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Quénéhervé L, Trang-Poisson C, Fantou A, Flamant M, Durand T, Bouguen G, Bregeon J, Oullier T, Amil M, Dewitte M, Bardot S, Blandin S, Braudeau C, Vibet MA, Josien R, Neunlist M, Bourreille A. Confocal laser endomicroscopy as predictive biomarker of clinical and endoscopic efficacy of vedolizumab in ulcerative colitis: The DETECT study. PLoS One 2024; 19:e0298313. [PMID: 38564601 PMCID: PMC10986992 DOI: 10.1371/journal.pone.0298313] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS In patients with ulcerative colitis (UC), no biomarker is available to help the physician to choose the most suitable biotherapy. The primary objective of this pilot study was to assess the feasibility of identification of α4β7- and TNF-expressing cells, to predict the response to vedolizumab using confocal laser endoscopy (CLE). METHODS Patients with moderate-to-severe UC, naïve of biotherapy, received vedolizumab. Clinical evaluation was performed at each infusion. Endoscopic evaluation was performed before inclusion and at week 22. Fresh colonic biopsies were stained using FITC-labelled vedolizumab and Alexa fluor-labelled adalimumab and ex vivo dual-band CLE images were acquired. Blood samples were collected to measure trough concentrations of vedolizumab and to determine absolute counts of T and B cells subpopulations, NK cells and monocytes. RESULTS Nineteen patients were enrolled in the study and received at least one dose of vedolizumab. Clinical remission and endoscopic improvement were observed in 58% of whom 5 patients (45%) had an endoscopic subscore of 0. In terms of clinical response and remission, endoscopic improvement and histologic response, FITC-conjugated vedolizumab staining tended to be higher in responder patients compared to non-responders at week 22. A threshold value of 6 positive FITC-vedolizumab staining areas detected by CLE seemed informative to discriminate the responders and non-responders. The results were similar in terms of clinical remission and endoscopic improvement with a sensitivity of 78% and a specificity of 85% (p = 0.05). Trough concentrations and blood immune cells were not associated with responses to vedolizumab. CONCLUSION This pilot study demonstrate that dual-band CLE is feasible to detect α4β7- and TNF-expressing cells. Positive α4β7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-α4β7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083.
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Affiliation(s)
- Lucille Quénéhervé
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Caroline Trang-Poisson
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Aurélie Fantou
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Mathurin Flamant
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Tony Durand
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Guillaume Bouguen
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Jérémy Bregeon
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Thibauld Oullier
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Morgane Amil
- CHD La Roche-Sur-Yon, Hepato-gastroentérologie, La Roche-Sur-Yon, France
| | - Marie Dewitte
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Stéphanie Bardot
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Stéphanie Blandin
- Nantes Université, UMS BioCore, Inserm US16—UAR CNRS 3556, Nantes, France
| | - Cécile Braudeau
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Marie-Anne Vibet
- CHU Nantes, Methodology and Biostatistics Department, Direction de la Recherche Clinique et de l’Innovation, Nantes, France
| | - Régis Josien
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Michel Neunlist
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Arnaud Bourreille
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
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Le Bras P, Cauchin E, De Lange G, Moussata D, Garcia GA, Quénéhervé L, Saurin JC, Coron E. Impact of Endoscopic Treatment in Severe Duodenal Polyposis: A National Study in Familial Adenomatous Polyposis Patients. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00289-1. [PMID: 38555039 DOI: 10.1016/j.cgh.2024.03.007] [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: 10/25/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND & AIMS The majority of patients with familial adenomatous polyposis (FAP) develop duodenal adenomas with a risk of progression to duodenal cancer. Endoscopic management of FAP duodenal adenomas has been proposed as a less-invasive option than surgery, but available data still are limited. Our aims were to assess the feasibility and safety of endoscopic treatment in duodenal polyposis and to evaluate its long-term efficacy in terms of recurrence and malignant degeneration. METHODS FAP patients with stage IV duodenal polyposis were enrolled in 5 French centers as part of a national cohort and followed up for a median period of 5.66 years (interquartile range, 6.39 y). Primary outcomes were duodenal surgery-free and cancer-free survival. Two groups of patients were identified according to endoscopic procedures: group 1: resection and or destruction (by argon plasma coagulation) of duodenal polyps, and group 2: papillectomy. RESULTS Fifty-eight patients were enrolled (29 men; median age, 44 y). Endoscopic therapy was performed in 37 patients in group 1 and in 19 patients in group 2. Duodenal cancer-free and surgery-free survival were 95.8% at 5 years and 92.6% at 10 years. Four patients required surgery and 2 patients developed cancers. In the 58 patients, the calculated Spigelman score decreased from 9.24 points at entry to 6.35 at 5 years and then plateaued. Complications (mostly bleeding and perforation) occurred in 20 patients. CONCLUSIONS In this long-term cohort follow-up evaluation, endoscopic treatment of patients with severe duodenal polyposis appears relatively safe and effective as an alternative to surgery for the prevention of cancer.
