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Spindler L, Etienney I, Abramowitz L, de Parades V, Pigot F, Siproudhis L, Adam J, Balzano V, Bouchard D, Bouta N, Bucau M, Carlo A, Chanal J, Charpentier C, Clifford G, Draullette M, Fathallah N, Ferré V, Fléjou JF, Fouéré S, Higuero T, Kassouri L, Kurt S, Laurain A, Leclerc E, Lepiller Q, Lesage AC, Mège D, Ménard A, Merle P, Mortreux P, Noël C, Péré H, Prétet JL, Roland D, Staumont G, Tracanelli L, Vuitton L, Wylomanski S, Zaegel-Faucher O. Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice. Tech Coloproctol 2024; 28:23. [PMID: 38198036 PMCID: PMC10781838 DOI: 10.1007/s10151-023-02899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.
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Affiliation(s)
- L Spindler
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - I Etienney
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - L Abramowitz
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - V de Parades
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Siproudhis
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Adam
- Service d'Anatomopathologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Balzano
- Service de Gastroentérologie et Oncologie Digestive, CHU Tours, Tours, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - N Bouta
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - M Bucau
- Service d'Anatomopathologie, AP-HP Hôpital Bichat-Claude Bernard, Paris, France
| | - A Carlo
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Chanal
- Service de Dermatologie, AP-HP, Hôpital Tarnier, Paris, France
| | - C Charpentier
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - G Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research On Cancer, Lyon, France
| | - M Draullette
- Service d'Hépato-Gastroentérologie et Assistance Nutritive, AP-HP, Hôpital Beaujon, Clichy, France
| | - N Fathallah
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Ferré
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - J-F Fléjou
- Service d'Anatomopathologie, Cerbapath, Paris, France
| | - S Fouéré
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
- Centre des Maladies Sexuellement Transmises, AP-HP, Hôpital Saint-Louis, Paris, France
| | - T Higuero
- Gastro-entérologue, proctologue medico-chirurgical, Beausoleil, France
| | - L Kassouri
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Kurt
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Laurain
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - E Leclerc
- Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Inserm, 3iHP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Q Lepiller
- Laboratoire de Virologie, CHU de Besançon, Besançon, France
| | - A-C Lesage
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - D Mège
- Service de Chirurgie Digestive, Université d'Aix Marseille, AP-HM, Hôpital de la Timone, Marseille, France
| | - A Ménard
- Institut Hospitalo-Universitaire Méditerranée Infection, AP-HM, Hôpital Nord, Université d'Aix Marseille, Marseille, France
| | - P Merle
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - P Mortreux
- Service de Gastroentérologie, Centre Hospitalier de Bethune Beuvry, Beuvry, France
| | - C Noël
- Service d'Hépato-Gastroentérologie, CHU de Brest, Brest, France
| | - H Péré
- Laboratoire de Virologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Functional Genomics of Solid Tumors (FunGeST), Centre de Recherche des Cordelier, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - J-L Prétet
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - D Roland
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - G Staumont
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - L Tracanelli
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Vuitton
- Service de Gastroentérologie, CHU de Besançon, Université de Bourgogne Franche-Comté, Besançon, France
| | - S Wylomanski
- Service de Gynécologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - O Zaegel-Faucher
- Service d'Immuno-Hématologie Clinique, AP-HM, CHU Sainte-Marguerite, Marseille, France
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Mege D, Meurette G, Brochard C, Damon H, Lambrescak E, Faucheron JL, Wyart V, Lehur PA, Sielezneff I, Siproudhis L, Mion F, Etienney I, Houivet E, Bridoux V, Leroi AM. Sacral nerve modulation for faecal incontinence: influence of age on outcomes and complications. A multicentre study. Colorectal Dis 2019; 21:1058-1066. [PMID: 30985984 DOI: 10.1111/codi.14649] [Citation(s) in RCA: 7] [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: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 02/08/2023]
Abstract
AIM Faecal incontinence is frequent in the elderly. Little is currently known about the efficacy of sacral nerve modulation (SNM) in the elderly. The present study aimed to assess the impact of age on the outcome of SNM and on the surgical revision and explantation rates by comparing the results of a large data set of patients. METHOD Prospectively collected data from patients who underwent an implant procedure between January 2010 and December 2015 in seven French centres were retrospectively evaluated. In total, 352 patients [321 women; median age (range): 63 (24-86) years] were included. Clinically favourable and unfavourable outcomes, and surgical revision and explantation rates, were compared according to the age of the patients. RESULTS A similar outcome was observed when comparing patients < 70 years and ≥ 70 years (a favourable outcome in 79.2% and 76.2%, respectively, P = 0.89). The probability of a successful treatment as a function of time was similar for the two age groups (< 70 years and ≥ 70 years, P = 0.54). The explantation and revision rates were not influenced by age (explantation rate: 17% in patients < 70 years vs 14% in patients ≥ 70 years, P = 0.89; and revision rate: 42% in patients < 70 years vs 40% in patients ≥ 70 years, P = 0.89). The probability of explantation as a function of time was similar for the two age groups (P = 0.82). The limitations of this study were its retrospective status, the rate of loss at follow-up and different durations of patient follow-up. CONCLUSIONS Our results suggest that patients ≥ 70 years suffering from faecal incontinence benefit from SNM with a similar risk as a younger population.
