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Gonzalez JM, Mion F, Pioche M, Garbay V, Baumstarck K, Boucekine M, Debourdeau A, Rivory J, Barthet M, Vitton V. Gastric peroral endoscopic myotomy versus botulinum toxin injection for the treatment of refractory gastroparesis: results of a double-blind randomized controlled study. Endoscopy 2024; 56:345-352. [PMID: 38141620 DOI: 10.1055/a-2235-3286] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Gastric peroral endoscopic myotomy (G-POEM) is a promising technique for treating refractory gastroparesis. We present the first double-blind randomized study comparing the clinical efficacy of G-POEM versus pyloric botulinum toxin injection (BTI). METHODS This randomized study, conducted in two expert centers, enrolled patients with refractory gastroparesis, medically managed for >6 months and confirmed by gastric emptying scintigraphy (GES), into two groups, G-POEM versus BTI, with follow-up of 1 year. The primary end point was the 3-month clinical efficacy, defined as a >1-point decrease in the mean Gastroparesis Cardinal Symptom Index (GCSI) score. Secondary end points were: 1-year efficacy, GES evolution, adverse events, and quality of life. RESULTS 40 patients (22 women; mean age 48.1 [SD 17.4]), with mean symptom duration of 5.8 (SD 5.7) years, were randomized. Etiologies included idiopathic (n=18), diabetes (n=11), postoperative (n=6), and mixed (n=4). G-POEM showed a higher 3-month clinical success than BTI (65% vs. 40%, respectively; P=0.10), along with non-significantly higher 1-year clinical success (60% vs. 40%, respectively) on intention-to-treat analysis. The GCSI decreased in both groups at 3 months and 1 year. Only three minor adverse events occurred in the G-POEM group. The GES improvement rate was 72% in the G-POEM group versus 50% in the BTI group (non-significant). CONCLUSION G-POEM seems to have a higher clinically relevant success rate than BTI, but this was not statistically demonstrated. This study confirms the interest in treatments targeting the pylorus, either mechanically or chemically, for managing refractory gastroparesis.
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Affiliation(s)
| | | | - Mathieu Pioche
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Victor Garbay
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
| | - Karine Baumstarck
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | - Mohamed Boucekine
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | | | - Jérôme Rivory
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Marc Barthet
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
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Ouazzani S, Lemmers A, Gonzalez JM, Closset J, El Moussaoui I, Devière J, Barthet M. Digestive neo-epithelialization after endoscopic stenting for upper digestive tract complete disunion. Endoscopy 2024. [PMID: 38485138 DOI: 10.1055/a-2288-4725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Complete digestive disunion due to anastomotic necrosis is considered a contraindication to endoscopic repair. However, recent publications have suggested that endoscopic treatment by insertion of a self-expandable metal stent (SEMS) is possible. The report of this patient series aims to demonstrate the use of endoscopic management in selected cases with complete digestive disunion. METHODS Seven consecutive patients with complete and circumferential upper gastrointestinal anastomotic disunion were treated at two European tertiary care centers between 2009 and 2021 by endoscopic insertion of an SEMS. Treatment was performed with a therapeutic gastroscope under general anesthesia, carbon dioxide insufflation, and fluoroscopic guidance, after surgical or percutaneous drainage. RESULTS All patients were successfully treated by endoscopic insertion of fully or partially covered SEMS left in place for a median of 8 weeks, with a median of 3 endoscopic sessions. Digestive neo-epithelialization was associated with a restored circumferential gut lumen in all cases. The rate of stent migration was 23% and three patients (43%) experienced symptomatic strictures, which were successfully treated by endoscopic dilation. CONCLUSION Complete digestive rupture could be successfully treated by endoscopy in selected cases, adding proof-of-concept data regarding guided tissue regeneration alongside SEMS placement.
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Affiliation(s)
- Sohaib Ouazzani
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Marseille, France
| | - Arnaud Lemmers
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Michel Gonzalez
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Marseille, France
| | - Jean Closset
- Department of Abdominal Surgery, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Imad El Moussaoui
- Department of Abdominal Surgery, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Marseille, France
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Onana Ndong P, Gonzalez JM, Beyrne A, Barthet M, Vitton V. Does the presence of an esophageal motor disorder influence the response to anti-reflux mucosectomy (ARMS) for refractory GERD? Scand J Gastroenterol 2024:1-8. [PMID: 38497142 DOI: 10.1080/00365521.2024.2331554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The prevalence of esophageal motor disorders (EMD) in PPI-refractory gastroesophageal reflux disease (GERD) is substantial. However, limited data exist on their impact on the efficacy of endoscopic treatments like anti-reflux mucosectomy (ARMS). This study aimed to evaluate the influence of EMD on ARMS efficacy in patients with PPI-refractory GERD. METHOD This single-center retrospective study enrolled patients with refractory GERD treated with ARMS-b (anti-reflux mucosectomy band-ligation). High-resolution esophageal manometry (HREM) was conducted before the procedure to identify EMD presence. The primary endpoint was treatment efficacy, defined as >50% improvement in GERD-HRQL score at 1 year. Secondary endpoints included PPI intake, symptom control, ARMS complications, and overall patient satisfaction at 12 months. RESULTS The study included 65 patients, with 41 (63.1%) showing EMD on HREM. Treatment efficacy was achieved by 33.8% (22) of patients, with 8 without EMD, 11 having isolated LES hypotonia, and 3 with both LES hypotonia and esophageal body motor disorder. No significant differences were observed between patients with and without EMD regarding the primary endpoint, PPI use, symptom control, or complications. Dysphagia developed in 52.3% (34) within 6 months, leading to esophageal dilatation in 15.3% (10). Two patients experienced acute hemorrhage, and one had perforation. CONCLUSION The presence of esophageal motor disorders does not seem to impact ARMS response, suggesting the technique's consideration in this population. Larger studies are essential for confirming these results and exploring treatment response and post-operative predictors.
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Affiliation(s)
- Philippe Onana Ndong
- Service de Gastroentérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jean-Michel Gonzalez
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Ana Beyrne
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marc Barthet
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Veronique Vitton
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France
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Debourdeau A, Gonzalez JM, Mathias F, Prost C, Barthet M, Vitton V. Gastric volumetry for the assessment of fundic compliance and visceral hypersensitivity in patients with gastroparesis: a retrospective comparative study. Scand J Gastroenterol 2024; 59:254-259. [PMID: 37975245 DOI: 10.1080/00365521.2023.2279928] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND/AIMS The evaluation of visceral hypersensitivity and gastric accommodation in patients with gastroparesis (GP) is difficult. CT-scan gastric volumetry allows to test the distension of different regions of the stomach. We aimed to study gastric volumes and patient's sensitivity to gastric distension between in patients with GP compared to patients with GERD. METHOD Retrospective study including patients who had CT-scan volumetry for GP or GERD. Two CT-scan series were made after gastric distension: left lateral decubitus 30° (LLD30) for antrum and right lateral decubitus (RLD) for body. Pain and discomfort were assessed using visual analogue scale (VAS). Gastric volumes were measured for LLD30 and RLD. RESULTS 13 patients (7 GP and 6 GERD) were included. Mean age was 35.6+/-7.3 years. Median gastric volume in the RLD was lower in GP vs GERD (927+/-208 ml vs. 1115+/-163 ml; p = 0.046) while it was similar for LLD30 (1053+/-228 ml vs. 1054+/-193 ml; p = 0.603). GP patients had significantly more pain and discomfort during the procedure: pain VAS for GP was 6[0-9] versus 0[0-2] for GERD, p = 0.004, discomfort VAS for GP was 7[4-10] versus 4[0-5] for GERD, p = 0.007. 66.7% of GERD patients felt no pain vs. 14.3% in GP, p = 0.053. CONCLUSION This pilot study suggests that GP could be associated with a reduced gastric volume compared to GERD in RLD after gaseous distension. In contrast, patient self-assessment of pain related to gastric distension was greater int GP patients. A lack of fundus accommodation and visceral hypersensitivity could explain some mechanisms in the genesis of GP symptoms.
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Affiliation(s)
- Antoine Debourdeau
- Gastroenterology Unit, CHU de Montpellier, Montpellier University MUSE, Montpellier, France
- Gastroenterology Unit, CHU de Nîmes, Montpellier University MUSE, Montpellier, France
| | - Jean-Michel Gonzalez
- Gastroenterology Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Fanny Mathias
- Pharmacy Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | | | - Marc Barthet
- Gastroenterology Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Véronique Vitton
- Gastroenterology Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
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Mailhe M, Ricaboni D, Vitton V, Gonzalez JM, Bachar D, Dubourg G, Cadoret F, Rober C, Delerce J, Levasseur A, Fournier PE, Angelakis E, Lagier JC, Raoult D. Retraction Note: Repertoire of the gut microbiota from stomach to colon using culturomics and next-generation sequencing. BMC Microbiol 2024; 24:10. [PMID: 38172679 PMCID: PMC10765687 DOI: 10.1186/s12866-023-03167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Morgane Mailhe
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Davide Ricaboni
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, Milan, 20157, Italy
| | - Véronique Vitton
- Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, 13915, France
| | - Jean-Michel Gonzalez
- Service de Gastroentérologie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, 13915, France
| | - Dipankar Bachar
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Grégory Dubourg
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Frédéric Cadoret
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Catherine Rober
- Aix Marseille Univ, IRD, VITROME, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseillle, 13005, France
| | - Jérémy Delerce
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Anthony Levasseur
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, VITROME, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseillle, 13005, France
| | - Emmanouil Angelakis
- Aix Marseille Univ, IRD, VITROME, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseillle, 13005, France
| | - Jean-Christophe Lagier
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, 13005, France.