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Affiliation(s)
- Pierrine Le Bras
- Nantes Université, CHU Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Estelle Cauchin
- Nantes Université, CHU Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Glenn De Lange
- Medical School, University of Geneva, Geneva, Switzerland
| | - Driffa Moussata
- Gastroenterology Department, Tours University Hospital, Tours, France
| | | | - Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France
| | - Jean-Christophe Saurin
- Hôpital E. Herriot, Hospices Civils de Lyon, National Reference Centre for Genetic Polyposes, Lyon, France; Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland
| | - Emmanuel Coron
- Nantes Université, CHU Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France; ▪▪▪.
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Vauquelin B, Quénéhervé L, Pioche M, Barret M, Wallenhorst T, Chabrun E, Coron E, Roman S, Mion F, Chaussade S, Ponchon T, Olivier R, Rivière P, Zerbib F, Berger A. Factors associated with early failure of peroral endoscopic myotomy in achalasia. Gastrointest Endosc 2024; 99:349-357.e3. [PMID: 37806398 DOI: 10.1016/j.gie.2023.10.025] [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] [Received: 05/01/2023] [Revised: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Achalasia can be treated very effectively with peroral endoscopic myotomy (POEM), but factors associated with early failure remain to be determined, especially in European cohorts. METHODS All consecutive adult patients who underwent a first POEM to treat primary achalasia were included in this multicenter retrospective study. Early failure was defined by an Eckardt score (ES) >3 at 3 months after POEM. When evaluating factors predictive of early failure, 2 cohorts were considered: one consisted of the total population, for whom only basic variables were collected, and the other a cohort built for a case-control study that included matched early-failure and early-success patients (ratio, 1:2). RESULTS Among 746 patients, the early failure rate was 9.4%. Predictive factors were age ≤45 years (P = .019), achalasia types I and III (P < .001), and the development of a severe adverse event during the procedure (P = .023). In the case-control study, the only additional independent risk factor for early failure was a high pre-POEM ES (P = .001). Only the retrosternal pain subscore was significantly associated with the early failure rate. CONCLUSION The early failure rate of POEM used to treat primary achalasia is <10%. Younger age, type I/III achalasia, and a high pre-POEM ES were significantly associated with failure.
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Affiliation(s)
- Blandine Vauquelin
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France
| | - Mathieu Pioche
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | - Edouard Chabrun
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Sabine Roman
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - François Mion
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Thierry Ponchon
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Raphael Olivier
- Department of Gastroenterology, Nantes University Hospital, Nantes, France
| | - Pauline Rivière
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Frank Zerbib
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Arthur Berger
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France.
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Quénéhervé L, Pioche M, Jacques J. Curative criteria for endoscopic treatment of colorectal cancer. Best Pract Res Clin Gastroenterol 2024; 68:101883. [PMID: 38522881 DOI: 10.1016/j.bpg.2024.101883] [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: 10/02/2023] [Accepted: 01/17/2024] [Indexed: 03/26/2024]
Abstract
As endoscopic treatment enables en bloc resection of T1 colorectal cancers, the risk of recurrence, often assimilated to the risk of lymph node metastases, must be assessed in order to offer patients an additional treatment if this risk is deemed significant. The curative criteria currently used by most guidelines are depth of invasion <1 mm, well or moderately differentiated tumour, absence of lympho-vascular invasion, absence of significant budding and tumour-free resection margins. However, these factors must be assessed by qualified pathologists, as they are difficult to evaluate. Moreover, the combination of these factors leads to unnecessary surgery in over 80 % of patients whose tumours are classified as high risk. Refinement of current criteria and research into new tumour and immunological markers are needed to better predict the actual risk of our patients.
