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Coupier A, Khoury T, Gincul R, Fumex F, Lisotti A, Leblanc S, Napoléon B. Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas. Endoscopy 2023; 55:E951-E952. [PMID: 37604456 PMCID: PMC10442209 DOI: 10.1055/a-2127-4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Antoine Coupier
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Tawfik Khoury
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
- Galilee Medical Center, Gastroenterology, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rodica Gincul
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Sarah Leblanc
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
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Teoh AYB, Napoleon B, Kunda R, Arcidiacono PG, Kongkam P, Larghi A, Van der Merwe S, Jacques J, Legros R, Thawee RE, Saxena P, Aerts M, Archibugi L, Chan SM, Fumex F, Kaffes AJ, Ma MTW, Messaoudi N, Rizzatti G, Ng KKC, Ng EKW, Chiu PWY. EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial). Gastroenterology 2023; 165:473-482.e2. [PMID: 37121331 DOI: 10.1053/j.gastro.2023.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND & AIMS Several studies have compared primary endoscopic ultrasound (EUS)-guided biliary drainage to endoscopic retrograde cholangiopancreatography (ERCP) with insertion of metal stents in unresectable malignant distal biliary obstruction (MDBO) and the results were conflicting. The aim of the current study was to compare the outcomes of the procedures in a large-scale study. METHODS This was a multicenter international randomized controlled study. Consecutive patients admitted for obstructive jaundice due to unresectable MDBO were recruited. Patients were randomly allocated to receive EUS-guided choledocho-duodenostomy (ECDS) or ERCP for drainage. The primary outcome was the 1-year stent patency rate. Other outcomes included technical success, clinical success, adverse events, time to stent dysfunction, reintervention rates, and overall survival. RESULTS Between January 2017 and February 2021, 155 patients were recruited (ECDS 79, ERCP 76). There were no significant differences in 1-year stent patency rates (ECDS 91.1% vs ERCP 88.1%, P = .52). The ECDS group had significantly higher technical success (ECDS 96.2% vs ERCP 76.3%, P < .001), whereas clinical success was similar (ECDS 93.7% vs ERCP 90.8%, P = .559). The median (interquartile range) procedural time was significantly shorter in the ECDS group (ECDS 10 [5.75-18] vs ERCP 25 [14-40] minutes, P < .001). The rate of 30-day adverse events (P = 1) and 30-day mortality (P = .53) were similar. CONCLUSION Both procedures could be options for primary biliary drainage in unresectable MDBO. ECDS was associated with higher technical success and shorter procedural time then ERCP. Primary ECDS may be preferred when difficult ERCPs are anticipated. This study was registered to Clinicaltrials.gov NCT03000855.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | | | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium; Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Pradermchai Kongkam
- Division of Hospital and Ambulatory Medicine and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, The University of Leuven, Leuven, Belgium
| | - Jeremies Jacques
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | | | - Payal Saxena
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
| | - Maridi Aerts
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fabien Fumex
- Hopital Privé Jean Mermoz, Ramsay Santé, Lyon Cedex 08, France
| | - Arthur J Kaffes
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
| | - Mark Tsz Wah Ma
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nouredin Messaoudi
- Department of Surgery, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kelvin Kwok Chai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Schoch A, Lisotti A, Walter T, Fumex F, Leblanc S, Artru P, Desramé J, Brighi N, Marsot J, Souquet JC, Napoléon B. Efficacy of EUS-guided hepaticogastrostomy in prolonging survival of patients with perihilar cholangiocarcinoma. Endosc Ultrasound 2022; 11:487-494. [PMID: 36537386 PMCID: PMC9921975 DOI: 10.4103/eus-d-22-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives The background of this study was to evaluate the outcomes of perihilar cholangiocarcinoma (pCCA) patients treated with EUS-guided hepaticogastrostomy (EUS-HGS). Methods All patients with pCCA who underwent EUS-HGS from 2010 to 2020 were analyzed. The primary outcome was clinical success; the secondary outcomes were technical success, adverse events (AEs), stent patency, and oncological outcomes. Cox proportional-hazards regression and Kaplan-Meier curves were analyzed to identify variables related to survival. Results Thirty-four patients (50% females, 76 years old) were included; 24 (70.6%) presented with distant metastasis. Indications for EUS-HGS were ERCP failure (64.7%), duodenal stricture (23.5%), postsurgical anatomy (5.9%), and dilation limited to the left intrahepatic duct (5.9%). The technical success rate was 97.1%. The clinical success rate was 64.7%. Nine (26.5%) presented AEs, 2 fatal (bleeding and leakage). The overall survival was 91 (31-263) days. On multivariate analysis, EUS-HGS clinical success (Exp[b]: 0.23 [0.09-0.60]; P = 0.003) and chemotherapy (Exp[b]: 0.06 [0.02-0.23]; P < 0.001) were significantly associated with survival. The survival was longer in patients who achieved EUS-HGS clinical success (178[61-393] vs. 15[73-24] days; hazard ratio: 6.3; P < 0.001) and in those starting chemotherapy (324[178-439] vs. 31 [9-48]; hazard ratio: 1.2; P < 0.001). Conclusions EUS-HGS is effective in pCCA patients despite a not negligible AE rate. Clinical success, potentially leading to jaundice resolution and chemotherapy start, significantly improves survival.
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Affiliation(s)
- Armelle Schoch
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Andrea Lisotti
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France,Hospital of Imola, University of Bologna, Italy
| | - Thomas Walter
- Department of Medical Oncology, Edoard Herriot Hospital, Lyon, France
| | - Fabien Fumex
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Sarah Leblanc
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Pascal Artru
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Jérôme Desramé
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France
| | - Nicole Brighi
- Department of Medical Oncology, IRCCS Institute for the Study of Cancer (IRST) “Dino Amadori”, Meldola, Italy
| | - Julien Marsot
- Department of Radiology, Jean Mermoz Private Hospital, Lyon, France
| | | | - Bertrand Napoléon
- Endoscopic Department, Jean Mermoz Private Hospital, Lyon, France,Address for correspondence Dr. Bertrand Napoléon, Endoscopic Department, Jean Mermoz Private Hospital, Ramsay Sante, 55 avenue Jean Mermoz, 69008 Lyon, France. E-mail:
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El Bacha H, Harizi R, Laugier R, Lorenzo D, Rivallin P, Leblanc S, Barange K, Fumex F, Laquière A, Napoléon B, Vedrenne B, Grabar S, Prat F. Identification of endoscopic predictors of biliary malignancy during digital cholangioscopy. Dig Endosc 2022; 34:1224-1233. [PMID: 35138664 DOI: 10.1111/den.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Biliary brushings and biopsies obtained during endoscopic retrograde cholangiopancreatography (ERCP) have a low sensitivity for the diagnosis of malignant biliary strictures. While cholangioscopic analysis is useful, visual criteria have not yet been defined. The aim of this study was to identify visual criteria for the diagnosis of indeterminate biliary strictures (IDBS). METHODS A multicenter study was conducted based on the analysis of cholangioscopic recordings of IBDS. Diagnostic criteria were identified in a study group and verified in a validation group. RESULTS Four criteria were identified to be associated with malignancy, one negatively ("endobiliary material," odds ratio [OR] 0.62, 95% confidence interval [CI] 0.41-0.92) and three positively ("vascularized villous projections," OR 1.52, 95% CI 1.03-2.24; "twisted or dilated vessels," OR 2.18, 95% CI 1.47-3.24; and "dark color of the mucosa," OR 1.82, 95% CI 1.23-2.70). Between two playbacks, the mean (95% CI) sensitivity of the observer's visual diagnosis increased from 66.1% (60-72) to 73.8% (69-78) (P = 0.004); in the second playback, the kappa value for interobserver agreement ranged between 0.36 (color) and 0.56 (endobiliary material), with a significant improvement (P = 0.0031-0.0001) between the first and second playbacks. Blind assessment by endoscopists not involved in this study had a diagnostic accuracy of 73% (71.4-74.5). CONCLUSION The four identified cholangioscopic features are easy to implement in clinical practice and have the potential to increase the level of diagnostic confidence during the workup of IDBS.