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Mugnier A, Vitton V, Barthet M, Gonzalez JM. Mid-gastric peroral endoscopic myotomy in the treatment of post-sleeve gastrectomy gastric tube twist: Four cases. Endosc Int Open 2024; 12:E139-E144. [PMID: 38292588 PMCID: PMC10827480 DOI: 10.1055/a-2211-8903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background and study aims Laparoscopic sleeve gastrectomy (LSG) may lead to symptomatic mid-gastric twist in 0.1% to 4% of cases. Endoscopic balloon dilatation often fails, requiring a switch to Roux-en-Y bypass. Submucosal endoscopic treatment is expanding, so we propose a new technique of fibrosis incision after tunnelization, called medio-gastric peroral endoscopic myotomy (MG-POEM). Patients and methods Four patients aged 41 to 70 years underwent MG-POEM in 2020 for symptomatic post-LSG medio-gastric twist. The aim was to describe the technique, and document the efficacy, using the Gastric Outlet Obstruction Scoring System (GOOSS) score and a quality-of-life scale (QOLS). The procedures consisted of a POEM with myotomy and fibrosis incision. Results Median preoperative GOOSS and QOLS were 1/3 ([0-3] and 1.75/10 [0-10], respectively. All procedures were technically successful. One patient had immediate postoperative complications, which were treated conservatively. The median follow-up was 18 months. All patients had improved quality of life and food intake, with median postoperative GOOSS and QOLS of 3/3 and 6,5/10 [6-8], respectively. Two patients required additional pneumatic dilatation for scarring strictures. Follow-up endoscopies and esophagograms showed that the twist had disappeared. Conclusions MG-POEM shows promise for safe and effective management of post-LSG mid-gastric twist, despite requiring a high level of endoscopic skill to perform submucosal tunneling.
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Affiliation(s)
| | | | - Marc Barthet
- Hôpital Nord, Gastroenterologie, AP-HM, Marseille, France
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Gonzalez JM, Barthet M, Debourdeau A, Monino L, Vitton V. Peroral endoscopic myotomy and valve section for treatment of persistent and disabling dysphagia after laparoscopic fundoplication (with video). Gastrointest Endosc 2023; 98:839-842. [PMID: 37385551 DOI: 10.1016/j.gie.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND AIMS The use of laparoscopic fundoplication (LF) to treat refractory GERD may induce refractory dysphagia (5%-10%). The management is complex, and peroral endoscopic myotomy (POEM) including valve incision is a new therapeutic option. METHODS This retrospective study involved patients with postfundoplication refractory dysphagia treated by POEM associated with complete wrap incision. Patients were evaluated with Eckardt and dysphagia scores. Study objectives were to evaluate clinical and technical outcomes, adverse events, and GERD recurrence. RESULTS Twenty-six patients, with a mean age of 57.3 ± 15.6 years, were included. Mean follow-up was 25.3 ± 17.6 months. The technical and clinical success rates were 96% and 84.6%, respectively. Among failures, 1 patient underwent Lewis-Santy, 2 required dilations, and 1 was lost to follow-up. Three late recurrences occurred and were endoscopically managed. Five patients (19%) had GERD recurrence that was mainly improved by proton pump inhibitors. CONCLUSIONS POEM with fundoplication is a serious therapeutic option for managing persistent dysphagia after LF, with a low risk of GERD recurrence.
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Affiliation(s)
- Jean-Michel Gonzalez
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Antoine Debourdeau
- Service d'hépatogastro-enrtérologie, CH Lapeyronie, Université de Montpellier-Nîmes, Montpellier, France
| | - Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Véronique Vitton
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
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Monino L, Perez-Cuadrado-Robles E, Gonzalez JM, Snauwaert C, Alric H, Gasmi M, Ouazzani S, Benosman H, Deprez PH, Rahmi G, Cellier C, Moreels TG, Barthet M. Endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stents: a retrospective multicentric comparison of wireless and over-the-wire techniques. Endoscopy 2023; 55:991-999. [PMID: 37380033 DOI: 10.1055/a-2119-7529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) appears to be effective and safe in gastric outlet obstruction (GOO); however, the EUS-GE procedure is not standardized, with the use of assisted or direct methods still debated. The aim of this study was to compare the outcomes of EUS-GE techniques focusing on an assisted with orointestinal drain wireless endoscopic simplified technique (WEST) and the nonassisted direct technique over a guidewire (DTOG). METHOD This was a multicenter European retrospective study involving four tertiary centers. Consecutive patients who underwent EUS-GE for GOO between August 2017 and May 2022 were included. The primary aim was to compare the technical success and adverse event (AE) rates of the different EUS-GE techniques. Clinical success was also analyzed. RESULTS 71 patients (mean [SD] age 66.2 10 years; 42.3 % men; 80.3 % malignant etiology) were included. Technical success was higher in the WEST group (95.1 % vs. 73.3 %; estimate of relative risk from odds ratio (eRR) 3.2, 95 %CI 0.94-10.9; P = 0.01). The rate of AEs was lower in the WEST group (14.6 % vs. 46.7 %; eRR 2.3, 95 %CI 1.2-4.5; P = 0.007). Clinical success was comparable between the two groups at 1 month (97.5 % vs. 89.3 %). The median follow-up was 5 months (range 1-57). CONCLUSION The WEST resulted in a higher technical success rate with fewer AEs, with clinical success comparable with the DTOG. Therefore, the WEST (with an orointestinal drain) should be preferred when performing EUS-GE.
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Affiliation(s)
- Laurent Monino
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Enrique Perez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | | | - Hadrien Alric
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Mohamed Gasmi
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Sohaib Ouazzani
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Hedi Benosman
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
| | - Pierre H Deprez
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Tom G Moreels
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Ouazzani S, Monino L, Beyer-Berjot L, Garnier E, Berdah S, Barthet M, Gonzalez JM. Efficacy of endoscopic gastrojejunal bypass in obese Yucatan pigs: a comparative animal study. BMC Gastroenterol 2023; 23:375. [PMID: 37915010 PMCID: PMC10621135 DOI: 10.1186/s12876-023-03000-1] [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: 06/15/2022] [Accepted: 10/15/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Natural orifice transluminal endoscopy surgery (NOTES) gastrojejunal anastomosis (GJA) with duodenal exclusion (DE) could be used as a less invasive alternative to surgical gastric bypass. The aim of this study was to compare the efficacy and safety of both methods for bariatric purpose. METHODS This was a prospective, experimental and comparative study on 27 obese living pigs, comparing 4 groups: GJA alone (group 1, G1), GJA + DE (group 2, G2), surgical gastric bypass (group 3, G3), control group (group 4, G4). GJA was endoscopically performed, using NOTES technic and LAMS, while DE was performed surgically for limb length selection. Animals were followed for 3 months. Primary outcome included technical success and weight change, while secondary endpoints included the rate of perioperative mortality and morbidity, histological anastomosis analysis and biological analysis. RESULTS Technical success was 100% in each intervention group. No death related to endoscopic procedures occurred in the endoscopic groups, while early mortality (< 1 month) was 57,1% in the surgical group, all due to anastomotic dehiscence. At 3 months, compared to baseline, mean weight change was + 3,1% in G1 (p = 0,46); -14,9% in G2 (p = 0,17); +5,6% in G3 (p = 0,38) and + 25% in G4 (p = 0,029). Histopathological analysis of endoscopic GJA showed complete fusion of different layers without leak or abscess. CONCLUSIONS Endoscopic GJA with DE provides the efficacy of bypass on weight control in an animal model. Next steps consist of the development of devices to perform exclusively endoscopically limb length selection and DE.
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Affiliation(s)
- S Ouazzani
- AP-HM, Department of gastroenterology, Aix-Marseille Univ, Hôpital Nord, Marseille, France.
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France.