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Affiliation(s)
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France.
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Dupuytren, Limoges, France.
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Quénéhervé L, Grainville T, Arnachellum R, Pioche M, Michel T, Jacques J, Wallenhorst T. Targeted coagulation of large stalk vessels in giant pedunculated colorectal polyp: is endoscopic submucosal dissection the new way to go? Endoscopy 2023; 55:E924-E925. [PMID: 37500092 PMCID: PMC10374397 DOI: 10.1055/a-2113-9626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France
- LaTIM, UMR 1101, Brest University Hospital, Brest, France
| | - Thomas Grainville
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Tony Michel
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Timothée Wallenhorst
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
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Pérez-Cuadrado-Robles E, Alric H, Quénéhervé L, Monino L, Poghosyan T, Benosman H, Vienne A, Perrod G, Rebibo L, Aidibi A, Tenorio-González E, Ragot E, Karoui M, Cellier C, Rahmi G. Risk factors of anastomosis-related difficult endoscopic retrograde cholangiopancreatography following endoscopic ultrasound-guided gastro-gastrostomy using a standardized protocol (with video). Dig Endosc 2023; 35:909-917. [PMID: 36872440 DOI: 10.1111/den.14544] [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: 11/19/2022] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES Little is known about how to perform the endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) in patients with gastric bypass using lumen-apposing metal stents (LAMS). The aim was to assess the risk factors of anastomosis-related difficult ERCP. METHODS Observational single-center study. All patients who underwent an EDGE procedure in 2020-2022 following a standardized protocol were included. Risk factors for difficult ERCP, defined as the need of >5 min LAMS dilation or failure to pass a duodenoscope in the second duodenum, were assessed. RESULTS Forty-five ERCPs were performed in 31 patients (57.4 ± 8.2 years old, 38.7% male). The EUS procedure was done using a wire-guided technique (n = 28, 90.3%) for biliary stones (n = 22, 71%) in most cases. The location of the anastomosis was gastro-gastric (n = 24, 77.4%) and mainly in the middle-excluded stomach (n = 21, 67.7%) with an oblique axis (n = 22, 71%). The ERCP technical success was 96.8%. There were 10 difficult ERCPs (32.3%) due to timing (n = 8), anastomotic dilation (n = 8), or failure to pass (n = 3). By multivariable analysis adjusted by two-stage procedures, the risk factors for a difficult ERCP were the jejuno-gastric route (85.7% vs. 16.7%; odds ratio [ORa ] 31.875; 95% confidence interval [CI] 1.649-616.155; P = 0.022), and the anastomosis to the proximal/distal excluded stomach (70% vs. 14.3%; ORa 22.667; 95% CI 1.676-306.570; P = 0.019). There was only one complication (3.2%) and one persistent gastro-gastric fistula (3.2%) in a median follow-up of 4 months (2-18 months), with no weight regain (P = 0.465). CONCLUSIONS The jejunogastric route and the anastomosis with the proximal/distal excluded stomach during the EDGE procedure increase the difficulty of ERCP.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Hadrien Alric
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Lucille Quénéhervé
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Laurent Monino
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Tigran Poghosyan
- Paris Cité University, Paris, France
- Department of Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hedi Benosman
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ariane Vienne
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Perrod
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Rebibo
- Department of Surgery, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Ali Aidibi
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elena Tenorio-González
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilia Ragot
- Department of Surgery, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mehdi Karoui
- Department of Surgery, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Christophe Cellier
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Gabriel Rahmi
- >Department of Gastroenterology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