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Affiliation(s)
- Hicham El Bacha
- Gastroenterology and Endoscopy Unit Medicine B, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Rafik Harizi
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu, University Hospitals of Paris (AP-HP), Paris, France
| | - René Laugier
- Gastroenterology and Endoscopy Unit, La Timone University Hospital, Marseilles, France
| | - Diane Lorenzo
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
| | - Paul Rivallin
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
| | - Sarah Leblanc
- Digestive Endoscopy Unit, Jean Mermoz Clinic, Lyon, France
| | - Karl Barange
- Gastroenterology and Endoscopy Unit, Toulouse University Hospital, Toulouse, France
| | - Fabien Fumex
- Digestive Endoscopy Unit, Jean Mermoz Clinic, Lyon, France
| | - Arthur Laquière
- Gastroenterology and Endoscopy Unit, Saint Joseph Hospital, Marseilles, France
| | | | - Bruno Vedrenne
- Gastroenterology and Endoscopy Unit, Mulhouse and Southern Alsace Regional Hospital, Mulhouse, France
| | - Sophie Grabar
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu, University Hospitals of Paris (AP-HP), Paris, France
| | - Frederic Prat
- Endoscopy Unit, Beaujon Hospital, University Hospitals of Paris (AP-HP) and University of Paris, Clichy, France
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Meunier C, Lisotti A, Gupta V, Lemaistre AI, Fumex F, Gincul R, Lefort C, Lepillez V, Bourdariat R, Napoléon B. Oral anticoagulants but not antiplatelet agents increase the risk of delayed bleeding after endoscopic papillectomy: a large study in a tertiary referral center. Surg Endosc 2022; 36:7376-7384. [PMID: 35233659 DOI: 10.1007/s00464-022-09138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic papillectomy (EP) is an effective curative treatment in patients with ampullary adenomas. However, EP is burdened by a not-negligible risk of bleeding. The aim of this study was to determine risk factors for delayed bleeding after EP. METHODS A retrospective analysis of a prospectively-collected database was performed, retrieving all EP performed over a 20-year period. Anti-thrombotic treatments were managed according to guidelines. Delayed bleeding was defined as overt gastrointestinal bleeding or drop in haemoglobin level. Multivariate logistic regression was used to identify variables related to delayed bleeding. RESULTS Three-hundred-seven patients (48.5% male, median age 68-year-old) entered the study; of them, 51 (16.6%) received anti-thrombotic treatments. Delayed bleeding occurred in 44 (14.3%) patients. No difference was observed in patients receiving antiplatelet agents. Multivariate analysis identified oral anticoagulant agents (odd Ratio 4.37 [2.86-5.95]) and procedural bleeding (OR 2.22 [1.10-4.40]) as independently related to delayed bleeding; in patients with no procedural bleeding, oral anticoagulant agents (OR 5.63 [2.25-9.83]) and ampullary tumor size (OR 1.07 [1.01-1.13]) were independently related to delayed bleeding. Patients on anticoagulant agents presented significantly higher need for blood transfusion (16.7 vs. 1.5%); no difference in intensive care unit admission, surgery or mortality was observed. CONCLUSIONS This study demonstrates that patients on oral antiplatelet agents do not present increased risk for post-EP delayed bleeding. EP represents a valid alternative to surgery even in patients on anticoagulant agents, despite significantly increased risk of delayed bleeding. A tailored approach to those cases should be planned.
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Affiliation(s)
- Camille Meunier
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Andrea Lisotti
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.,Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Vikas Gupta
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.,Gastroenterology Unit, Sunshine Coast University Hospital, Queensland, Australia
| | | | - Fabien Fumex
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Rodica Gincul
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Christine Lefort
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Vincent Lepillez
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Raphael Bourdariat
- Department of Digestive Surgery, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Bertrand Napoléon
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
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Lefort C, Gupta V, Lisotti A, Palazzo L, Fusaroli P, Pujol B, Gincul R, Fumex F, Palazzo M, Napoléon B. Diagnosis of gastric submucosal tumors and estimation of malignant risk of GIST by endoscopic ultrasound. Comparison between B mode and contrast-harmonic mode. Dig Liver Dis 2021; 53:1486-1491. [PMID: 34272196 DOI: 10.1016/j.dld.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND standard B-mode EUS assessment and EUS-guided tissue acquisition present sub-optimal diagnostic yield in the differential diagnosis of gastric submucosal tumors (SMTs). AIMS to evaluate the performances of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) to differentiate gastric SMTs and predict malignancy risk of gastrointestinal stromal tumors (GIST). METHODS a retrospective analysis was performed retrieving consecutive patients with gastric SMTs who underwent EUS between 2009 and 2014. Patients with available EUS video recordings and histological diagnosis were included. De-identified videos were presented to experts who made a diagnosis on B-mode EUS and CH-EUS. RESULTS fifty-four patients (29 female, 64-year-old) were included. Final diagnoses were 40 GISTs (8 high-grade), 9 leiomyomas, 5 rare SMTs. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the differential diagnosis of GIST were 95.0% vs. 85.0%, 57.1% for both techniques, and 85.2% vs. 77.8%, respectively. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the estimation of the malignancy GISTs risk were 62.5% vs. 100%, 83.3% vs. 82.1%, and 78.9% vs. 86.1%, respectively. CONCLUSIONS CH-EUS showed better diagnostic performance than B-mode EUS in differentiating leiomyomas and risk stratification of GIST. When considering high-grade GISTs, the addition of CH-EUS allowed an improvement in diagnostic accuracy.