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Affiliation(s)
- D Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - G Meurette
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France
| | - C Brochard
- Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, CHU Pontchaillou, CIC1414, INPHY, INSERM U1241, Université de Rennes 1, Rennes, France
| | - H Damon
- Digestive Physiology, University Hospital of Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France
| | - E Lambrescak
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France.,University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - V Wyart
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France
| | - P-A Lehur
- Digestive and Endocrine Surgery Clinic, Diseases of the Digestive Tract Institute, University Hospital of Nantes, Nantes, France.,Department of General Surgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - I Sielezneff
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - L Siproudhis
- Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, CHU Pontchaillou, CIC1414, INPHY, INSERM U1241, Université de Rennes 1, Rennes, France
| | - F Mion
- Digestive Physiology, University Hospital of Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France
| | - I Etienney
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - E Houivet
- Biostatistics Unit, INSERM CIC 1404, Rouen, France
| | - V Bridoux
- Department of Digestive Surgery, Normandie Univ, UNIROUEN Inserm U1073, Rouen University Hospital, Rouen, France
| | - A-M Leroi
- Department of Digestive Physiology and CIC-CRB 1404, Normandie Univ, UNIROUEN, Inserm U1073, Rouen University Hospital, Rouen, France
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Egal A, London J, Lidove O, Atienza P, Etienney I. [Anorectal manifestations in systemic diseases]. Rev Med Interne 2019; 40:729-732. [PMID: 31400822 DOI: 10.1016/j.revmed.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
Numerous systemic diseases (vasculitis, connective tissue disease or sarcoidosis) can display an involvement of the perianal skin, the rectum and/or the anus. Such knowledge is important in order to treat these complications specifically when possible. Lesions of the anorectum arising from systemic diseases can sometimes cause perforations in the peritoneal cavity (if concerning the higher portion of the rectum) and/or fistulization to the anal margin. Differential diagnosis, mostly infectious or inflammatory (Crohn's disease) must be ruled out in every case. Other systemic diseases can display specific manifestations as this is the case in scleroderma which can lead to anal incontinence. Despite the relative rarity of these manifestations, their ignorance would forbid global management of these complex diseases. It should thus be detected in each consultation and a regular follow-up must be provided with a proctologist and/or a gastroenterologist when needed.
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Affiliation(s)
- A Egal
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France.