- Department of gastroenterology and Hepatopancreatology, ULB, HUB, Erasme Hospital, Brussels, Belgium.
| | - L Monino
- AP-HM, Department of gastroenterology, Aix-Marseille Univ, Hôpital Nord, Marseille, France
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France
| | - L Beyer-Berjot
- AP-HM, Department of digestive surgery, Aix-Marseille Univ, Hôpital Nord, Marseille, France
| | - E Garnier
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France
| | - S Berdah
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France
- AP-HM, Department of digestive surgery, Aix-Marseille Univ, Hôpital Nord, Marseille, France
| | - M Barthet
- AP-HM, Department of gastroenterology, Aix-Marseille Univ, Hôpital Nord, Marseille, France
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France
| | - J M Gonzalez
- AP-HM, Department of gastroenterology, Aix-Marseille Univ, Hôpital Nord, Marseille, France
- Centre d'Enseignement et de Recherche Chirurgical, Aix-Marseille Univ, Marseille, France
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10
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Napoléon B, Lisotti A, Caillol F, Gasmi M, Ah-Soune P, Belle A, Charachon A, Cholet F, Eyraud PY, Grandval P, Gonzalez JM, Habersetzer F, Koch S, Le Rhun M, Mangialavori L, Musquer N, Palazzo M, Poincloux L, Privat J, Sportes A, Stouvenot M, Subtil C, Thomassin L, Vanbiervliet G, Vidal G, Vuitton L, Giovannini M, Barthet M. Risk factors for EUS-guided radiofrequency ablation adverse events in patients with pancreatic neoplasms: a large national French study (RAFPAN study). Gastrointest Endosc 2023; 98:392-399.e1. [PMID: 37059368 DOI: 10.1016/j.gie.2023.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS EUS-guided radiofrequency ablation (EUS-RFA) has been described as a potentially curative option for solid and cystic pancreatic neoplasms. We aimed to assess the safety and efficacy of pancreatic EUS-RFA in a large study population. METHODS A retrospective study retrieving all consecutive patients who underwent pancreatic EUS-RFA during 2019 and 2020 in France was conducted. Indication, procedural characteristics, early and late adverse events (AEs), and clinical outcomes were recorded. Risk factors for AEs and factors related to complete tumor ablation were assessed on univariate and multivariate analyses. RESULTS One hundred patients (54% men, 64.8 ± 17.6 years old) affected by 104 neoplasms were included. Sixty-four neoplasms were neuroendocrine neoplasms (NENs), 23 were metastases, and 10 were intraductal papillary mucinous neoplasms with mural nodules. No procedure-related mortality was observed, and 22 AEs were reported. Proximity of pancreatic neoplasms (≤1 mm) to the main pancreatic duct was the only independent risk factor for AEs (odds ratio [OR), 4.10; 95% confidence interval [CI), 1.02-15.22; P = .04). Fifty-nine patients (60.2%) achieved a complete tumor response, 31 (31.6%) a partial response, and 9 (9.2%) achieved no response. On multivariate analysis, NENs (OR, 7.95; 95% CI, 1.66-51.79; P < .001) and neoplasm size <20 mm (OR, 5.26; 95% CI, 2.17-14.29; P < .001) were independently related to complete tumor ablation. CONCLUSIONS The results of this large study confirm an overall acceptable safety profile for pancreatic EUS-RFA. Close proximity (≤1 mm) to the main pancreatic duct represents an independent risk factor for AEs. Good clinical outcomes in terms of tumor ablation were observed, especially for small NENs.
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Affiliation(s)
- Bertrand Napoléon
- Digestive Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Digestive Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Fabrice Caillol
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Mohamed Gasmi
- Digestive Endoscopy Unit, Hôpital Nord, Marseille, France
| | | | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Franck Cholet
- Digestive Endoscopy Unit, University Hospital, Brest, France
| | - Pierre-Yves Eyraud
- Hepato-Gastroenterology Department, University Hospital, Grenoble, France
| | | | | | | | - Stéphane Koch
- Digestive Endoscopy Unit, Jean Minjoz Hospital, Besançon, France
| | - Marc Le Rhun
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Luigi Mangialavori
- Digestive Endoscopy Unit, Hopital Privé A Brillard, Ramsay Sante, Nogent sur Marne, France
| | - Nicolas Musquer
- Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Maxime Palazzo
- Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Laurent Poincloux
- Digestive Endoscopy Unit, Estaing University Hospital, Clermont-Ferrand, France
| | | | - Adrien Sportes
- Digestive Endoscopy, Institut Arnault Tzanck Gastroenterology Unit, Saint-Laurent-du-Var, France
| | | | - Clement Subtil
- Digestive Endoscopy Unit, University Hospital, Bordeaux, France
| | - Lucie Thomassin
- Department of Gastroenterology, Rouen University Hospital, University of Rouen, France
| | | | - Guillaume Vidal
- Digestive Endoscopy Unit, Estaing University Hospital, Clermont-Ferrand, France
| | - Lucine Vuitton
- Digestive Endoscopy Unit, Jean Minjoz Hospital, Besançon, France
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
| | - Marc Barthet
- Digestive Endoscopy Unit, Hôpital Nord, Marseille, France
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11
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Vitton V, Barthet M, Granel B, Gonzalez JM. Refractory GERD and systemic sclerosis: The end of a dead end? Clin Res Hepatol Gastroenterol 2023; 47:102140. [PMID: 37187259 DOI: 10.1016/j.clinre.2023.102140] [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] [Received: 10/16/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Véronique Vitton
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, France.
| | - Marc Barthet
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, France
| | - Brigitte Granel
- Service de médecine interne, Hôpital NORD, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, France
| | - Jean-Michel Gonzalez
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, France
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12
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Ouazzani S, Gasmi M, Gonzalez JM, Barthet M. Candy cane syndrome: a new endoscopic treatment for this underappreciated surgical complication. Endoscopy 2023; 55:E414-E415. [PMID: 36758628 PMCID: PMC9911291 DOI: 10.1055/a-2007-1952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Sohaib Ouazzani
- Gastroenterology, Hopital Erasme, Bruxelles, Belgium,Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Mohamed Gasmi
- Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | | | - Marc Barthet
- Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
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13
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Debourdeau A, Gonzalez JM, Barthet M, Vitton V. Dysphagia in Children, Do Not Blame Eosinophils Too Quickly. Children (Basel) 2022; 10:children10010063. [PMID: 36670614 PMCID: PMC9856664 DOI: 10.3390/children10010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
Dysphagia in children is a relatively frequent symptom in childhood, and the main causes are congenital and linked to ear-nose-throat etiologies. However, non-congenital esophageal dysphagia is less common, and the main cause in such cases is eosinophilic esophagitis (EoE). When there is no response to a well-conducted treatment, with normalization of histology, the diagnosis of EoE must then be reconsidered. Here, we present the case of a 10-year-old patient whose initial diagnosis of eosinophilic esophagitis delayed the diagnosis of type III achalasia.
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Affiliation(s)
- Antoine Debourdeau
- Gastroenterology and Endoscopy Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
- Endoscopy Unit, CHU Montpellier, Montpellier University, 34000 Montpellier, France
- Gastroenterology Unit, CHU de Nîmes, Montpellier University MUSE, 30000 Nîmes, France
- Correspondence:
| | - Jean-Michel Gonzalez
- Gastroenterology and Endoscopy Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
| | - Marc Barthet
- Gastroenterology and Endoscopy Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
| | - Véronique Vitton
- Gastroenterology and Endoscopy Unit, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, 13015 Marseille, France
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14
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Pérez-Cuadrado-Robles E, Bronswijk M, Prat F, Barthet M, Palazzo M, Arcidiacono P, Schaefer M, Devière J, van Wanrooij RLJ, Tarantino I, Donatelli G, Camus M, Sanchez-Yague A, Pham KDC, Gonzalez JM, Anderloni A, Vila JJ, Jezequel J, Larghi A, Jaïs B, Vazquez-Sequeiros E, Deprez PH, Van der Merwe S, Cellier C, Rahmi G. Endoscopic ultrasound-guided drainage using lumen-apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video). Dig Endosc 2022; 34:1433-1439. [PMID: 35429360 DOI: 10.1111/den.14330] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. METHODS This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. RESULTS Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. CONCLUSION EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Fréderic Prat
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Marc Barthet
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Maxime Palazzo
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Paolo Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ilaria Tarantino
- Endoscopy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy
| | - Gianfranco Donatelli
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Marine Camus
- Sorbonne University, Endoscopic Unit, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Khanh Do-Cong Pham
- Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jean-Michel Gonzalez
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Julien Jezequel
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bénédicte Jaïs
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pierre H Deprez
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Schalk Van der Merwe
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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15
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Baret F, Jacques J, Pioche M, Albouys J, Vitton V, Vanbiervliet G, Debourdeau A, Barthet M, Gonzalez JM. Evaluation of the safety profile of endoscopic pyloromyotomy by G-POEM: a French multicenter study. Therap Adv Gastroenterol 2022; 15:17562848221122472. [PMID: 36213725 PMCID: PMC9536103 DOI: 10.1177/17562848221122472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastric per oral endoscopic esophageal myotomy (G-POEM) is a promising procedure to treat refractory gastroparesis. The safety profile of G-POEM is an important topic because gastroparesis is a functional pathology, with a procedure whose effectiveness is between 50 and 65% depending on the studies. OBJECTIVES We present this retrospective multicenter study, with the aim of establishing a safety profile, focusing on serious adverse events (AEs). DESIGN This was a multicenter observational cohort study conducted in five French expert centers. METHODS All patients who underwent G-POEM for refractory gastroparesis between 2015 and 2021 were included for analysis. AEs were classified into per endoscopic, early postoperative, and late postoperative, up to 1 month. Their severity was assessed using Dindo-Clavien and American Society for Gastrointestinal Endoscopy classification. The primary objective was to evaluate the rate of G-POEM severe AEs. Secondary objectives were to document other postoperative AEs, and to identify predictive factors. RESULTS In all, 217 patients were included: 81 men and 136 women, mean age 52 ± 17 years. The average procedural time was 44 ± 14 min (12-78). The average hospital stay was 3.7 ± 2.3 days. The AEs rate classified as Clavien-Dindo ⩾3 was 0.4% (one delayed bleeding requiring blood transfusion and endoscopic management). There were no deaths or patients admitted to intensive care unit. The rates of mucosotomy and capnoperitoneum were 3.7 and 1.8%, respectively, without clinical consequences. Most patients (81.5%) did not experience any AE. Three cases of dumping syndrome occurred, quickly managed by dietary measures. CONCLUSION Our study confirms the safety of G-POEM with less than 0.5% of serious AEs, medically managed. This outcome makes this a procedure to have a good benefit-risk ratio.