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Affiliation(s)
- Christine Lefort
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France.
| | - Vikas Gupta
- Gastroenterology Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrea Lisotti
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France; Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Bertrand Pujol
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France
| | - Rodica Gincul
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France
| | - Fabien Fumex
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France
| | | | - Bertrand Napoléon
- Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, Lyon 69008, France
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Laquière AE, Privat J, Fumex F, Grandval P, Lecomte L, Curel L, Belle A, Trottier-Tellier F, Urena-Campos R, Penaranda G, Boustière C, Napoléon B. Performance of digital single-operator cholangiopancreatoscope for biliopancreatic diseases in real life: results from a prospective multicenter study. Scand J Gastroenterol 2020; 55:1381-1388. [PMID: 33095075 DOI: 10.1080/00365521.2020.1832143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Peroralcholangio-pancreatoscopy (POCP) is used for diagnosis and treatment of biliopancreatic disease when standard endoscopy (ERCP) or pre-operative imaging workup failed. We aimed to evaluate the diagnostic and therapeutic performance of POCP in complex biliary and pancreatic diseases. MATERIALS AND METHODS Patients with indeterminate biliary or pancreatic duct (PD) strictures, and patients with failure of complex biliary or pancreatic stones removal, were enrolled (six centers). The primary endpoint evaluated malignancy diagnostic performances (accuracy, sensitivity, specificity) and therapeutic performances (biliary or pancreatic stones extraction). Secondary endpoints evaluated: technical success in lesion visualization, ease of maneuvering, image quality and 30-days complications. RESULTS From November 2016 to March 2018, 66 patients were included: 29/37 women/men, median age (IQR): 73 (64-82). Fifty-three patients had diagnostic POCP and 13 patients therapeutic POCP. One endoscopist with one or two endoscopy nurses performed 94% of the POCP. The 'POCP visual impression' of malignancy showed 92.0% sensitivity, 92.9 % specificity and 92.5 % overall accuracy compared with the final diagnosis. 'POCP-guided samples histological analysis' showed 75.0 % sensitivity and 91.6% specificity. The technical success for lesion visualization was 98.5%. The median VAS scores for insertions in bile and PD were respectively 9.0 (8.1-9.6) and 9.0 (8.8-10.0). Median VAS score for access to the lesion and image quality were respectively 9.0 (7.7-9.6) and 9.0 (7.9-9.7). Only three 30-day minor complications occurred without any major complications. CONCLUSIONS POCP was an effective, safe and easy-to-use tool in routine clinical practice for the management of complex diagnostic and therapeutic biliary and pancreatic diseases (NCT03190343).
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Affiliation(s)
- Arthur E Laquière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Jocelyn Privat
- Department of Hepatogastroenterology, Centre Hospitalier Vichy, Vichy, France
| | - Fabien Fumex
- Department of Hepatogastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Philippe Grandval
- Digestive Endoscopy and Gastroenterology Department, AP-HM Hôpital de la Timone, Marseille, France
| | - Laurence Lecomte
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Laurence Curel
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Arthur Belle
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Félix Trottier-Tellier
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Romina Urena-Campos
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | | | - Christian Boustière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Bertrand Napoléon
- Department of Hepatogastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
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Jacques J, Privat J, Pinard F, Fumex F, Chaput U, Valats JC, Cholet F, Jezequel J, Grandval P, Legros R, Lepetit H, Albouys J, Napoleon B. EUS-guided choledochoduodenostomy by use of electrocautery-enhanced lumen-apposing metal stents: a French multicenter study after implementation of the technique (with video). Gastrointest Endosc 2020; 92:134-141. [PMID: 32084411 DOI: 10.1016/j.gie.2020.01.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS EUS-guided biliary drainage is indicated in cases of impossibility or failure of classic biliary drainage by ERCP. Recently we reported good efficiency of EUS-guided choledochoduodenostomy (EUS-CDS) using the electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) in a retrospective multicenter study. Use of the recommended technique (direct puncture with the ECE-LAMS with use of a pure cut current and a 6-mm stent) was the only predictive factor of clinical success. We re-evaluated this procedure after 1 year in the same centers. METHODS This was a French retrospective multicenter study of a prospective database including all cases of EUS-guided CDS with ECE-LAMS in the 7 centers that participated in the first study. RESULTS Seventy consecutive patients were included in this study between September 1, 2017, and September 22, 2018. Failure of primary ERCP was due to duodenal stenosis in 44% of cases and to tumoral infiltration of the papilla in 22% of cases. The mean duration of the procedure was 5 ± 3 minutes. The recommended technique was used in 98.5% of cases. The technical and clinical success rates were both 97.1% (69/70). Short-term adverse events (periprocedural and intrahospital) occurred in 1.6%. CONCLUSIONS EUS-CDS with the ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct in cases of ERCP failure with impressive results once expertise is acquired and the recommended technique (direct fistulotomy, pure cut current, and 6-mm stent) is followed.
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Affiliation(s)
- Jérémie Jacques
- service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jocelyn Privat
- service d'Hépato-gastro-entérologie, CH Jacques Lacarin, Vichy, France
| | - Fabien Pinard
- service d'Hépato-gastro-entérologie, Hopital de Cournouaille, Quimper, France
| | - Fabien Fumex
- service d'Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, France
| | - Ulriika Chaput
- service d'Hépato-gastro-entérologie, CHU Saint Antoine, Paris, France
| | | | - Franck Cholet
- service d'Hépato-gastro-entérologie, CHU Brest, Brest, France
| | - Julien Jezequel
- service d'Hépato-gastro-entérologie, CHU Brest, Brest, France
| | - Philippe Grandval
- service d'Hépato-gastro-entérologie, Hopital La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Romain Legros
- service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Hugo Lepetit
- service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jeremie Albouys
- service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Bertrand Napoleon
- service d'Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, France
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9
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Jacques J, Privat J, Pinard F, Fumex F, Valats JC, Chaoui A, Cholet F, Godard B, Grandval P, Legros R, Kerever S, Napoleon B. Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis. Endoscopy 2019; 51:540-547. [PMID: 30347424 DOI: 10.1055/a-0735-9137] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 12/15/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided biliary drainage is an alternative to percutaneous biliary drainage in cases of malignant biliary obstruction and failure of classic endoscopic drainage by endoscopic retrograde cholangiopancreatography (ERCP). Recently, a new electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) that allows for endoscopic anastomosis (apposition stent) has become available for use in EUS-choledochoduodenostomy (EUS-CDS) and facilitates the procedure. METHODS This was a retrospective study of all EUS-CDS procedures performed in France between April 2016 and August 2017. The primary end point was the technical and clinical success rates of EUS-CDS using an ECE-LAMS. RESULTS 52 consecutive patients were included in the study. The etiology of distal bile duct obstruction was distal pancreatic adenocarcinoma in 43 patients (82.7 %). The technical success rate was 88.5 % (46 /52 patients), and the clinical success rate was 100 % (46/46 patients). The mean duration of the procedure was 10.2 minutes (range 1 - 90). Two patients (3.8 %) presented with short-term complications after EUS-CDS and before discharge from hospital. In univariate analyses, a small diameter of the common bile duct and not following the recommended procedure technique were significant risk factors for technical failure. Over a mean follow-up of 157 days, the median survival time without biliary complications was 135 days. CONCLUSION EUS-CDS with an ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct and could be proposed as the first option in cases of ERCP failure.
