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Djinbachian R, Amar L, Pohl H, Safih W, Bouchard S, Deslandres E, Dorais J, von Renteln D. Local recurrence rates after resection of large colorectal serrated lesions with or without margin thermal ablation. Scand J Gastroenterol 2024; 59:112-117. [PMID: 37743643 DOI: 10.1080/00365521.2023.2257824] [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: 05/08/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Serrated lesions (SLs) including traditional serrated adenomas (TSA), large hyperplastic polyps (HP) and sessile serrated lesions (SSLs) are associated with high incomplete resection rates. Margin ablation combined with EMR (EMR-T) has become routine to reduce local recurrence while cold snare polypectomy (CSP) is becoming recognized as equally effective for large SLs. Our aim was to evaluate local recurrence rates (LRR) and the use of margin ablation in preventing recurrence in a retrospective cohort study. METHODS Patients undergoing resection of ≥15 mm colorectal SLs from 2010-2022 were identified through a pathology database and electronic medical records search. Hereditary CRC syndromes, first follow-up > 18 months or no follow-up, surgical resection were excluded. Primary outcome was LRRs (either histologic or visual) during the first 18-month follow-up. Secondary outcomes were LRRs according to size, and resection technique. RESULTS 191 polyps in 170 patients were resected (59.8% women; mean age, 65 years). The mean size of polyps was 22.4 mm, with 107 (56.0%) ≥20 mm. 99 polyps were resected with EMR, 39 with EMR-T, and 26 with CSP. Mean first surveillance was 8.2 mo. Overall LRR was 18.8% (36/191) (16.8% for ≥20 mm, 17.9% for ≥30 mm). LRR was significantly lower after EMR-T when compared with EMR (5.1% vs. 23.2%; p = 0.013) or CSP (5.1% vs. 23.1%; p = 0.031). There was no difference in LRR between EMR without margin ablation and CSP (p = 0.987). CONCLUSION The local recurrence rate for SLs ≥15 mm is high with 18.8% overall recurrence. EMR with thermal ablation of the margins is superior to both no ablation and CSP in reducing LRRs.
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Affiliation(s)
- Roupen Djinbachian
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Laetitia Amar
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Division of Gastroenterology, VA Medical Center, VT, USA
| | - Widad Safih
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Simon Bouchard
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Erik Deslandres
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Judy Dorais
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Daniel von Renteln
- Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
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Therrien A, Chapuy L, Bsat M, Rubio M, Bernard G, Arslanian E, Orlicka K, Weber A, Panzini BP, Dorais J, Bernard EJ, Soucy G, Bouin M, Sarfati M. Recruitment of activated neutrophils correlates with disease severity in adult Crohn's disease. Clin Exp Immunol 2018; 195:251-264. [PMID: 30347439 DOI: 10.1111/cei.13226] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 12/17/2022] Open
Abstract
Neutrophils are detected in inflamed colon in Crohn's disease (CD). However, whether the frequency and/or activation of circulating or gut tissue neutrophils correlate with endoscopic severity remains to be investigated. A cohort of 73 CD patients was prospectively enrolled according to endoscopic severity and treatment history. Individuals with active disease were stratified using the Montreal classification. Harvey-Bradshaw Index (HBI) and Simple Endoscopic Score for Crohn's Disease (SES-CD) were performed at the time of ileocolonoscopy. Frequency of neutrophils and their expression of CD66b and CD64 were assessed in paired blood and colonic biopsies using flow cytometry. The percentage of neutrophils increased in inflamed colon and correlated with SES-CD in the entire cohort of patients examined, as well as in the subgroup with inflammatory (B1) active disease. SES-CD further correlated with neutrophil CD66b expression in mucosa but not blood and, conversely, with neutrophil CD64 expression in blood but not mucosa. However, the evaluation of neutrophil activation in mucosa when compared to blood reflected disease activity more clearly. Finally, a neutrophil activation power index (CD66b in mucosa X CD64 in blood) that correlated with SES-CD discriminated between patients with mild and severe disease. In conclusion, the frequency and activation of colonic neutrophils correlated with SES-CD, highlighting that mucosal neutrophils are associated with disease severity in CD.