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Affiliation(s)
| | - Jeremie Jacques
- Service de Gastroentérologie, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service de Gastroentérologie, CHU Edouard Herriot, Lyon, France
| | - Jeremie Albouys
- Service de Gastroentérologie, CHU Dupuytren, Limoges, France
| | | | | | | | - Marc Barthet
- Service de Gastroentérologie, CHU Nord, Marseille, France
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16
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Labonde A, Lades G, Debourdeau A, Ragi O, Lehmann L, Vitton V, Barthet M, Legros R, Albouys J, Geyl S, Loustaud-Ratti V, Monteil J, Gonzalez S, Gonzalez JM, Jacques J. Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection. Gastrointest Endosc 2022; 96:500-508.e2. [PMID: 35413333 DOI: 10.1016/j.gie.2022.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 10/12/2021] [Accepted: 04/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Limited data exist concerning the long-term efficiency of gastric peroral endoscopic myotomy (G-POEM) as a treatment of refractory gastroparesis. This study evaluated the 3-year results of G-POEM in patients with refractory gastroparesis. METHODS This was a prospective multicenter study of all G-POEM operations performed in 2 expert French centers for 46 patients with refractory gastroparesis with at least 3 years of follow-up. RESULTS Clinical success was 65.2% at 36 months. There was significant improvement in symptom severity. Median Gastroparesis Cardinal Symptom Index decreased from 3.33 to 1.80 (P < .0001), with improvement in all subscales. We created a predictive score concerning G-POEM success (G-POEM predictive score) to which points were assigned as follows: nausea subscale <2: predictive of success, 1 point; satiety subscale >4: predictive of success, 1 point; bloating subscale >3.5: predictive of success, 1 point; percentage of gastric retention at 4 hours on scintigraphy >50%: 1 point. A threshold of 2 was identified by receiver operating characteristic curve analysis with an area under the curve of .825 that predicted clinical success with a sensitivity of 93.3% (95% confidence interval [CI], .77-.99), specificity of 56.3% (95% CI, .33-.77), positive predictive value of 80% (95% CI, .67-.93), negative predictive value of 81.8% (95% CI, .59-1.00), and accuracy of 80.4% (95% CI, .69-.92). Patients with a score ≥2 were significantly more likely to be responders at 3 years than were patients with a score <2 (80% and 18%, respectively; P = .0004). CONCLUSIONS The clinical success of G-POEM for refractory gastroparesis was 65.2% at 36 months. Our predictive score offers an easy tool that needs to be confirmed in other studies.
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Affiliation(s)
- Amélie Labonde
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | | | - Antoine Debourdeau
- Service d'Hépato-gastro-entérologie, CHU Montpellier, Montpellier, France
| | - Olivier Ragi
- Service d'Hépato-gastro-entérologie, CHU Lyon, Lyon, France
| | - Lauriane Lehmann
- Service d'Hépato-gastro-entérologie, Polyclinique de Limoges, Limoges, France
| | - Véronique Vitton
- Service d'Hépato-gastro-entérologie, APHM Hôpital Nord, Marseille, France
| | - Marc Barthet
- Service d'Hépato-gastro-entérologie, APHM Hôpital Nord, Marseille, France
| | - Romain Legros
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Jérémie Albouys
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Sophie Geyl
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | | | - Jacques Monteil
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Sandra Gonzalez
- Service de médecine nucléaire, APHM Hôpital Nord, Marseille, France
| | | | - Jérémie Jacques
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France.
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17
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Ortiz Banguera S, Busquets Carrera O, Ysamat M, Gonzalez JM, Riera Gil E, Garcia JR. Imagenomics. Findings in PET with 68Ga-DOTA-TOC associated with the detection of the mutation of the succinate dehydrogenase B (SDHB) gene in the screening of hereditary pheochromocytoma/paraganglioma. Rev Esp Med Nucl Imagen Mol 2022; 41:268-270. [PMID: 35668017 DOI: 10.1016/j.remnie.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - M Ysamat
- CETIR ASCIRES Grupo Biomédico, Barcelona, Spain.
| | - J M Gonzalez
- CETIR ASCIRES Grupo Biomédico, Barcelona, Spain.
| | - E Riera Gil
- CETIR ASCIRES Grupo Biomédico, Barcelona, Spain.
| | - J R Garcia
- CETIR ASCIRES Grupo Biomédico, Barcelona, Spain.
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18
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Bouteiller I, Guingand M, Thomas PA, Gonzalez JM, Vitton V. Endoscopic anti-reflux mucosectomy (ARMS): A new therapeutic option in the treatment of gerd in case of oesophageal atresia? Clin Res Hepatol Gastroenterol 2022; 46:101902. [PMID: 35296448 DOI: 10.1016/j.clinre.2022.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ivann Bouteiller
- Service de gastroentérologie, Hôpital NORD, AP-HM, Aix-Marseille Université, France
| | - Marine Guingand
- Service de gastroentérologie, Hôpital NORD, AP-HM, Aix-Marseille Université, France
| | | | - Jean-Michel Gonzalez
- Service de gastroentérologie, Hôpital NORD, AP-HM, Aix-Marseille Université, France
| | - Veronique Vitton
- Service de gastroentérologie, Hôpital NORD, AP-HM, Aix-Marseille Université, France.
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19
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Bonniaud P, Jacques J, Lambin T, Gonzalez JM, Dray X, Coron E, Leblanc S, Chevaux JB, Léger-Nguyen F, Hamel B, Lienhart I, Rivory J, Ponchon T, Saurin JC, Monzy F, Legros R, Lépilliez V, Subtil F, Barret M, Pioche M. Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification. Endosc Int Open 2022; 10:E145-E153. [PMID: 35047345 PMCID: PMC8759940 DOI: 10.1055/a-1613-5328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 10/26/2022] Open
Abstract
Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen's Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different ( P < 0.001): the highest sensitivities were for NICE 2 (84.2 %) and CONECCT IIC (78.9 %), and the lowest for Kudo Vi (31.6 %). Conclusions The CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma.
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Affiliation(s)
- Paul Bonniaud
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University hospital, Limoges, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gonzalez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France
| | - Xavier Dray
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Emmanuel Coron
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nantes University Hospital, Nantes, France
| | - Sarah Leblanc
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Jean-Baptiste Chevaux
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nancy University Hospital, Nancy, France
| | | | - Benjamin Hamel
- Department of Gastroenterology, North-Ouest Hospital, Villefranche-Sur-Saône, France
| | | | - Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Frédéric Monzy
- Department of Gastroenterology, Clinique Claude Bernard, Albi, France
| | - Romain Legros
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Vincent Lépilliez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Maximilien Barret
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Hôpital Cochin, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France,Inserm U1032 LabTau, Lyon, France
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Vitton V, Barthet M, Gonzalez JM. Endoscopic myotomy for non-achalasia esophageal motor disorder: The role of a complete examination of the eso-gastric junction. Clin Res Hepatol Gastroenterol 2022; 46:101776. [PMID: 34332141 DOI: 10.1016/j.clinre.2021.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/09/2021] [Accepted: 07/09/2021] [Indexed: 02/04/2023]
Affiliation(s)
- V Vitton
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, France.