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Affiliation(s)
- Jeremie Jacques
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jocelyn Privat
- Service d'Hépato-gastro-entérologie, CH Jacques Lacarin, Vichy, France
| | - Fabien Pinard
- Service d'Hépato-gastro-entérologie, Hopital de Cournouaille, Quimper, France
| | - Fabien Fumex
- Service d'Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, Farnce
| | | | - Azzedine Chaoui
- Service d'Hépato-gastro-entérologie, CH Moulins, Moulins, France
| | - Franck Cholet
- Service d'Hépato-gastro-entérologie, CHU Brest, Brest, France
| | - Bruno Godard
- Service d'Hépato-gastro-entérologie, CHU Trousseau, Tours, France
| | - Philippe Grandval
- Service d'Hépato-gastro-entérologie, Hopital La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Romain Legros
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Sebastien Kerever
- Service de Biostatistique et Information Médicale Hôpital Saint Louis APHP, Paris, France
| | - Bertrand Napoleon
- Service d'Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, Farnce
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10
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Leung Ki EL, Lemaistre AI, Fumex F, Gincul R, Lefort C, Lepilliez V, Pujol B, Napoléon B. Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation. Endosc Int Open 2019; 7:E189-E194. [PMID: 30705952 PMCID: PMC6338542 DOI: 10.1055/a-0770-2726] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/18/2018] [Indexed: 01/15/2023] Open
Abstract
Background and aims This study aimed to evaluate the performance of Macroscopic On-site Evaluation (MOSE) using a novel endoscopic ultrasound (EUS) fine needle biopsy (FNB) needle (22-G Franseen-tip needle, Acquire, Boston Scientific Incorporated, Boston, Massachusetts, United States), and without using Rapid On-Site Evaluation (ROSE). Method Between May 2016 and August 2016, all consecutive patients referred to our center for EUS tissue acquisition (TA) for solid lesions underwent EUS-FNB with the 22-G Franseen-tip needle unless contra-indicated. The operator performed MOSE. If no macroscopic core was visualized, a second pass was performed. The final diagnosis was defined as unequivocal histology from EUS-TA with compatible 18 months follow-up, surgical resection, or both. We retrospectively analyzed the performance of MOSE. Results A total of 46 consecutive patients was included, and 54 solid lesions were biopsied. The endosonographer visualized core tissue in 93 % (50/54) of targets with a single pass, of which the pathologist confirmed histologic core fragments in 94 % (47/50). Four lesions required two passes, and the overall correlation between MOSE and histologic core fragments was 94 % (48/51). Diagnostic adequacy was 98 % (53/54) with one biliary target biopsied without significant material. The overall diagnostic accuracy was 94 %. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 92 %, 100 %, 100 %, and 81 %, respectively. No adverse events were reported. Conclusion Our study demonstrated that MOSE using the 22-G Franseen-tip needle could limit needle passes by accurately estimating histologic core fragments. It also demonstrated that high diagnostic adequacy and accuracy of > 90 % could be achieved without ROSE.
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Affiliation(s)
- En-Ling Leung Ki
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France,Department of Gastroenterology, Hôpital de La Tour, Geneva, Switzerland
| | | | - Fabien Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Rodica Gincul
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Christine Lefort
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lepilliez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Pujol
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France,Corresponding author Bertrand Napoleon, MD Department of GastroenterologyHôpital Privé Jean Mermoz55 avenue Jean Mermoz69008 LyonFrance+33-478-742655
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11
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Alvarez-Sánchez MV, Luna OB, Oria I, Marchut K, Fumex F, Singier G, Salgado A, Napoléon B. Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study. J Gastrointest Surg 2018; 22:1213-1220. [PMID: 29532359 DOI: 10.1007/s11605-018-3731-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
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Affiliation(s)
- María Victoria Alvarez-Sánchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain.
| | - O B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - I Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - K Marchut
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - F Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - G Singier
- Department of Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - A Salgado
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - B Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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12
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Palazzo M, Napoléon B, Gincul R, Pioche M, Pujol B, Lefort C, Fumex F, Hautefeuille V, Fabre M, Cros J, Felce M, Couvelard A, Sauvanet A, Lévy P, Ruszniewski P, Palazzo L. Contrast harmonic EUS for the prediction of pancreatic neuroendocrine tumor aggressiveness (with videos). Gastrointest Endosc 2018; 87:1481-1488. [PMID: 29325706 DOI: 10.1016/j.gie.2017.12.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 06/19/2017] [Accepted: 12/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Contrast harmonic EUS (CH-EUS) has the ability to depict tumor microvasculature. Decreased microvascular density has been identified as a factor associated with tumor aggressiveness. We aimed to study the accuracy of CH-EUS for the prediction of pancreatic neuroendocrine tumor (PNET) aggressiveness. METHODS Between June 2009 and March 2015, all consecutive patients with histology-proven PNETs and CH-EUS examination were included. Nine endosonographers blindly analyzed all videos. CH-EUS tumor aggressiveness was defined as a heterogeneous enhancement at the early arterial phase. The final diagnosis of tumor aggressiveness was defined as follows: G3 tumors, morphologic and/or histologic findings of metastatic disease in G1/G2 tumors. Diagnostic values were calculated. Intratumoral microvascular density and fibrosis were assessed on pathologic specimens. RESULTS Eighty-one tumors were included, of which 26 were aggressive (32.1%). In CH-EUS 35 tumors (43.2%) had a heterogeneous enhancement. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CH-EUS for the diagnosis of tumor aggressiveness were 86%, 96%, 82%, 71%, and 98%, respectively. The interobserver agreement among the 9 endosonographers was good (k = .66). The intraobserver agreement was excellent for the junior (κ = .83) and senior (κ = .82) endosonographers. Heterogeneous tumors at CH-EUS corresponded to fewer vascular and more fibrotic tumors (P < .01). CONCLUSIONS CH-EUS is accurate in the prediction of PNET aggressiveness and could be a decision-making element in their management.