| | - J London
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - P Atienza
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
| | - I Etienney
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
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Etienney I, Canestri A, Poizot-Martin I, Arvieux C, Piroth L, Reynes J, Ferry T, Patey O, Heard I, Fléjou J. Dépistage des lésions anales précancéreuses chez les HSH VIH +. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arana R, Fléjou JF, Si-Mohamed A, Bauer P, Etienney I. Clinicopathological and virological characteristics of superficially invasive squamous-cell carcinoma of the anus. Colorectal Dis 2015; 17:965-72. [PMID: 25784158 DOI: 10.1111/codi.12951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/01/2014] [Accepted: 02/12/2015] [Indexed: 02/08/2023]
Abstract
AIM The clinicopathological and virological characteristics of anal superficially invasive squamous-cell carcinoma (SISCCA) were determined. METHOD Seventeen patients with a completely excised stage T1N0M0 anal squamous-cell carcinoma (SCC) were included in the study. The tumours were divided into superficially invasive and invasive. Patients with anal high-grade squamous intraepithelial dysplasia, which corresponded to anal intraepithelial neoplasia (AIN) Grades 2 or 3, were used as a control group. Clinicopathological and virological characteristics were investigated. Overall survival and cancer recurrence-free survival were also assessed. RESULTS Of the 17 patients, 12 (70.5%) were men. Ten (58.8%) were human immunodeficiency virus positive. Seven (41%) patients met the same diagnostic criteria as those recently proposed for anal SISCCA. According to the results obtained using the polymerase chain reaction, human papillomavirus (HPV) 16 was the most commonly detected (94%) type of HPV. Twelve (70.6%) patients with an inadequate surgical margin around the tumour received adjuvant radiotherapy, including the two (11.7%) tumours that locally recurred, one of which was an anal SISCCA. Superficially invasive anal cancers differed from the other T1N0M0 anal carcinomas according to the clinical presentation and the absence of lymph-vascular invasion (LVI). There were no differences in cancer recurrence-free and overall survival rates between the superficially invasive and invasive groups. CONCLUSION Anal SISCCAs have a low index of clinical suspicion, are associated with an absence of LVI and are linked to high-risk HPV. Prospective studies are needed to define the clinical behaviour of these anal tumours and to determine their best therapeutic strategy.
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Affiliation(s)
- R Arana
- Department of Pathology, Hôpital Saint-Antoine, Hôpitaux Universitaires Paris Est, AP-HP, Paris, France.,Université Pierre et Marie Curie - Paris 6, Paris, France
| | - J-F Fléjou
- Department of Pathology, Hôpital Saint-Antoine, Hôpitaux Universitaires Paris Est, AP-HP, Paris, France.,Université Pierre et Marie Curie - Paris 6, Paris, France
| | - A Si-Mohamed
- Department of Virology, Hôpital Européen Georges Pompidou, Hôpitaux Universitaires Paris Ouest, AP-HP, Paris, France
| | - P Bauer
- Department of Proctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - I Etienney
- Department of Proctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
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Leroi AM, Siproudhis L, Etienney I, Damon H, Zerbib F, Amarenco G, Vitton V, Faucheron JL, Thomas C, Mion F, Roumeguère P, Gourcerol G, Bouvier M, Lallouche K, Menard JF, Queralto M. Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (CONSORT 1a). Am J Gastroenterol 2012; 107:1888-96. [PMID: 23032981 DOI: 10.1038/ajg.2012.330] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [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
OBJECTIVES The objective of this study was to show that although transcutaneous electrical tibial nerve stimulation (TENS) is being increasingly used to treat fecal incontinence (FI), its efficacy has never been proved using controlled trials. METHODS In this randomized, double-blind, sham-controlled trial, 144 patients aged 30-82 years from nine centers were randomly assigned to receive either active or sham stimulations for 3 months. The primary end point was the response to treatment based on the number of incontinence and urgency episodes. Secondary end points were severity scores, quality of life scores, delay to postpone defecation, patient self-assessment of treatment efficacy, physician assessment of TENS efficacy, anorectal manometry, and adverse events. RESULTS No statistically significant difference was seen between active and sham TENS in terms of an improvement in the median number of FI/urgency episodes per week. Thirty-four patients (47%) who received the active TENS treatment exhibited a >30% decrease in the FI severity score compared with 19 patients (27%) who received the sham treatment (odds ratio 2.4, 95% confidence interval 1.1-5.1, P=0.02). No differences in delay to postpone defecation, patient self-assessment of treatment efficacy, or anorectal manometry were seen between the two groups. The evaluating physicians rated the active stimulations as more effective than the sham stimulations (P=0.01). One minor therapy-related adverse event was observed (1.5%) (see Supplementary Consort 1b). CONCLUSIONS We failed to demonstrate any benefit of TENS on our primary end-point.
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Affiliation(s)
- A M Leroi
- INSERM U1073, Service de Physiologie Digestive, Hôpital Charles Nicolle, CHU Rouen, INSERM CIC 0204, Rouen, France.