| | - M Barthet
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, France
| | - J M Gonzalez
- Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, France
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21
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Guingand M, Gasmi M, Serrero M, Barthet M, Gonzalez JM. Endoscopic ultra-sound (EUS) guided management of symptomatic pelvic collections: puncture-aspiration or drainage? Results from mono-centric retrospective experience with therapeutic algorithm. Scand J Gastroenterol 2022; 57:112-118. [PMID: 34565279 DOI: 10.1080/00365521.2021.1979093] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pelvic collections may occur after surgery or in medical diseases. EUS transmural (TM) treatment has been shown as highly effective and safe, becoming an alternative to surgery or radiology. We aimed to assess the results of EUS management of pelvic collections. METHODS Retrospective, single-center observational study conducted between 2004 and 2018. Patients with symptomatic collections treated by EUS-TM approach were enrolled. The procedures were performed with a therapeutic EUS-scope, following two possible options: puncture-aspiration-injection of antibiotics PAIA (group 1) or EUS-drainage by plastic double pigtail stents (DPS) with an ano-cavitary drain (ACD) or lumen-apposing metal Stent (LAMS) (group 2). The main objective was to assess the clinical effectiveness based on symptoms and collection resolution. RESULTS Seventy-three patients were included. Mean age was 42.5 years [12-87]. 30 patients in group 1 (41%) underwent PAIA and 43 in group 2 (59%) underwent DPS ± ACD in 41 patients (95%) and LAMS in 2. The collection was postoperative in 58%. The mean size was 48.9 mm [8-120], 33 +/- 17 mm in group 1, compared to 67 ± 21 mm in group 2 (p < .0001). All the procedures were technically successful. Overall clinical success was 96% (93% in group 1 (28/30), 98% (42/43) in group 2). Failures occurred in 2 post sigmoiditis abscesses and 1 ileo-colic Crohn's disease. No adverse event was reported. During the median follow-up of 7.5 years [4.4-8.9], no patient had recurrence. CONCLUSIONS EUS-TM with either PAIA or drainage depending on the collection size is confirmed to be highly effective and safe.
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Affiliation(s)
- Marine Guingand
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Mohamed Gasmi
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Mélanie Serrero
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
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Debourdeau A, Vitton V, Barthet MA, Gonzalez JM. If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it? Gut 2022; 71:221-222. [PMID: 33785553 DOI: 10.1136/gutjnl-2021-324238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Antoine Debourdeau
- Endoscopy Unit, CHU Montpellier, Montpellier Univ, Montpellier, France .,Medicine Faculty, Montpellier Univ, Montpellier, France
| | - Véronique Vitton
- Gastroenterology Department, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Marc A Barthet
- Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Jean-Michel Gonzalez
- Gastroenterology, Hopital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Napoléon B, Gonzalez JM, Grandval P, Lisotti A, Laquière AE, Boustière C, Barthet M, Prat F, Ponchon T, Donatelli G, Vanbiervliet G. Evaluation of the performances of a single-use duodenoscope: Prospective multi-center national study. Dig Endosc 2022; 34:215-221. [PMID: 33666280 DOI: 10.1111/den.13965] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A single-use duodenoscope (SUD) has been recently developed to overcome issues with endoscopic retrograde cholangiopancreatography (ERCP)-related cross-infections. The aim was to evaluate SUD safety and performance in a prospective multi-centre study. METHODS All consecutive patients undergoing ERCP in six French centers were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators' satisfaction based on a VAS 0-10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID-RCB: 2020-A00346-33). External companies collected the database and performed statistical analysis. RESULTS Sixty patients (34 females, median age 65.5 years old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty-seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (one duodenal stricture, one ampullary infiltration, and one tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators' satisfaction was 9 (7-9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an adverse event. None was SUD-related. CONCLUSIONS The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.
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Affiliation(s)
- Bertrand Napoléon
- Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Jean-Michel Gonzalez
- Service de Gastro-entérologie, Hôpital Nord, Aix Marseille Université, Marseille, France
| | - Philippe Grandval
- Digestive Endoscopy and Gastroenterology Department, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Andrea Lisotti
- Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.,Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Arthur E Laquière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Christian Boustière
- Departments of Hepatogastroenterology and Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Marc Barthet
- Service de Gastro-entérologie, Hôpital Nord, Aix Marseille Université, Marseille, France
| | - Frédéric Prat
- Service d'Endoscopie, GHU AP-HP Nord, Université de Paris et Inserm, Paris, France
| | - Thierry Ponchon
- Hepato-Gastroenterology Department, Edouard Herriot University Hospital, Lyon, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
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Gonzalez JM, Reed SD, Johnson FR. Stratified psoriasis treatment plans: why is patient preference information needed? Br J Dermatol 2021; 185:882-883. [PMID: 34463961 DOI: 10.1111/bjd.20697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gonzalez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - F R Johnson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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25
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Vitton V, Benoît D'Journo X, Reynaud-Gaubert M, Barthet M, Gonzalez JM. Gastric peroral endoscopic myotomy (GPOEM) for severe gastroparesis after lung transplantation: A promising minimally invasive option. Clin Transplant 2021; 35:e14434. [PMID: 34291504 DOI: 10.1111/ctr.14434] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND After lung transplantation (LT), gastroparesis is frequent, occurring in 25-63% of cases and leading to pulmonary infections. In refractory disease, classical management has demonstrated limited efficacy. Gastric peroral endoscopic myotomy (G-POEM) is a recently developed safe and effective procedure that has been performed here on five patients with severe post-LT gastroparesis. METHODS In all patients, the diagnosis was confirmed by disturbed gastric emptying scintigraphy and GCSI calculation showing severe disease. Upper gastrointestinal endoscopies confirmed the absence of organic lesions. All patients were informed about the procedure and signed informed consent forms. The procedure consisted of performing an endoscopic pyloromyotomy under general anesthesia. RESULTS The patients were between 35 and 64 years of age. Four had chronic disease, starting approximately 1 year following LT, and one had acute, severe gastroparesis requiring intubation in the intensive care unit. All patients underwent G-POEM after failure of medical treatment, without any complications. Three of the patients with chronic disease improved; they resumed a normal diet and gained weight. The patient with acute disease was discharged within a few days following the procedure and resumed oral intake. CONCLUSION G-POEM is promising for managing post-LT refractory gastroparesis and should be further evaluated.
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Affiliation(s)
- Véronique Vitton
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Xavier Benoît D'Journo
- Department of Thoracic Surgery, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | | | - Marc Barthet
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
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Mercier C, Pioche M, Albuisson E, Ponchon T, Gonzalez JM, Barthet M, Boytchev I, Vanbiervliet G, Fortier Beaulieu C, Prat F, Belle A, Branche J, Grandval P, Valats JC, Rudler F, Wallenhorst T, Koch S, Comte A, Williet N, Musquer N, Coron E, Derosiere A, Le Mouel JP, Schaefer M, Chabot C, Scheers I, Deprez PH, Chevaux JB. Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study. Endoscopy 2021; 53:586-594. [PMID: 32599632 DOI: 10.1055/a-1209-0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. METHODS All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. RESULTS 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 - 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 - 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. CONCLUSION Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.
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Affiliation(s)
- Clémence Mercier
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Nancy, Nancy, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Eliane Albuisson
- CHRU-Nancy, DRCI, Département MPI, Unité de Méthodologie, Data management et Statistique UMDS, Nancy, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Michel Gonzalez
- Department of Digestive Endoscopy, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Digestive Endoscopy, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Isabelle Boytchev
- Gastroenterology Department, Kremlin-Bicêtre University Hospital, Paris, France
| | | | | | - Frederic Prat
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Julien Branche
- Gastroenterology Department, Claude Huriez Hospital, Lille, France
| | - Phillipe Grandval
- Hepatogastroenterology Department, AP-HM, Hôpital La Timone, Marseille, France
| | | | - Franz Rudler
- Department of Endoscopy and Gastroenterology, Lapeyronie Hospital, Montpellier, France
| | - Timothee Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, France
| | - Stephane Koch
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Aurélie Comte
- Department of Pediatric Hepatology, Gastroenterology and Nutrition, CHU Besançon, Besançon, France
| | - Nicolas Williet
- Department of Hepato-gastro-enterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Nicolas Musquer
- Digestive Endoscopy Department, Nantes University Hospital, Nantes, France
| | - Emmanuel Coron
- Digestive Endoscopy Department, Nantes University Hospital, Nantes, France
| | - Aline Derosiere
- Department of Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Jean-Phillippe Le Mouel
- Department of Gastroenterology, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| | - Caroline Chabot
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Nancy, Nancy, France
| | - Isabelle Scheers
- Department of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Baptiste Chevaux
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
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Falque A, Gasmi M, Barthet M, Gonzalez JM. Safety and efficacy of EUS-guided pancreatic duct drainage in symptomatic main pancreatic duct obstruction: Is there still a place for surgery? Endosc Int Open 2021; 9:E934-E942. [PMID: 34079881 PMCID: PMC8159606 DOI: 10.1055/a-1302-1484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background and study aims In patients with symptomatic dilation of the main pancreatic duct (MPD) for whom endoscopic retrograde cholangiopancreatography (ERCP) is impossible, surgery has long been the only available treatment. EUS-PD is described as a minimally invasive alternative for ductal decompression surgery. We describe the results of our experience with it.
Patients and methods This was a retrospective single-center study over 9 years. Twenty-seven patients, median age 61.8 years (range 36 to 85) who underwent EUS-PD for symptomatic MPD dilatation were included. The main objective was to evaluate the technical success (placement of a plastic stent between the stomach and the MPD). Secondary objectives were to document clinical success based on pain and quality of life (visual analogic scales and treatments) and complication rates, and to define a standardized management algorithm.