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Affiliation(s)
- Maxime Palazzo
- Beaujon Hospital, Department of Digestive Endoscopy, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Rodica Gincul
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Bertrand Pujol
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Christine Lefort
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Vincent Hautefeuille
- Department of Gastroenterology, Amiens-Picardie University Hospital, Amiens, France
| | - Monique Fabre
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Jérome Cros
- Department of Pathology, Beaujon Hospital, Clichy, France
| | - Michèle Felce
- Department of Pathology, Beaujon Hospital, Clichy, France
| | | | - Alain Sauvanet
- Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital, Clichy, France
| | - Philippe Lévy
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France
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13
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Alvarez-Sanchez MV, Oria I, Luna OB, Pialat J, Gincul R, Lefort C, Bourdariat R, Fumex F, Lepilliez V, Scoazec JY, Salgado-Barreira A, Lemaistre AI, Napoléon B. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater? Surg Endosc 2016; 31:1564-1572. [PMID: 27530895 DOI: 10.1007/s00464-016-5141-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The therapeutic role of endoscopic papillectomy (EP) for early ampullary cancer (AC) is still controversial. The aim of the present study was to evaluate the curative potential of EP for early AC and to identify predictors of lymph node metastases (LNMs). METHODS We retrospectively reviewed 173 patients who were prospectively included in a database and who underwent EP between 1999 and 2013. Adenocarcinoma was present in 28 resected specimens. An additional surgery was proposed in cases of duodenal submucosal infiltration, duct ingrowth, R1 resection or lymphovascular invasion. Clinicopathological information and outcomes were collected, and predictors of LNMs were evaluated. RESULTS Duodenal submucosal invasion was present in 16/28 cases and LNMs, in 9/28 cases. ACs of the biliopancreatic subtype were smaller (NS); 100 % had submucosal invasion, and 71 % had LNMs. Smaller tumour size, biliopancreatic subtype and submucosal invasion were significantly correlated with LNMs (p < 0.028, p < 0.028 and p < 0.014). Predictive factors of LNMs in the multivariate analysis were submucosal invasion and tumour size (OR 0.032, p < 0.023 and OR 0.711, p < 0.035). EP was curative in 100 % of cancers with R0 resection and no evidence of submucosal or lymphovascular invasion. CONCLUSION EP may be curative for patients with AC limited to the duodenal mucosa or the sphincter of Oddi without lymphovascular invasion. Due to the presence of more invasive stages at diagnosis, EP may not be curative for ACs of the biliopancreatic subtype. The significance of tumour size is limited by other confounders, such as the histological subtype.
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Affiliation(s)
- María-Victoria Alvarez-Sanchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Inés Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - Olivia B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - Jean Pialat
- Office of Pathology, 41, Allée des Cyprès, Limonest, France
| | - Rodica Gincul
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lefort
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Raphael Bourdariat
- Department of Digestive Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Vincent Lepilliez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Jean Yves Scoazec
- Department of Pathology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | | | - Bertrand Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France.
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14
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Barret M, Lepilliez V, Coumaros D, Chaussade S, Leblanc S, Ponchon T, Fumex F, Chabrun E, Bauret P, Cellier C, Coron E, Bichard P, Bulois P, Charachon A, Rahmi G, Bellon S, Lerhun M, Arpurt JP, Koch S, Napoleon B, Vaillant E, Esch A, Farhat S, Robin F, Kaddour N, Prat F. The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey. United European Gastroenterol J 2016; 5:45-53. [PMID: 28405321 DOI: 10.1177/2050640616644392] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/20/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. MATERIAL AND METHODS All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period. RESULTS Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 (p = 0.004). En bloc resection improved from 77.1% to 91.7% (p < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p = 0.01) and perforations from 18.1% to 8.1% (p = 0.002) over time. No procedure-related mortality was recorded. CONCLUSIONS In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.
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Affiliation(s)
- Maximilien Barret
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Vincent Lepilliez
- Edouard Herriot Hospital, Lyon, France; Jean Mermoz Hospital, Lyon, France
| | | | | | - Sarah Leblanc
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | | | | | | | | | | | | | | | | | - Antoine Charachon
- Henri Mondor Hospital, Creteil, France, and Princess Grace Hospital, Monaco
| | | | | | | | | | | | | | | | - Anouk Esch
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | | | | | | | - Frédéric Prat
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
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15
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Napoléon B, Lemaistre AI, Pujol B, Caillol F, Lucidarme D, Bourdariat R, Morellon-Mialhe B, Fumex F, Lefort C, Lepilliez V, Palazzo L, Monges G, Filoche B, Giovannini M. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 2015; 47:26-32. [PMID: 25325684 DOI: 10.1055/s-0034-1390693] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS The differential diagnosis of solitary pancreatic cystic lesions is frequently difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a new technology enabling real-time imaging of the internal structure of such cysts. The aim of this pilot study was to identify and validate new diagnostic criteria on nCLE for pancreatic cystic lesions. PATIENTS AND METHODS A total of 31 patients with a solitary pancreatic cystic lesion of unknown diagnosis were prospectively included at three centers. EUS-FNA was combined with nCLE. The final diagnosis was based on either a stringent gold standard (surgical specimen and/or positive cytopathology) or a committee consensus. Six nonblinded investigators reviewed nCLE sequences from patients with the most stringent final diagnosis, and identified a single feature that was only present in serous cystadenoma (SCA). The findings were correlated with the pathology of archived specimens. After a training session, four blinded independent observers reviewed a separate independent video set, and the yield and interobserver agreement for the criterion were assessed. RESULTS A superficial vascular network pattern visualized on nCLE was identified as the criterion. It corresponded on pathological specimen to a dense and subepithelial capillary vascularization only seen in SCA. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this sign for the diagnosis of SCA were 87 %, 69 %, 100 %, 100 %, and 82 %, respectively. Interobserver agreement was substantial (κ = 0.77). CONCLUSION This new nCLE criterion seems highly specific for the diagnosis of SCA. The visualization of this criterion could have a direct impact on the management of patients by avoiding unnecessary surgery or follow-up.Clinicaltrials.gov NCT01563133.
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Affiliation(s)
- Bertrand Napoléon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | | | - Bertrand Pujol
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | - Fabrice Caillol
- Department of Hepatogastroenterology, Institut Paoli Calmettes, Marseille, France
| | - Damien Lucidarme
- Medicosurgical Department of Hepatogastroenterology, Saint-Philibert Hospital Centre, Lomme-lès-Lille, France
| | - Raphaël Bourdariat
- Department of Digestive Surgery, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | | | - Fabien Fumex
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | - Christine Lefort
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | - Vincent Lepilliez
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
| | - Laurent Palazzo
- Department of Gastroenterology, Clinique du Trocadéro, Paris, France
| | - Geneviève Monges
- Department of Biopathology, Institut Paoli Calmettes, Marseille, France
| | - Bernard Filoche
- Medicosurgical Department of Hepatogastroenterology, Saint-Philibert Hospital Centre, Lomme-lès-Lille, France
| | - Marc Giovannini
- Department of Hepatogastroenterology, Institut Paoli Calmettes, Marseille, France
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Vanbiervliet G, Napoléon B, Saint Paul MC, Sakarovitch C, Wangermez M, Bichard P, Subtil C, Koch S, Grandval P, Gincul R, Karsenti D, Heyries L, Duchmann JC, Bourgaux JF, Levy M, Calament G, Fumex F, Pujol B, Lefort C, Poincloux L, Pagenault M, Bonin EA, Fabre M, Barthet M. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46:1063-70. [PMID: 25098612 DOI: 10.1055/s-0034-1377559] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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 AND STUDY AIMS A new core biopsy needle for endoscopic ultrasound (EUS)-guided sampling has recently been developed. The aim of this prospective multicenter study was to compare this needle with a standard needle in patients with solid pancreatic masses. PATIENTS AND METHODS Consecutive patients with solid pancreatic masses referred to 17 centers for EUS-guided sampling were included. Each patient had two passes with a standard 22G needle and a single pass with a 22G core needle performed in a randomized order. Samples from both needles were separately processed for liquid-based cytology and cell-block preparation and were assessed independently by two blinded expert pathologists. The primary endpoint was the accuracy of the detection of malignancy. The reference standard was based on further cytohistological analysis obtained under ultrasound or computed tomography scanning, endoscopic or surgical guidance, and/or by clinical follow-up with repeated imaging examinations for at least 12 months. The secondary endpoints were the rate of technical failure and the quality of the cytohistological samples obtained. RESULTS Of the 80 patients included (49 men; mean age 67.1 ± 11.1), 87.5 % had final malignant diagnoses (adenocarcinoma n = 62, 77.5 %). There was no difference between the needles in diagnostic accuracy (standard needle 92.5 % vs. core needle 90 %; P = 0.68) or technical failure. Both pathologists found the overall sample quality significantly better for the standard needle (expert 1, P = 0.009; expert 2, P = 0.002). CONCLUSIONS The diagnostic accuracy of EUS sampling for solid pancreatic masses using standard and core needles seems comparable but with a better overall histological sample quality for the former. ClinicalTrial.gov identifier: NCT01479803.