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Affiliation(s)
- A Therrien
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - L Chapuy
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - M Bsat
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - M Rubio
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - G Bernard
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - E Arslanian
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - K Orlicka
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - A Weber
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - B-P Panzini
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - J Dorais
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - E-J Bernard
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - G Soucy
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - M Bouin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - M Sarfati
- Immunoregulation Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
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Conway D, Maas K, Slater C, Gurtcheff S, Dorais J, Schuermann T. What male factors predict embryo development to the blastocyst stage? Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bernier A, Dorais J, Gagnon B, Lepage C, Jodoin N, Soland V, Panisset M, Chouinard S, Duquette A. Enteral Feeding Using Levodopa-Carbidopa Intestinal Gel Percutaneous Endoscopic Gastrostomy Tube. Mov Disord Clin Pract 2017; 4:787-788. [PMID: 30838290 DOI: 10.1002/mdc3.12490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/21/2017] [Accepted: 03/08/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Andréane Bernier
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Judy Dorais
- Service de Gastro-entérologie du Département de Médecine Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Benoit Gagnon
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Christiane Lepage
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Nicolas Jodoin
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Valérie Soland
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Michel Panisset
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Sylvain Chouinard
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
| | - Antoine Duquette
- Service de Neurologie du Département de Médecine Unité des Troubles du Mouvement André-Barbeau Centre Hospitalier de l'Université de Montréal Montréal Canada
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Johnstone E, Link M, Patel B, Hotaling J, Moore A, Dorais J, Carrell D, Peterson C, Aston K. Does outcome of the first IVF cycle allow selection of candidates for repeat IVF prior to PGS? Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dorais J, Kuzbari O, Johnstone E, Peterson C, Moore A, Hammoud A. AMH level is predicts the likelihood of having embryos available for cryopreservation in fresh, non-donor IVF cycles. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tang SJ, Haber GB, Kortan P, Zanati S, Cirocco M, Ennis M, Elfant A, Scheider D, Ter H, Dorais J. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy 2005; 37:58-65. [PMID: 15657860 DOI: 10.1055/s-2004-826077] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Failed biliary cannulation occurs in up to 10% of patients undergoing ERCP. There is some controversy as to the safety and efficacy of using precut techniques to achieve biliary cannulation in difficult cases. To date, no randomized trial has compared the success and complication rates of precut with the rates for persistence when biliary cannulation is difficult. The aim of this study was to compare the success rates and complication rates of precut with the success rates and complication rates of persistence in cases of difficult biliary cannulation. PATIENTS AND METHODS Patients without prior sphincterotomy who required biliary cannulation were screened. A "difficult biliary cannulation" was arbitrarily defined as failed cannulation after 12 minutes. These patients were then randomized to continue treatment by needle-knife cut over the roof of the papilla or by persistence with a non-wire-guided, single-lumen papillotome. "Primary" success was defined as deep cannulation within 15 minutes of randomization. Primary and final success rates and complication rates within 30 days after ERCP were compared. RESULTS Over a 38-month period a total of 642 patients were screened. Patients in whom biliary cannulation was successful within a time period of 12 minutes or less formed the reference group (n = 580). The remainder of the patients were randomly assigned to the "precut" arm (n = 32) or to the "persistence" arm (n = 30). Primary success rates and complication rates were similar in the precut and persistence arms (75% and 4% respectively for the precut arm vs. 73% and 9% for the persistence arm). The final successful cannulation rate in the entire group of 642 patients was 99.5%. CONCLUSIONS In experienced hands, precut papillotomy and persistence in cannulation are equally effective in cases of difficult cannulation, with a similar complication rate.