Results The technical success rate was 92.5 %. The rate of minor adverse events was 21 % (4 cases of non-specific postoperative pain and two cases of delayed benign edematous pancreatitis). The clinical success rate was 88 %, and half of patients in whom the procedure was successful had "complete regression" of pain and half "partial regression." Median follow-up was 34.2 months (range 4 to 108). During follow-up, 74 % of patients reported improvement in quality of life and no patients required secondary surgery.
Conclusion Provided it is performed in an expert center, EUS-PD is a minimally invasive, effective, and safe alternative to pancreatic surgical drainage in patients with symptomatic MPD dilatation with failure or in whom ERCP is impossible.
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Affiliation(s)
- Arthur Falque
- Aix-Marseille Université, AP-HM, Hôpital Nord, Gastroenterologie, Marseille, France
| | - Mohamed Gasmi
- Aix-Marseille Université, AP-HM, Hôpital Nord, Gastroenterologie, Marseille, France
| | - Marc Barthet
- Aix-Marseille Université, AP-HM, Hôpital Nord, Gastroenterologie, Marseille, France
| | - Jean-Michel Gonzalez
- Aix-Marseille Université, AP-HM, Hôpital Nord, Gastroenterologie, Marseille, France
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Ragi O, Jacques J, Branche J, Leblanc S, Vanbiervliet G, Legros R, Pioche M, Rivory J, Chaussade S, Barret M, Wallenhorst T, Barthet M, Kerever S, Gonzalez JM. One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study. Endoscopy 2021; 53:480-490. [PMID: 32575130 DOI: 10.1055/a-1205-5686] [Citation(s) in RCA: 18] [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: 12/19/2022]
Abstract
BACKGROUND Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. METHODS This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). RESULTS 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % - 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 - 4.0). Clinical success was achieved in 65.8 % of the patients at 1 year, with a median rate of reduction in the GCSI score of 41 %. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 1.01 - 11.54; P = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95 %CI 0.95 - 1.00; P = 0.03). CONCLUSIONS The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.
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Affiliation(s)
- Olivier Ragi
- Service de gastroentérologie, CHU Limoges, France
| | - Jérémie Jacques
- Service de gastroentérologie, CHU Limoges, France.,CNRS, XLIM, UMR 7252, Limoges, France
| | - Julien Branche
- Service de gastroentérologie, CHU Claude Huriez, Lille, France
| | - Sarah Leblanc
- Service de gastroentérologie, APHP, Hôpital Cochin, Paris, France
| | | | | | - Mathieu Pioche
- Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
| | - Jérôme Rivory
- Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
| | | | | | | | - Marc Barthet
- Service de gastroentérologie, APHM, Hôpital Nord, Marseille, France
| | - Sébastien Kerever
- Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Fernand Widal University Hospital, AP-HP, Paris, France
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Debourdeau A, Barthet M, Benezech A, Vitton V, Gonzalez JM. Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case-control study. Surg Endosc 2021; 36:1098-1105. [PMID: 33650008 DOI: 10.1007/s00464-021-08376-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/09/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures. METHODS Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year. RESULTS 39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS). CONCLUSION Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.
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Affiliation(s)
- Antoine Debourdeau
- Endoscopy Unit, CHU Saint Eloi, Université de Montpellier, 80 avenue Gaston Fliche, 34090, Montpellier, France.
| | - Marc Barthet
- Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France
| | | | - Véronique Vitton
- Gastroenterology Unit, North Universitary Hospital, AP-HM, Marseille, France
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Ortiz Banguera S, Busquets Carrera O, Ysamat M, Gonzalez JM, Riera Gil E, Garcia JR. Imagenomics. Findings in PET with 68Ga-DOTA-TOC associated with the detection of the mutation of the succinate dehydrogenase B (SDHB) gene in the screening of hereditary pheochromocytoma/paraganglioma. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00021-4. [PMID: 33637460 DOI: 10.1016/j.remn.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - M Ysamat
- CETIR ASCIRES Grupo biomédico, Barcelona, España
| | - J M Gonzalez
- CETIR ASCIRES Grupo biomédico, Barcelona, España
| | - E Riera Gil
- CETIR ASCIRES Grupo biomédico, Barcelona, España
| | - J R Garcia
- CETIR ASCIRES Grupo biomédico, Barcelona, España
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31
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Hoibian S, Ratone JP, Gonzalez JM, Bories E, Pesenti C, Caillol F, Grimaud JC, Giovannini M, Barthet M. Endoscopic mucosal resection of sporadic duodenal nonampullary adenoma: outcomes of 130 patients with a long-term follow up in two tertiary French centers. Ann Gastroenterol 2021; 34:169-176. [PMID: 33654355 PMCID: PMC7903584 DOI: 10.20524/aog.2021.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background The long-term outcomes and safety of endoscopic mucosal resection (EMR) of sporadic duodenal adenoma (SDA), and the management of adverse events need to be confirmed. Methods A bicentric retrospective study was performed including all patients who underwent EMR for SDAs from 2003-2016. The primary aim was to evaluate the efficiency of EMR for SDA. The secondary objectives were to assess safety, recurrence management, predictive factors for treatment success, and adverse events. Results One hundred thirty patients (134 procedures) were included (median age 65 years, 49.3% male). The mean SDA size was 20.7 (range 5-50) mm. Of the SDAs, 58.2% were category 3 of the Vienna classification, 35.8% were category 4, and 5.9% were category 5. The median follow up was 25.0 (range 2-120) months. Complete mucosal resection was achieved for 129/134 lesions (96.2%), with en bloc resection in 59/134 (44%). Recurrence occurred in 28.6% of cases (30/105 procedures). Recurrence was successfully treated by new endoscopic procedures in 72.2% (13/18) and by surgery in 27.8% (5/18). Delayed bleeding occurred in 13.4% of cases (18/134) and was successfully managed endoscopically. The perforation rate was 3.7% (5/134); perforations were managed without surgery in 60% (3/5 patients) of cases. Conclusions Endoscopic treatment of SDA appears to be effective and relatively safe in tertiary centers. All bleeding complications were endoscopically controlled, and perforation was rare. Recurrence was frequent but could be managed endoscopically. EMR is confirmed as a first-line treatment in cases of SDA, and surgery is useful only if repeated EMRs fail.
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Affiliation(s)
- Solène Hoibian
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet).,Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Philippe Ratone
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Michel Gonzalez
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
| | - Erwan Bories
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Christian Pesenti
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Jean-Charles Grimaud
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute (Solène Hoibian, Jean-Philippe Ratone, Jean-Michel Gonzaleza Erwan Bories, Christian Pesenti, Fabrice Caillol, Marc Giovannini), Marseille, France
| | - Marc Barthet
- Gastroenterology Unit, Hôpitaux Universitaires de Marseille Nord, Chemin des Bourrely (Solène Hoibian, Jean-Michel Gonzalez, Jean-Charles Grimaud, Marc Barthet)
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Affiliation(s)
- Mohamed Gasmi
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Arthur Falque
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Gasmi M, Gonzalez JM, Barthet M. Endoscopic ultrasound-directed transgastrojejunal ERCP: a new technique to treat biliary stricture through the afferent limb after Whipple surgery. Endoscopy 2020; 52:E441-E442. [PMID: 32396953 DOI: 10.1055/a-1158-8559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mohamed Gasmi
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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34
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Gonzalez JM, Beyer L, Garnier E, Berdah S, Barthet M. Safety and clinical outcomes of endoscopic gastrojejunal anastomosis in obese Yucatan pigs with or without duodenal exclusion using new 20mm lumen-apposing metal stent: A pilot study. Clin Res Hepatol Gastroenterol 2020; 44:786-789. [PMID: 32473815 DOI: 10.1016/j.clinre.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
| | - Laura Beyer
- CERC, Aix-Marseille University, Marseille, France
| | | | | | - Marc Barthet
- CERC, Aix-Marseille University, Marseille, France
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35
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Monino L, Gonzalez JM, Barthet M, Vitton V. Redo gastric peroral endoscopic myotomy in case of recurrence of gastroparesis after the first GPOEM: It seemed to be a good option! Gastrointest Endosc 2020; 92:975-976. [PMID: 32964837 DOI: 10.1016/j.gie.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium; Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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36
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Benammar L, İnan Bektaş K, Menasria T, Beldüz AO, Güler HI, Bedaida IK, Gonzalez JM, Ayachi A. Diversity and enzymatic potential of thermophilic bacteria associated with terrestrial hot springs in Algeria. Braz J Microbiol 2020; 51:1987-2007. [PMID: 32959204 DOI: 10.1007/s42770-020-00376-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/25/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
This study aims to determine the diversity of culturable thermophilic bacteria isolated from eight terrestrial hot springs in Northeastern of Algeria using the conventional methods, SDS-PAGE fingerprinting of whole-cell proteins and 16S rRNA gene sequencing. In addition, their hydrolytic enzyme activities were also investigated. A total of 293 strains were isolated from the hot springs' water and sediment using different culture media. Overall, five distinct bacterial groups were characterized by whole-cell protein pattern analysis. Based on the 16S rRNA gene sequencing of 100 selected strains, the isolates were assigned to the following three major phyla: Firmicutes (93%), Deinococcus-Thermus (5%), and Actinobacteria (2%), which included 27 distinct species belonging to 12 different phylotypes, Aeribacillus, Aneurinibacillus, Anoxybacillus, Bacillus, Brevibacillus, Geobacillus, Laceyella, Meiothermus, Saccharomonospora, Thermoactinomyces, Thermobifida, and Thermus. The screening for nine extracellular enzymes showed that 65.87% of the isolates presented at least five types of enzyme activities, and 6.48% of strains combined all tested enzymes (amylase, cellulase, pectinase, esculinase, protease, gelatinase, lipase, lecithinase, and nuclease). It was found that Bacillus, Anoxybacillus, Aeribacillus, and Aneurinibacillus were the genera showing the highest activities. Likewise, the study showed an abundant and diverse thermophilic community with novel taxa presenting a promising source of thermozymes with important biotechnological applications. This study showed that a combined identification method using SDS-PAGE profiles of whole-cell proteins and subsequent 16S rRNA gene sequence analysis could successfully differentiate thermophilic bacteria from Algerian hot springs.