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Affiliation(s)
- Geoffroy Vanbiervliet
- Université de Nice Sophia Antipolis, Faculté de Médecine and Centre Hospitalier Universitaire de l'Archet 2, Pôle digestif, Nice, France
| | | | | | - Charlotte Sakarovitch
- Centre Hospitalier Universitaire Cimiez, Département de la recherche clinique, Nice, France
| | - Marc Wangermez
- Centre Hospitalier Universitaire de Poitiers, Gastroentérologie, Poitiers, France
| | - Philippe Bichard
- Hôpitaux Universitaires de Genève, Gastroentérologie, Genève, Switzerland
| | - Clément Subtil
- Centre hospitalier Universitaire du Haut-Lévêque, Gastroentérologie, Pessac, France
| | - Stéphane Koch
- Centre hospitalier Universitaire de Besançon, Gastroentérologie, Besançon, France
| | - Philippe Grandval
- Assistance publique des hôpitaux de Marseille, Hôpital de la Timone, Gastroentérologie, Marseille, France
| | - Rodica Gincul
- Hospices civils de Lyon, Gastroentérologie, Lyon, France
| | - David Karsenti
- Clinique de Bercy, Pôle digestif, Charenton le Pont, France
| | - Laurent Heyries
- Assistance publique des hôpitaux de Marseille, Hôpital de la Conception, Gastroentérologie, Marseille, France
| | | | | | - Michaël Levy
- Assistance Publique des hôpitaux de Paris, Hôpital Mondor, Gastroentérologie, Créteil, France
| | - Gilles Calament
- Centre Hospitalier Universitaire de la Cavale Blanche, Gastroentérologie, Brest, France
| | - Fabien Fumex
- Hôpital Privé Mermoz, Gastroentérologie, Lyon, France
| | | | | | - Laurent Poincloux
- Centre Hospitalier Universitaire Estaing, Gastroentérologie, Clermont Ferrand, France
| | - Maël Pagenault
- Centre Hospitalier Universitaire de Pontchaillou, Gastroentérologie, Rennes, France
| | - Eduardo Aimé Bonin
- Assistance publique des hôpitaux de Marseille, Hôpital Nord, Gastroentérologie, Marseille, France
| | - Monique Fabre
- Gustave Roussy, Pathologie Morphologique, Villejuif, France
| | - Marc Barthet
- Assistance publique des hôpitaux de Marseille, Hôpital Nord, Gastroentérologie, Marseille, France
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Chaput U, Heresbach D, Audureau E, Vanbiervliet G, Gaudric M, Bichard P, Bauret P, Coumaros D, Ponchon T, Fumex F, Bensoussan E, Lamouliatte H, Chryssostalis A, Robin F, Prat F. Comparison of a standard fully covered stent with a super-thick silicone-covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study. United European Gastroenterol J 2014; 1:93-102. [PMID: 24917946 DOI: 10.1177/2050640613476501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 12/07/2012] [Accepted: 01/07/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents. OBJECTIVE Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS). PATIENTS AND METHODS The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N = 24), and BS-FCMS were used in group 2 (N = 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months' recurrence rate and stent-related morbidity. RESULTS Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p < 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p = 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p = 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6-12 months) and 1 month (group 2, 0.1-6 months). Study limitations include its nonrandomized design. CONCLUSION The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.
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Affiliation(s)
- Ulriikka Chaput
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Denis Heresbach
- Hepato-gastroenterology Department, Hôpital Pontchaillou, Rennes, France
| | - Etienne Audureau
- Biostatistical and Epidemiology Unit, Hôpital Hôtel Dieu, Université Paris Descartes, Paris, France
| | | | - Marianne Gaudric
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Philippe Bichard
- Hepato-gastroenterology Department, Centre Hospitalier Universitaire La Tronche, Grenoble, France
| | - Paul Bauret
- Hepato-gastroenterology Department, Hôpital Saint Eloi, Montpellier, France
| | - Dimitri Coumaros
- Hepato-gastroenterology Department, Hôpital Civil de Strasbourg, Strasbourg, France
| | - Thierry Ponchon
- Hepato-gastroenterology Department, Hôpital Edouard Herriot, Lyon, France
| | - Fabien Fumex
- Hepato-gastroenterology Department, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint Priest en Jarez, France
| | | | - Hervé Lamouliatte
- Hepato-gastroenterology Department, Hôpital Saint-André, Bordeaux, France
| | - Ariane Chryssostalis
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
| | - Françoise Robin
- Société Française d'Endoscopie Digestive, Lyon and Paris, France
| | - Frédéric Prat
- Hepato-gastroenterology Department, Université Paris-Descartes, Hôpital Cochin, Paris, France
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Gincul R, Palazzo M, Pujol B, Tubach F, Palazzo L, Lefort C, Fumex F, Lombard A, Ribeiro D, Fabre M, Hervieu V, Labadie M, Ponchon T, Napoléon B. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy 2014; 46:373-9. [PMID: 24532350 DOI: 10.1055/s-0034-1364969] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Histology is the gold standard for the diagnosis of pancreatic adenocarcinoma. However, the negative predictive value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis remains low. The aims of this prospective multicenter study were: (1) to compare the performance of contrast-harmonic EUS (CH-EUS) with that of EUS-FNA for the diagnosis of pancreatic adenocarcinoma; (2) to assess the intra- and interobserver concordances of CH-EUS. PATIENTS AND METHODS A total of 100 consecutive patients with a solid pancreatic mass of unknown origin were prospectively included at three centers (July 2009 - April 2010). All patients were examined by CH-EUS followed by EUS-FNA. Absence of vascular enhancement at CH-EUS was regarded as a sign for pancreatic adenocarcinoma. The final diagnosis (gold standard) was based on pathological examination (EUS-FNA, surgery) or 12-month follow-up. RESULTS The final diagnoses were: 69 adenocarcinoma, 10 neuroendocrine tumors, 13 chronic pancreatitis, and 8 other lesions. In diagnosing adenocarcinoma, CH-EUS and EUS-FNA had respective accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 95 %, 96 %, 94 %, 97 %, and 91 %, and of 95 %, 93 %, 100 %, 100 %, and 86 % without significant difference. Five false-negative cases with EUS-FNA were correctly classified by CH-EUS. Interobserver agreement (seven endosonographers) was good (kappa 0.66). Intraobserver agreement was good to excellent (kappa 0.76 for junior, 0.90 for senior). CONCLUSIONS The performance of CH-EUS for the diagnosis of pancreatic adenocarcinoma was excellent. The good intra- and interobserver concordances suggest an excellent reproducibility. CH-EUS could help to guide the choice between surgery and follow-up when EUS-FNA is inconclusive.