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Abstract
AIM To prospectively evaluate the long-term results and assess patient satisfaction after stapled haemorrhoidopexy (HS). METHOD A total of 150 patients (121 male patients) with symptomatic grade II (n = 50) or III (n = 100) haemorrhoids underwent stapled HS. Patients were followed up during consultations at regular intervals, allowing prospective data collection. A final telephone follow up was also undertaken. RESULTS Follow up data were obtained for 130 of 150 patients (86.6%). After a median follow up of 39 months (range, 12-72), 90% of the patients were fully satisfied and 92% were free of haemorrhoidal symptoms. There were no intraoperative complications. Postoperative bleeding that required operation was observed in five patients (3.3%). Most late postoperative complications were benign and easily resolved: unexplained pain for over a month (n = 1), external haemorrhoidal thrombosis (n = 2), anal fissure (n = 6) one with hypertrophic papilla, anal fistula (n = 1), rectal stenosis (n = 1), anal incontinence for (n = 1). Eight patients needed rubber band ligation to treat persistent or recurrent symptomatic prolapse. Four patients (2.6%) were reoperated on during the follow up period but none for haemorrhoidal pathology. CONCLUSION Stapled HS procedure is effective and has low morbidity, high patient satisfaction and provided good long-term control of haemorrhoidal symptoms in the treatment of second and third-degree haemorrhoids.
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Affiliation(s)
- S Sultan
- Service de proctologie interventionnelle, Groupe hospitalier Diaconesses-Croix, Saint Simon, Paris, France.
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Abstract
OBJECTIVE The study aimed to evaluate the efficacy of fibrin glue in the treatment of complex anal fistula. METHOD Thirty consecutive patients with a complex anal fistula underwent glue instillation after an 8 week period of seton drainage. Cure was defined as complete closure of any secondary opening, absence of fistula seepage, and no abscess formation. RESULTS The mean age of the patients (15 males) was 40.5 (range, 22.8-69.1) years. The mean duration of follow-up was 11.7 (range, 0.2-33.5) months. Complete closure of the fistula was achieved in 17 patients at 1 month but in two patients a delayed abscess occurred. At the end of follow-up, 15 (50%) patients were considered to have been cured. The success rate was no different in cases of Crohn's disease or when postoperative antibiotic therapy was given. There was, however, a significant difference in success following regional vs general anaesthesia (68.4 vs 18.2% success, P = 0.02). CONCLUSION Fibrin glue cured 50% of our first 30 patients, and regional anaesthesia was predictive of success.
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Affiliation(s)
- V de Parades
- Proctologie médico-interventionnelle Groupe hospitalier Diaconesses - Croix Saint Simon, rue du Sergent Bauchat, Paris, France.
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Etienney I, Rabahi N, Cuenod CA, Hoffmann P, Charachon A, Bauer P. Fibrin glue sealing in the treatment of a recto-urethral fistula in Crohn's disease: a case report. ACTA ACUST UNITED AC 2010; 33:1094-7. [PMID: 19477614 DOI: 10.1016/j.gcb.2009.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/11/2009] [Accepted: 03/13/2009] [Indexed: 11/27/2022]
Abstract
Recto-urethral fistulas in Crohn's disease are rare, and managing them is difficult. The various surgical techniques are not reliably effective and are associated with a significant risk of morbidity. The rectal mucosal transposition flap technique, which is used most frequently, requires the rectal mucosa to be in a healthy condition. We report here on a case where treatment was by injecting fibrin glue into a complex fistula with a single anorectal point of origin but combining a median recto-urethrocutaneous tract with two deep lateral rectoperineal tracts. The patient had presented with active rectal Crohn's disease. This treatment produced complete closure, verified by MRI, of all the fistula tracts, which was still maintained after three years, and with normal anal continence. When confronted with this type of fistula, and particularly when the condition of the rectal mucosa is poor, the specialist should be encouraged by this good result to consider the injection of fibrin glue, a technique without risk of morbidity, as a first course of action.
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Affiliation(s)
- I Etienney
- Service de proctologie médico-interventionnelle, groupe hospitalier Diaconesses Croix-Saint-Simon, 18 rue du Sergent Bauchat, Paris, France.