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Affiliation(s)
- L Benammar
- Department of Microbiology and Biochemistry, Faculty of Natural and Life Sciences, University of Batna 2, 05078, Batna, Algeria.
- Molecular Biology Research Laboratory, Department of Biology, Faculty of Science, Karadeniz Technical University, 61080, Trabzon, Turkey.
- Bacteriology Laboratory, Veterinary and Agricultural Sciences Institute, Department of Veterinary Sciences, University of Batna 1, 05000, Batna, Algeria.
| | - K İnan Bektaş
- Department of Molecular Biology and Genetics, Faculty of Science, Karadeniz Technical University, 61080, Trabzon, Turkey
| | - T Menasria
- Department of Applied Biology, Faculty of Exact Sciences and Natural and Life Sciences, University of Larbi Tebessi, 12002, Tebessa, Algeria.
| | - A O Beldüz
- Molecular Biology Research Laboratory, Department of Biology, Faculty of Science, Karadeniz Technical University, 61080, Trabzon, Turkey
| | - H I Güler
- Department of Molecular Biology and Genetics, Faculty of Science, Karadeniz Technical University, 61080, Trabzon, Turkey
| | - I K Bedaida
- Department of Microbiology and Biochemistry, Faculty of Natural and Life Sciences, University of Batna 2, 05078, Batna, Algeria
| | - J M Gonzalez
- Spanish National Research Council Seville (CSIC), Institute of Natural Resources and Agrobiology of Seville (IRNAS), Seville, Spain
| | - A Ayachi
- Bacteriology Laboratory, Veterinary and Agricultural Sciences Institute, Department of Veterinary Sciences, University of Batna 1, 05000, Batna, Algeria
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Monino L, Gonzalez JM, Barthet M, Vitton V. Role of pyloric botulinum injection and endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy: Why not? Gastrointest Endosc 2020; 92:798-799. [PMID: 32838923 DOI: 10.1016/j.gie.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 03/24/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium; Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, Dhillon A, Fragaki M, Gonzalez JM, Repici A, van Wanrooij RLJ, van Hooft JE. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy 2020; 52:792-810. [PMID: 32781470 DOI: 10.1055/a-1222-3191] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 02/08/2023]
Abstract
1: ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 : ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3: ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 : ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 : ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.
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Affiliation(s)
- Gregorios A Paspatis
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marc Dumonceau
- Gastroenterology Service, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Brian Saunders
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | | | - Angad Dhillon
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | - Maria Fragaki
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | | | - Alessandro Repici
- Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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Abstract
BACKGROUND Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis involving skin and multiple internal organs. Gastrointestinal manifestations occur with a prevalence of 75-90%, and severely impact the quality of life. Among them, gastric involvement may concern 50-80% of patients with gastroparesis. GPOEM has been recently proposed as effective treatment in refractory gastroparesis, reaching 80% of short-term efficacy with very low complication rate. This procedure has never been assessed in SSc patients; thus, we describe two cases of patient who benefited from GPOEM.Patients: There were 40 and 35 years old women suffering from SSc for 10 years, whom developed gastroparesis symptoms over the last year, with GCSI score of 3.4. The diagnosis was confirmed by gastric emptying scintigraphy showing increased half emptying time and residual percentages. After failure of medical therapy associating prokinetic agents and dietary measures, they were referred after multidisciplinary discussion for GPOEM procedure. The follow-up included GCSI score calculation, adverse events, and GES at 2 months. RESULTS The procedures were uneventful, and the patients were discharged after 4 days and gradual refeeding. The post-operative GCSI 1 and 2.1, respectively, with both patients feeling significant clinical improvement, after a follow-up of 6 months. GES were also normalized in one patient. Despite improvement, one patient did not gain weight and had an additional jejunostomy. CONCLUSIONS GPOEM may be an interesting therapeutic option in patient with SSc and severe gastroparesis after failure of classical treatment. This procedure could be proposed to patients after multidisciplinary discussion.
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Affiliation(s)
- Jean-Michel Gonzalez
- Service de Gastroentérologie, Hôpital Nord, Aix-Marseille Université, AP-HM, Marseille, France
| | - Brigitte Granel
- Service de Médecine Interne, Hôpital la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - Marc Barthet
- Service de Gastroentérologie, Hôpital Nord, Aix-Marseille Université, AP-HM, Marseille, France
| | - Véronique Vitton
- Service de Gastroentérologie, Hôpital Nord, Aix-Marseille Université, AP-HM, Marseille, France
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Weusten BLAM, Barret M, Bredenoord AJ, Familiari P, Gonzalez JM, van Hooft JE, Lorenzo-Zúñiga V, Louis H, Martinek J, van Meer S, Neumann H, Pohl D, Prat F, von Renteln D, Savarino E, Sweis R, Tack J, Tutuian R, Ishaq S. Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52:600-614. [PMID: 32462649 DOI: 10.1055/a-1171-3174] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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] [Indexed: 02/08/2023]
Abstract
ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker's diverticulum of any size.Weak recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends that emerging treatments for Zenker's diverticulum, such as Zenker's peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.Strong recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.Strong recommendation, low quality evidence, level of agreement 93.3 %.ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or laparoscopic fixation) to prevent leaks and infectious adverse events, whatever percutaneous endoscopic cecostomy method is used.Strong recommendation, very low quality evidence, level of agreement 86.7 %.ESGE recommends considering endoscopic decompression of the colon in patients with Ogilvie's syndrome that is not improving with conservative treatment.Strong recommendation, low quality evidence, level of agreement 93.8 %.ESGE recommends prompt endoscopic decompression if the cecal diameter is > 12 cm and if the Ogilvie's syndrome exists for a duration of longer than 4 - 6 days.Strong recommendation, low quality evidence, level of agreement 87.5 %.
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Affiliation(s)
- Bas L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, France
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Pietro Familiari
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Jeanin E van Hooft
- Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Hubert Louis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Daniel Pohl
- Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
| | - Frederic Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, France
| | - Daniel von Renteln
- Division of Gastroenterology, Montréal University Hospital (CHUM), Montréal, Canada
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padova, Padova, Italy
| | - Rami Sweis
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Radu Tutuian
- Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK
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Weusten BLAM, Barret M, Bredenoord AJ, Familiari P, Gonzalez JM, van Hooft JE, Lorenzo-Zúñiga V, Louis H, Martinek J, van Meer S, Neumann H, Pohl D, Prat F, von Renteln D, Savarino E, Sweis R, Tack J, Tutuian R, Ishaq S. Correction: Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52:C7. [PMID: 32580233 DOI: 10.1055/a-1201-7524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bas L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, France
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Pietro Familiari
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Jeanin E van Hooft
- Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Hubert Louis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Daniel Pohl
- Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
| | - Frederic Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, France
| | - Daniel von Renteln
- Division of Gastroenterology, Montréal University Hospital (CHUM), Montréal, Canada
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padova, Padova, Italy
| | - Rami Sweis
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Radu Tutuian
- Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group NHS Foundation Trust and Birmingham City University, Birmingham, UK
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Gonzalez JM, Monino L, Ah-Soune P, Vitton V, Barthet M. Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication. Endoscopy 2020; 52:583-588. [PMID: 32325512 DOI: 10.1055/a-1147-1348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
INTRODUCTION Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % - 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. METHODS A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow - Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. RESULTS HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. CONCLUSION POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.