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Affiliation(s)
- S-J Tang
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Garrel D, Patenaude J, Nedelec B, Samson L, Dorais J, Champoux J, D'Elia M, Bernier J. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: A prospective, controlled, randomized clinical trial*. Crit Care Med 2003; 31:2444-9. [PMID: 14530749 DOI: 10.1097/01.ccm.0000084848.63691.1e] [Citation(s) in RCA: 231] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on burn patients is not known. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity, length of care, and the immune system in burn patients. DESIGN Double-blinded, randomized clinical trial. SETTING Burn center. PATIENTS Forty-five adults with severe burns. INTERVENTIONS Patients were randomized to receive either glutamine or an isonitrogenous control mixture until complete healing occurred. Length of care, incidence of positive blood culture, and mortality were recorded. Phagocytosis by circulating polymorphonuclear cells was measured every 3 days. MEASUREMENTS AND MAIN RESULTS Patient characteristics were similar in both groups. Four patients were excluded from the analysis, because three of them died within 72 hrs and the fourth could not receive enteral nutrition and amino acid supplements for the first 10 days. Of the remaining 41 patients, length of care in the survivors was not different between groups (0.9 vs. 1.0 days/percent total body surface area for glutamine vs. control, respectively), positive blood culture was three times more frequent in control than in glutamine treatment (4.3 vs. 1.2 days/patient, p <.05), and Pseudomonas aeruginosa was detected in six patients on control and zero on glutamine (p <.05). Phagocytosis by polymorphonuclear cells was not different between groups. Mortality rate was significantly lower in glutamine than in control: intention to treat, two vs. 12 (p <.05); per protocol analysis, zero vs. eight (p <.01). CONCLUSIONS Enteral glutamine supplementation in adult burn patients reduces blood infection by a factor of three, prevents bacteremia with P. aeruginosa, and may decrease mortality rate. It has no effect on level of consciousness and does not appear to influence phagocytosis by circulating polymorphonuclear cells.
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Affiliation(s)
- Dominique Garrel
- Burn Centre, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu, Quebec, Canada.
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Dorais J, Haber GB. Future of endoscopy in nonvariceal upper gastrointestinal bleeding. What remains to be done. Gastrointest Endosc Clin N Am 1997; 7:717-31. [PMID: 9376960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The centennial of the American Gastroenterological Association provides an occasion for a critical appraisal of past developments and future directions in endoscopy. The relevance of recent technologic advances in endoscopy must be questioned, and practical management issues need to be considered. New strategies are being developed that permit physicians to impact on the incidence and recurrence of bleeding peptic ulcers.
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Affiliation(s)
- J Dorais
- The Wellesley Hospital, Toronto, Ontario, M4Y 1J3, Canada
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Couture R, Laneuville O, Dorais J. Characterization of neurokinin receptors in a spinal nociceptive reflex of the rat by the use of selective agonists. ACTA ACUST UNITED AC 1988. [DOI: 10.1016/0167-0115(88)90272-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Laneuville O, Dorais J, Couture R. Characterization of the effects produced by neurokinins and three agonists selective for neurokinin receptor subtypes in a spinal nociceptive reflex of the rat. Life Sci 1988; 42:1295-305. [PMID: 2451105 DOI: 10.1016/0024-3205(88)90223-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In the awake restrained rat the intrathecal (i.th.) administration of 6.5 pmol-40 nmol of substance P (SP), neurokinin A (NKA) or one of two selective NK-1 receptor agonists [Pro9, Met(O2)11]SP, denoted ana1 and [beta-Ala4, Sar9, Met(O2)11]SP , denoted ana2 decreased reaction time (RT) to a noxious radiant heat stimulus in a dose-related manner. The following rank order of potency was observed in relation to this response: ana1 = ana2 greater than SP much greater than NKA. The decrement of tail-flick latency was greatest at 1 min and RT returned to the basal level within 6-11 min post-administration. However, in some rats SP produced a small increase in RT (anti-nociception) at 6-11 min post-administration. The i.th. administration of neurokinin B (NKB) or a selective NK-3 receptor agonist [beta-Asp4, MePhe7]NKB), denoted ana3 induced an antinociceptive effect which was greatest at 1 min and lasted less than 11 min after NKB or more than 30 min after ana3 administration. The magnitude of the increase in RT produced by 65 pmol-40 nmol doses of these peptides is ana3 much greater than NKB much greater than SP. The effect of NKB (8.0 nmol) was significantly blocked (P less than 0.005) by prior i.th. administration of naloxone (opioid antagonist) but not by idazoxan (alpha 2-adrenoceptor antagonist), [Thi5,8, D-Phe7]BK (kinin antagonist), or following bilateral adrenalectomy. From these results, we conclude that NKB-induced antinociception is mediated by the spinal release of an opioid and not through a BK or NA mechanism. The results also suggest that the nociceptive and antinociceptive effects of neuro-kinins are mediated by the activation of NK-1 and NK-3 receptor subtypes respectively, in the rat spinal cord.
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Affiliation(s)
- O Laneuville
- Department of Physiology, Faculty of Medicine, University of Montreal, Québec, Canada
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Roy PE, Dorais J, Morin PJ. [Areas of focal intracellular necrosis in human cardiac muscle]. Ann Anat Pathol (Paris) 1972; 17:39-51. [PMID: 5082964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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