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Affiliation(s)
- Rodica Gincul
- Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
| | - Maxime Palazzo
- Department of Gastroenterology, Beaujon Hospital, Public Assistance Hospitals of Paris, France
| | - Bertrand Pujol
- Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
| | - Florence Tubach
- Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France
| | - Laurent Palazzo
- Department of Gastroenterology, Clinic of Trocadero, Paris, France
| | - Christine Lefort
- Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
| | - Alexandra Lombard
- Department of Epidemiology and clinical research, Bichat Hospital, Public Assistance Hospitals of Paris, France
| | - Daniel Ribeiro
- Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
| | - Monique Fabre
- Department of Anatomopathology, Gustave Roussy Hospital, Villejuif, France
| | - Valerie Hervieu
- Department of Anatomopathology, Edouard Herriot hospital, Hospices Civils of Lyon, France
| | - Michel Labadie
- Department of Anatomopathology, Jean Mermoz Privat Hospital, Lyon, France
| | - Thierry Ponchon
- Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils of Lyon, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Jean Mermoz Privat Hospital, Lyon, France
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Rahmi G, Samaha E, Vahedi K, Ponchon T, Fumex F, Filoche B, Gay G, Delvaux M, Lorenceau-Savale C, Malamut G, Canard JM, Chatellier G, Cellier C. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol 2013; 28:992-8. [PMID: 23488827 DOI: 10.1111/jgh.12188] [Citation(s) in RCA: 39] [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] [Accepted: 02/15/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Spiral enteroscopy is a novel technique for small bowel exploration. The aim of this study is to compare double-balloon and spiral enteroscopy in patients with suspected small bowel lesions. METHODS Patients with suspected small bowel lesion diagnosed by capsule endoscopy were prospectively included between September 2009 and December 2010 in five tertiary-care academic medical centers. RESULTS After capsule endoscopy, 191 double-balloon enteroscopy and 50 spiral enteroscopies were performed. Indications were obscure gastrointestinal bleeding in 194 (80%) of cases. Lesions detected by capsule endoscopy were mainly angioectasia. Double-balloon and spiral enteroscopy resulted in finding one or more lesions in 70% and 75% of cases, respectively. The mean diagnosis procedure time and the average small bowel explored length during double-balloon and spiral enteroscopy were, respectively, 60 min (45-80) and 55 min (45-80) (P=0.74), and 200 cm (150-300) and 220 cm (200-300) (P=0.13). Treatment during double-balloon and spiral enteroscopy was possible in 66% and 70% of cases, respectively. There was no significant major procedure-related complication. CONCLUSION Spiral enteroscopy appears as safe as double-balloon enteroscopy for small bowel exploration with a similar diagnostic and therapeutic yield. Comparison between the two procedures in terms of duration and length of small bowel explored is slightly in favor of spiral enteroscopy but not significantly.
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Affiliation(s)
- Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Rene Descartes University, France.
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20
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Voermans RP, Ponchon T, Schumacher B, Fumex F, Bergman JJGHM, Larghi A, Neuhaus H, Costamagna G, Fockens P. Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial. Gastrointest Endosc 2011; 74:1285-93. [PMID: 21981813 DOI: 10.1016/j.gie.2011.07.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 07/27/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND EUS-guided drainage of pancreatic fluid collections (PFCs) is commonly performed with oblique-viewing echoendoscopes. However, accessing the PFC under an oblique angle can make drainage difficult. These difficulties might be overcome by using a forward-viewing echoendoscope. OBJECTIVE To compare endoscopic PFC drainage with an oblique-viewing versus a forward-viewing echoendoscope with emphasis on ease of endoscopic drainage. DESIGN Multicenter, randomized, controlled trial. SETTING Four tertiary-care referral centers. PATIENTS This study involved 58 patients with PFCs. INTERVENTION Patients with PFCs (≥ 6 cm) in whom drainage was indicated were randomized to receive EUS-guided drainage with a forward-viewing echoendoscope or an oblique-viewing echoendoscope. In cases of failed drainage, patients were crossed over to the other study arm. MAIN OUTCOME MEASUREMENTS Ease of EUS-guided drainage measured by procedure time. Secondary endpoints included technical success, EUS endoscope preference, clinical success, and adverse events. RESULTS Fifty-eight consecutive patients underwent randomization, of whom 52 were available for primary endpoint analysis. All 26 EUS-guided procedures done with the oblique-viewing echoendoscope and 24 of the 26 procedures done with the forward-viewing echoendoscope were technically successful. Mean (± standard deviation) procedure time was 24:55 ± 9:58 minutes in the forward-viewing echoendoscope group and 27:04 ± 9:58 minutes in the oblique-viewing echoendoscope group (P = .44). Median overall procedure ease was graded as equal (easy) in both groups. Drainage-related adverse events occurred in 2 patients (8%) in the forward-viewing echoendoscope group versus none in the oblique-viewing echoendoscope group (P = .56). Overall clinical success was achieved in 82% of patients (95% confidence interval, 69%-91%). LIMITATIONS Derived main outcome parameter and highly specialized endoscopists in tertiary-care referral centers. CONCLUSION This multicenter, randomized, controlled trial comparing the performance of oblique-viewing echoendoscopes and forward-viewing echoendoscopes in draining PFCs did not show a difference in ease of EUS-guided drainage or procedure safety and efficacy between the forward-viewing echoendoscope and the oblique-viewing echoendoscope. Clinical success was achieved in 82% of patients.
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Affiliation(s)
- Rogier P Voermans
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
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21
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Mohammedi I, Fumex F, Vial V, Leclercq P, Napoléon B. [End-tidal carbon dioxine is increasing during CO(2) insufflation in endoscopy]. Ann Fr Anesth Reanim 2010; 29:497. [PMID: 20547032 DOI: 10.1016/j.annfar.2010.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Affiliation(s)
- F Fumex
- Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France.