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Etienney I, Bauer P. [Prevention of anal lesions due to human papillomavirus at the time of screening and vaccination]. Gastroenterol Clin Biol 2008; 32:942-945. [PMID: 18926652 DOI: 10.1016/j.gcb.2008.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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de Parades V, Etienney I, Thabut D, Beaulieu S, Tawk M, Assemekang B, Marié V, Toubia ML, Wehbe A, Mosnier H, Gadonneix P, Harvey T, Atienza P. Anal sphincter injury after forceps delivery: myth or reality? A prospective ultrasound study of 93 females. Dis Colon Rectum 2004; 47:24-34. [PMID: 14719147 DOI: 10.1007/s10350-003-0007-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery. All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status. Physical examination and endoanal ultrasonography were performed after delivery. RESULTS Between November 1999 and November 2000, 93 females were included in the study after their first forceps delivery. Eleven patients (11.8 percent) had a partial defect involving the external sphincter, visible on ultrasonography. One patient (1.1 percent) had a partial defect of external sphincter with complete defect of internal sphincter (sequelae of primary repair of a third-degree perineal tear). Seventeen patients (18.2 percent) had flatus incontinence, and four patients (4.3 percent) had liquid stool incontinence. A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P=0.02). The development of anal incontinence was not related to sphincter defect on ultrasonography. There was a strong association between perineal tear and sphincter defect visible on ultrasonography (odds ratio, 4.5 (range, 1.2-16.7)). CONCLUSIONS Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.
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Affiliation(s)
- V de Parades
- Proctologie Médico-Chirurgicale, Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris, France.
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Aparicio T, Desramé J, Lecomte T, Mitry E, Belloc J, Etienney I, Montembault S, Vayre L, Locher C, Ezenfis J, Artru P, Mabro M, Dominguez S. Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. Br J Cancer 2003; 89:1439-44. [PMID: 14562014 PMCID: PMC2394343 DOI: 10.1038/sj.bjc.6601310] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The tolerance and efficacy of oxaliplatin and irinotecan for metastatic colorectal cancer are unknown in elderly patients. Methods. All consecutive patients over 74 years treated with oxaliplatin or irinotecan for metastatic colorectal cancer were enrolled. The tumour response was assessed every 2–3 months and toxicity was collected at each cycle according to World Health Organisation criteria. A total of 66 patients were enrolled from 12 centres. The median age was 78 years (range, 75–88 years); 39 patients had no severe comorbidity according to the Charlson score. In total, 44 and 22 patients received oxaliplatin or irinotecan, respectively, in combination with 5-fluororuracil±folinic acid or raltitrexed in 64 patients. A total of 545 chemotherapy cycles were administered in first (41%), second (51%) or third line (8%). A dose reduction occurred in 190 cycles (35%). Complete response, partial response and stabilisation occurred in 1.5, 20 and 47% of patients, respectively. The median time to progression and overall survival were 6.8 and 11.2 months in first line and 6.3 and 11.6 months in second line, respectively. Grade 3 and 4 toxicity occurred in 42% of patients: neutropenia 17%, diarrhoea 15%, neuropathy 11%, nausea and vomiting 8% and thrombopenia 6%. There was no treatment-related death. In selected elderly patients, chemotherapy with oxaliplatin or irinotecan is feasible with manageable toxicity.
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Affiliation(s)
- T Aparicio
- Service d'Hépato-Gastroentérologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, AP-HP, Paris 75018, France.
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Aparicio T, Désramé J, Lecomte T, Mitry E, Belloc J, Etienney I, Montembault S, Vayre L, Loche C, Eizenfis J. 255 Oxaliplatin or irinotecan based chemotherapy for metastic colorectal cancer in the elderly. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND AND AIMS Several cases of acute colitis induced by non-steroidal anti-inflammatory drugs (NSAIDs) have been reported but the general role of recent NSAID intake as a risk factor for acute diarrhoea has not been studied to date. The aim of our study was to determine whether the risk of acute diarrhoea is increased by NSAIDs in a prospective series of acute diarrhoea cases which were seen by general practitioners in France and were serious enough to require a stool culture. Patients, physicians, and methods: A total of 285 consecutive patients with acute diarrhoea, seen by Sentinel general practitioners (GPs) between December 1998 and July 1999, were enrolled in a case crossover study in which each case served as his/her own control. GPs collected information on exposure to NSAIDs during the four month period preceding the onset of diarrhoea. The relative risk of NSAID related acute diarrhoea was estimated by comparing exposure to NSAIDs during a risk period preceding the onset of diarrhoea with exposure during the first part of the four month observation period. Three risk periods lasting for one, three, and six days before the onset of diarrhoea were considered. RESULTS The relative risks of acute diarrhoea due to recent NSAID intake were increased for all three risk periods. These risks and their confidence intervals were 2.9 (1.4-6.1) for the one day risk period, 2.7 (1.4-5.1) for the three day period, and 3.3 (2.0-5.4) for the six day period. CONCLUSION Recent NSAID intake emerges as a risk factor for acute diarrhoea. We suggest that acute diarrhoea seen in general practice, and not only acute colitis seen by gastroenterologists, should be considered as a potential complication of recent NSAID intake.