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Affiliation(s)
- Jean-Michel Gonzalez
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Laurent Monino
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France.,Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Ah-Soune
- Service d'hépato-gastroentérologie, CHG Sainte Musse, Toulon, France
| | - Véronique Vitton
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
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Gonzalez JM, Barthet M, Vitton V. Gastric Peroral Endoscopic Myotomy (GPOEM): a Helpful Tool for Post Laparoscopic Sleeve Gastrectomy Gastroparesis. Obes Surg 2020; 31:403-404. [PMID: 32524525 DOI: 10.1007/s11695-020-04752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jean-Michel Gonzalez
- Department of Gastroenterology, AP-HM, Hôpital Nord, Aix-Marseille Université, Marseille, France. .,Service de Gastroenterologie, Hôpital Nord, Chemin des Bourrelys, 13015, Marseille, France.
| | - Marc Barthet
- Department of Gastroenterology, AP-HM, Hôpital Nord, Aix-Marseille Université, Marseille, France
| | - Véronique Vitton
- Department of Gastroenterology, AP-HM, Hôpital Nord, Aix-Marseille Université, Marseille, France
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Monino L, Gonzalez JM, Serrero M, Barthet M. First case of endoscopic ultrasound-guided gastrojejunal anastomosis for duodenal stricture in refractory Crohn's disease: a bridge toward inflammation control. Endoscopy 2020; 52:E204-E205. [PMID: 31858506 DOI: 10.1055/a-1066-4488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Melanie Serrero
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Monino L, Gonzalez JM, Lestelle V, Vitton V, Barthet M. DUAL-POEM for associated esophageal and gastric motility disorders: case series of endoscopic cardiomyotomy and endoscopic pyloromyotomy. Scand J Gastroenterol 2020; 55:634-637. [PMID: 32419525 DOI: 10.1080/00365521.2020.1766103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Per-oral esophageal myotomy endoscopic (E-POEM) has clearly proved safety and efficiency in the treatment of esophageal spastic disorders. Recent studies on endoscopic pyloromyotomy (G-POEM) suggest good efficiency and safety in the treatment of gastroparesis. In recent literature, some reports showed both esophageal motility disorders and gastroparesis.Methods: We report the case of four patients with esophageal and gastric motility disorders who were successfully treated with DUAL POEM (E-POEM and G-POEM) in two separate procedures.Results: Clinical improvement was reported in all patients with a decrease of the Eckardt score for esophageal motility disorders and a decrease of the GCSI score for gastroparesis. No adverse events occurred after any procedure. These reported cases suggest that is possible to perform an E-POEM and a G-POEM in the same patient in two distinct procedures.Conclusions: DUAL POEM seems to be faisable in patient with esophageal motility disorders associated with gastroparesis. The possibility of the concomitant occurrence of esophageal and gastric motility disorders could lead to change in practices with an overall assessment including gastric empting scintigraphy, high resolution manometry and pH-impedancemetry for patients with digestive motility disorders.
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Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Valentin Lestelle
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Serrero M, Santoni A, Grimaud JC, Desjeux A, Gonzalez JM, Barthet M. Cuffitis: is an endoscopic approach possible? Endosc Int Open 2020; 8:E544-E547. [PMID: 32258377 PMCID: PMC7089796 DOI: 10.1055/a-0996-7975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/01/2018] [Accepted: 07/09/2019] [Indexed: 01/01/2023] Open
Abstract
Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the reference surgical treatment for patients with ulcerative colitis (UC) refractory to medical treatment. One of the complications is leaving a strip of rectal mucosa which can be a cause of persistent inflammation or cuffitis. The objective of our study is to present an endoscopic approach for the treatment of cuffitis. Methods This retrospective study included three patients who suffered from cuffitis after a proctocolectomy with IPAA for UC refractory to medical treatment. An endoscopic resection of the cuffitis was performed by the same operator. Two different techniques were used: hybrid endoscopic submucosal dissection (ESD) for one patient and mucosectomy with cap and resection for the two others. Results The endoscopic treatment was performed successfully in all three patients. The only complication observed was rectal bleeding which did not require endoscopic revision. The three patients are now asymptomatic. Conclusion Endoscopic treatment of cuffitis appears to be an interesting approach with few complications in the short term and good clinical efficacy.
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Guingand M, Vitton V, Barthet M, Gonzalez JM. Comments on Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus After Sleeve Gastrectomy. Obes Surg 2020; 30:2415-2416. [DOI: 10.1007/s11695-020-04498-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Basile P, Gonzalez JM, Le Mouel JP, Irarrazaval R, Caillo L, Barthet M. Per-oral endoscopic myotomy with septotomy for the treatment of distal esophageal diverticula (D-POEM). Surg Endosc 2020; 34:2321-2325. [PMID: 32144556 DOI: 10.1007/s00464-019-07354-0] [Citation(s) in RCA: 4] [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: 05/21/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Epinephric diverticula are frequently associated with esophageal motility disorder. Their management implies surgery, with 15% morbidity and 3% mortality rates. Flexible endoscopy could be an effective and safer approach for treating esophageal diverticulum with motility disorder. We report our experience of seven consecutive cases treated with per-oral endoscopic submucosal septotomy and myotomy (D-POEM). METHODS Seven consecutive patients were referred for symptomatic non-zenker's esophageal diverticulum. The steps of the procedure were as follows: (i) analysis of the esophageal anatomy; (ii) vertical mucosal incision just above the upper edge of the diverticulum; (iii) submucosal tunneling by submucosal dissection, alongside the submucosal window of the diverticulum and the downstream septum; (iv) identification of the septum and the diverticular area; (v) diverticular septotomy followed by antegrade esocardial myotomy up to 2 cm below the cardia; and (vi) closure of the mucosal incision. RESULTS Three men and four women aged from 62 to 90 years were treated. Four patients had a diet with adapted texture before the treatment and five patients had weight loss (4 kg to 24 kg). At preoperative evaluation, all had an esophageal motility disorder at high-resolution manometry. The procedures were successfully performed in all the patients without per-operative complications. During the 30 postoperative days, no significant adverse events occurred. Three months after treatment, six patients (85%) had clinical improvement with complete or partial regression of dysphagia. All the patients stabilized or gained weight after the treatment. CONCLUSION The D-POEM technique is a mini-invasive effective and safe technique to treat symptoms due to both esophageal motility disorder and distal esophageal diverticula. It could be a very interesting solution for non-surgical patients in the first time that could be extended to other patients after favorable larger series.
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Affiliation(s)
- Paul Basile
- Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Rouen, 76031, Rouen Cedex, France.
| | - Jean-Michel Gonzalez
- Digestive Endoscopy Unit, Gastroenterology Department, Hopital Nord, APHM, Marseille, France
| | - Jean-Philippe Le Mouel
- Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Amiens, Amiens, France
| | | | - Ludovic Caillo
- Gastroenterology Department, University Hospital of Nîmes, Nîmes, France
| | - Marc Barthet
- Digestive Endoscopy Unit, Gastroenterology Department, Hopital Nord, APHM, Marseille, France
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Monino L, Gonzalez JM, Vitton V, Barthet M. Antireflux mucosectomy band in treatment of refractory gastroesophageal reflux disease: a pilot study for safety, feasibility and symptom control. Endosc Int Open 2020; 8:E147-E154. [PMID: 32010747 PMCID: PMC6976317 DOI: 10.1055/a-1038-4012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Antireflux mucosectomy band ligation (ARM-b) is an endoscopic procedure that mimics a fundoplication for managing gastroesophoageal reflux disease (GERD). The aim of this study was to assess safety and feasibility of ARM-b. Patients and methods This was a single-center study on consecutive patients operated between June 2017 and January 2019 with refractory GERD, confirmed with pH-metry and without motility disorder at high-resolution manometry. A piecemeal mucosectomy of three quarters of circumference of esophagogastric junction was performed using a band ligation system and a hexagonal snare. The primary objective was to assess procedural safety and feasibility. The secondary objective was to document the clinical improvement at 3 and 6 months based on patient satisfaction, proton pump inhibitor (PPI) intake, symptoms, and quality of life scores. Results Twenty-onepatients (11 men) with mean age 56.9 ± 14.4 years were analyzed. The technical success rate was 100 % (mean duration 35 ± 11 min). Four patients (19 %) had mild adverse events: one delayed bleeding at Day 1 managed conservatively, and three dysphagia endoscopically managed. Mean follow-up was 10 ± 5 months. Decrease/discontinuation of PPI intake was 76 % at 3 months and 72 % at 6 months. Improvement in mean symptoms and quality of life scores (GERD-Q and GERD-HQL) were statistically significant. One patient required laparoscopic fundoplication after ARM-b failure without complication. Conclusion ARM-b is safe, feasible, and symptom-effective for treating refractory GERD, and it can be performed in the ambulatory setting. Further prospective studies are required to confirm these promising outcomes.
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Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium,Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France,Corresponding author Laurent Monino, MD Department of HepatogastroenterologyAP-HM, Aix-Marseille UniversitéHôpital NordChemin des Bourrely13015 MarseilleFrance+33-4-91968737
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Bernardot L, Roman S, Barret M, Vitton V, Wallenhorst T, Pioche M, Chaussade S, Gonzalez JM, Ponchon T, Prat F, Barthet M, Vergniol J, Chabrun E, Zerbib F. Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders. Surg Endosc 2020; 34:5508-5515. [DOI: 10.1007/s00464-019-07348-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023]
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