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23
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Lapalus MG, Ben Soussan E, Saurin JC, Favre O, D'Halluin PN, Coumaros D, Gaudric M, Fumex F, Antonietti M, Gaudin JL, Jacob P, Heresbach D, Pilichos C, Fan R, Mozer M, Heyries L, Dumortier J, Ponchon T. Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial. Gastrointest Endosc 2008; 67:1091-6. [PMID: 18513551 DOI: 10.1016/j.gie.2007.11.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 11/24/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND Capsule endoscopy (CE) is the first procedure to explore the small bowel in obscure GI bleeding (OGB). OBJECTIVE To evaluate the role of bowel preparation with oral sodium phosphate (NaP) in this indication. DESIGN A prospective multicenter, controlled, randomized, blind study. METHODS A total of 129 patients with the diagnosis of OGB were included and were randomized into 2 groups (group A [n = 64] and group B [n = 63]). In group A, a CE was performed after an 8-hour fasting period. In group B, patients were asked to drink 2 doses of 45 mL NaP before swallowing the capsule. The quality of the images was assessed at 5 different locations of the small bowel. Bowel cleanliness and visibility were evaluated by using 2 scoring systems, which included assessing the presence of bubbles, liquid, and the rate of visibility. RESULTS A total of 127 patients (53 men; mean age 56.9 years, range 19-90 years) were analyzed for the preparation and detection of lesions (2 patients were not able to swallow the capsule). No difference was observed for cleanliness and visibility between the 2 groups at any of the small-bowel segments; no difference was found for gastric transit time (39.8 minutes vs 35.7 minutes, P = .63), small-bowel transit time (257.5 minutes vs 248.6 minutes, P = .59), and the detection of lesions (35.9% vs 42.8%, P = .54). LIMITATIONS The evaluation of bowel cleanliness was based on subjective features. CONCLUSIONS The results of the present study, despite a significant number of limitations, did not support that small-bowel preparation with oral NaP can be recommended for CE exploration in patients with OGB.
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Grève E, Dumas O, Fumex F, Cambou M, Burgard G, Décousus M, Audigier JC. [Solitary pancreatic metastasis four years after curative treatment for rectal carcinoma]. ACTA ACUST UNITED AC 2008; 32:258-60. [PMID: 18456107 DOI: 10.1016/j.gcb.2008.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Dumortier J, Josso C, Roman S, Fumex F, Lepilliez V, Prost B, Lot M, Guillaud O, Petit-Laurent F, Lapalus MG, Ponchon T. Prospective evaluation of a new ultrathin one-plane bending videoendoscope for transnasal EGD: a comparative study on performance and tolerance. Gastrointest Endosc 2007; 66:13-9. [PMID: 17591468 DOI: 10.1016/j.gie.2006.11.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 11/27/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND EGD, with small-diameter endoscopes, is routinely performed via a nasal route in adults. OBJECTIVE To evaluate a new ultrathin one-plane bending videoendoscope for transnasal EGD. DESIGN Single center, prospective, randomized study. SETTING Edouard Herriot University Hospital. PATIENTS A total of 122 outpatients (median age, 49 years [18-81 years], 62 men and 60 women) were randomized into 2 groups (on a 2:1 basis) according to the endoscope used: (1) a standard 5.9-mm-diameter videoendoscope (80 patients) or (2) a one-plane bending high resolution 4.9-mm-diameter videoendoscope (42 patients). MAIN OUTCOME MEASUREMENTS The operator assessed the quality of examination by using standard scores or a 100-mm visual scale. Patients quantified tolerance by using a 100-mm visual scale. RESULTS The duration of the procedure was the same in each group. The feasibility of transnasal insertion was significantly higher when using the 4.9-mm-diameter endoscope (97.61% [41/42 patients] vs 88.75% [71/80 patients], P<.05). The tolerance of EGD was significantly better in the group with the small videoendoscope, for global discomfort, pain, belching, and bloating. Similarly, acceptation of a new EGD in similar conditions was higher in group 2 (92.9% vs 80%, P<.05). The quality of examination (global, lavage, inflation, suction) was not different between the 2 groups. LIMITATIONS Evaluation of patient tolerance and quality of examination was based on subjective features. CONCLUSIONS Availability of a new ultrathin one-plane bending videoendoscope represents a major technical improvement for transnasal EGD, which significantly improves both feasibility and patient tolerance, without affecting the quality of the examination.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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26
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Fumex F, Coumaros D, Napoleon B, Barthet M, Laugier R, Yzet T, Le Sidaner A, Desurmont P, Lamouliatte H, Letard JC, Canard JM, Prat F, Rey JF, Ponchon T. Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy 2006; 38:787-92. [PMID: 17001568 DOI: 10.1055/s-2006-944515] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic biliary stenting is now a well-established treatment method in patients with unresectable malignant biliary obstruction. Despite advances with metal stents, the problem of stent occlusion has not yet been resolved. Covered metal stents could reduce the occlusion rate by preventing tumor ingrowth, but have not been well evaluated. A prospective multicenter study was therefore conducted to evaluate the efficacy and disadvantages of covered Wallstents. PATIENTS AND METHODS Covered Wallstents were implanted endoscopically in 62 patients with inoperable distal malignant biliary obstruction. Complications, stent patency, and patient survival were analyzed. RESULTS Stent insertion was achieved in 61 of the 62 patients (98.4 %). Procedure-related complications were observed in four patients, consisting of minor pancreatitis (n = 2) and abdominal pain due to stent expansion (n = 2). There was no procedure-related mortality. Seven patients died too early for proper assessment, so that a total of 54 patients were ultimately evaluated. Stent dysfunction occurred in 17 of the 54 patients (31.5 %). The reasons for dysfunction were proximal tumor overgrowth (n = 5), migration (n = 3), lithiasis or food impaction (n = 3), cholangitis without the need for a repeat biliary intervention (n = 5), and unknown (n = 1). The median period of stent patency was 142 days. No tumor ingrowth was observed. Acute cholecystitis was diagnosed in five patients (10 %) and was responsible for one death. Three stents were successfully removed. CONCLUSIONS Covered biliary metal stents are effective for the drainage of distal malignant biliary obstruction, with a dysfunction rate apparently similar to that of uncovered stents. However, the risk of acute cholecystitis appears to be a major concern with this type of stent in patients with gallbladder in situ. Further comparative studies are needed.
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Affiliation(s)
- F Fumex
- Deparment of Gastroenterology, North Hospital, University of Saint-Etienne, France.
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27
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Lapalus MG, Dumortier J, Fumex F, Roman S, Lot M, Prost B, Mion F, Ponchon T. Esophageal capsule endoscopy versus esophagogastroduodenoscopy for evaluating portal hypertension: a prospective comparative study of performance and tolerance. Endoscopy 2006; 38:36-41. [PMID: 16429353 DOI: 10.1055/s-2006-924975] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertension in cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. PATIENTS AND METHODS In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100-mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients' preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. RESULTS Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6 - 1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 %); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). CONCLUSIONS Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.
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Affiliation(s)
- M-G Lapalus
- Dept. of Digestive Diseases, Edouard Herriot Hospital Lyon, France.
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