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - F. Prat
- Service d’Hépatogastroentérologie, Hopital Cochin, Paris, France
| | - M. Le Rhun
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
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Heresbach D, Vedrenne B, Laugier R, Saurin JC, Burtin P, Bories E, Guillet M, Ponchon T, Richard-Molard B, Arpurt JP, Boustière C, Bulois P, Burtin P, Calazel A, Canard JM, Heresbach D, Lesur G, Lapuelle J, Laugier R, Prat F, Pujol B, Richard-Molard B, Saurin JC, Systchenko R, Pienkowski P, Ponchon T. Consensus en endoscopie digestive : Conduite à tenir après polypectomie ou mucosectomie rectocolique selon le résultat de l’analyse d’anatomie pathologique. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10190-011-0179-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barthet M, Napoléon B, Palazzo L, Chemali M, Letard JC, Laugier R, Arpurt JP, Boyer J, Boustière C, Canard JM, Cassigneul J, Dalbiès PA, Escourrou J, Gay G, Ponchon T, Richard-Molard B, Sautereau D, Tucat G, Vedrenne B. Management of cystic pancreatic lesions found incidentally. Endoscopy 2007; 39:926-8. [PMID: 17968813 DOI: 10.1055/s-2007-966786] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Boyer J, Laugier R, Chemali M, Arpurt JP, Boustière C, Canard JM, Dalbies PA, Gay G, Escourrou J, Napoléon B, Palazzo L, Ponchon T, Richard-Mollard B, Sautereau D, Tucat G, Vedrenne B. French Society of Digestive Endoscopy SFED guideline: monitoring of patients with Barrett's esophagus. Endoscopy 2007; 39:840-2. [PMID: 17703397 DOI: 10.1055/s-2007-966653] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Saurin JC, Napoleon B, Gay G, Ponchon T, Arpurt JP, Boustiere C, Boyer J, Canard JM, Dalbies PA, Escourrou J, Greff M, Lapuelle J, Laugier R, Letard JC, Marchetti B, Palazzo L, Sautereau D, Vedrenne B. Endoscopic management of patients with familial adenomatous polyposis (FAP) following a colectomy. Endoscopy 2005; 37:499-501. [PMID: 15844037 DOI: 10.1055/s-2005-861295] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J-C Saurin
- Hépatologie Gastroenterologie, Centre Hospitalier Lyon Sud, France.
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Barthet M, Napoleon B, Gay G, Ponchon T, Sautereau D, Arpurt JP, Boustiere C, Boyer J, Canard JM, Dalbies PA, Escourrou J, Greff M, Lapuelle J, Laugier R, Letard JC, Marchetti B, Palazzo L, Vedrenne B. Antibiotic prophylaxis for digestive endoscopy. Endoscopy 2004; 36:1123-5. [PMID: 15578308 DOI: 10.1055/s-2004-826118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Barthet
- Société Française d'Endoscopie Digestive (SFED)
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