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Affiliation(s)
- I Etienney
- Service de Gastroentérologie, Hôpital Rothschild, and Epidémiologie et Sciences de l'Information, INSERM Unit 444, Paris, France
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Bouhnik Y, Etienney I, Nemeth J, Thevenot T, Lavergne-Slove A, Matuchansky C. Very late onset small intestinal B cell lymphoma associated with primary intestinal lymphangiectasia and diffuse cutaneous warts. Gut 2000; 47:296-300. [PMID: 10896925 PMCID: PMC1728014 DOI: 10.1136/gut.47.2.296] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As only a handful of lymphoma cases have been reported in conjunction with primary intestinal lymphangiectasia, it is not yet clear if this association is merely fortuitous or related to primary intestinal lymphangiectasia induced immune deficiency. We report on two female patients, 50 and 58 years old, who developed small intestinal high grade B cell lymphoma a long time (45 and 40 years, respectively) after the initial clinical manifestations of primary intestinal lymphangiectasia. They presented with a longstanding history of fluctuating protein losing enteropathy, multiple cutaneous plane warts, and markedly dilated mucosal and submucosal lymphatic channels in duodenal biopsies. One had a large ulcerated tumour of the proximal ileum and the other diffuse ileal infiltration. In both, histological examination showed centroblastic high grade B cell lymphoma associated with duodenojejuno-ileal mucosal and submucosal lymphangiectasia. They were subsequently successfully treated with surgery and postoperative chemotherapy (AVmCP: adriamycin, cyclophosphamide, Vm26, and prednisolone), and chemotherapy alone (PACOB: adriamycin, cyclophosphamide, vincristine, bleomycine, and prednisolone), respectively. A three year follow up in both cases showed persistent diffuse lymphangiectasia without evidence of lymphoma. The present findings support the hypothesis that primary intestinal lymphangiectasia is associated with lymphoma development.
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Affiliation(s)
- Y Bouhnik
- Department of Gastroenterology and Hepatology, Hôpital Lariboisière, Paris, France.
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Etienney I, Levy M, Lepicard A, Chaumette MT, Rahmouni A, Delchier JC. [Pancreatic metastasis of a renal adenocarcinoma manifesting as steatorrhea]. Gastroenterol Clin Biol 1999; 23:538-40. [PMID: 10416123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Paupard T, Etienney I, Patey O, Torrent J, Guez C, Bettan L, Emond JP, Lafaix C, Cattan D. [Endoscopic diagnosis of a biliodigestive fistula of tuberculous origin revealing acquired immunodeficiency syndrome]. Gastroenterol Clin Biol 1995; 19:1055-8. [PMID: 8729418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report the case of a 32-year-old Malian man with abdominal tuberculosis revealing acquired immunodeficiency syndrome. A gastroscopy was made for epigastric pain and showed caseum in a digestive fistula with acid fast bacilli. Mycobacterium tuberculosis infection was confirmed by sputum culture. An early antituberculous therapy was prescribed. Outcome was good with rapid fistula closing and slower mass diminution of the abdominal lymph nodes. This case report confirms nodal tuberculosis as a possible cause of digestive fistulae. Rapid endoscopic diagnosis of this tuberculous fistula led to diagnosis of acquired immunodeficiency syndrome and early adapted medical treatment without invasive diagnostic methods.
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Affiliation(s)
- T Paupard
- Service d'Hépato-Gastroentérologie, Centre Hospitalier, Villeneuve-Saint-Georges
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