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Pérez-Cuadrado-Robles E, Phillpotts S, Bronswijk M, Conrad CC, Binda C, Monino L, Basiliya K, Hollenbach M, Papaefthymiou A, Alric H, Quénéhervé L, Di Gaeta A, Pioche M, Khani A, Lorenzo D, Moreels TG, Rahmi G, Boeken T, Fabbri C, Prat F, Laleman W, Cellier C, Van der Merwe S, Webster G, Ellrichmann M. PERcutaneous transhepatic CHOLangioscopy using a new single-operator short cholangioscope (PERCHOL): European feasibility study. Dig Endosc 2023. [PMID: 37772447 DOI: 10.1111/den.14697] [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: 06/04/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES A new short device for percutaneous endoscopic cholangioscopy was recently developed. However, feasibility and safety has not yet been evaluated. The aim of this study was to assess clinical success, technical success, and adverse events (AEs). METHODS This observational multicenter retrospective study included all patients who underwent percutaneous cholangioscopy using a short cholangioscope between 2020 and 2022. The clinical success, defined as the complete duct clearance or obtaining at least one cholangioscopy-guided biopsy, was assessed. The histopathological accuracy, technical success, and the AE rate were also evaluated. RESULTS Fifty-one patients (60 ± 15 years, 45.1% male) were included. The majority of patients had altered anatomy (n = 40, 78.4%), and biliary stones (n = 34, 66.7%) was the commonest indication. The technique was predominantly wire-guided (n = 44, 86.3%) through a percutaneous sheath (n = 36, 70.6%) following a median interval of 8.5 days from percutaneous drainage. Cholangioscopy-guided electrohydraulic lithotripsy was performed in 29 cases (56.9%), combined with a retrieval basket in eight cases (27.6%). The clinical success was 96.6%, requiring a median of one session (range 1-3). Seventeen patients (33.3%) underwent cholangioscopy-guided biopsies. There were four (7.8%) cholangioscopy-related AEs (cholangitis and peritonitis). Overall, the technical success and AE rates were 100% and 19.6%, respectively, in a median follow-up of 7 months. CONCLUSION Percutaneous endoscopic cholangioscopy with a new short device is effective and safe, requiring a low number of sessions to achieve duct clearance or accurate histopathological diagnosis.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Simon Phillpotts
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium
| | - Claudio Cim Conrad
- Department of Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Ravenna, Italy
| | - Laurent Monino
- Department of Gastroenterology, Cliniques Universitaires St. Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kirill Basiliya
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Hadrien Alric
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Lucille Quénéhervé
- Gastroenterology Department, University and Regional Hospital Centre Brest, Brest, France
| | - Alessandro Di Gaeta
- Department of Interventional Radiology, Georges-Pompidou European Hospital, Paris, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Aria Khani
- Department of Gastroenterology, Royal Free Hospital, London, UK
| | - Diane Lorenzo
- Digestive Endoscopy Department, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Tom G Moreels
- Department of Gastroenterology, Cliniques Universitaires St. Luc, Université catholique de Louvain, Brussels, Belgium
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Tom Boeken
- University of Paris-Cité, Paris, France
- Department of Interventional Radiology, Georges-Pompidou European Hospital, Paris, France
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Ravenna, Italy
| | - Frédéric Prat
- Digestive Endoscopy Department, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Münster, Germany
| | - Christophe Cellier
- Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France
- University of Paris-Cité, Paris, France
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - George Webster
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Mark Ellrichmann
- Department of Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Olivier R, Brochard C, des Varannes SB, Ropert A, Wallenhorst T, Reboux N, Quénéhervé L, Coron E. Peroral endoscopic myotomy: is it better to perform it in naive patients or as second-line therapy? Results of an open-label-controlled study in 105 patients. Surg Endosc 2023; 37:3760-3768. [PMID: 36670217 PMCID: PMC10156842 DOI: 10.1007/s00464-021-08767-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 10/09/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Whether Peroral Endoscopic Myotomy (POEM) can be proposed as a second-line treatment in patients with achalasia remains to be confirmed in real-life series. OBJECTIVE This study aimed to compare the efficacy, feasibility and safety of POEM between treatment-naïve patients and patients who had prior endoscopic or surgical therapies for achalasia. METHODS All consecutive patients who underwent a POEM procedure for achalasia in our centre from June 2015 to September 2018 were included in this retrospective study. They were classified into treatment-naïve patients (POEM1) and patients who had at least one previous endoscopic and/or surgical treatment for achalasia (POEM2). RESULTS A total of 105 patients were included, 52 in the POEM1 group and 53 in the POEM2 group. Clinical success (defined as an Eckardt score ≤ 3) at 6 months was observed in 93% of POEM1 patients and 84% of POEM2 patients (p = 0.18). Technical success rate was not significantly different between the two groups (100% vs 96%, respectively; p = 0.50). No significant difference was noted in terms of adverse event rate (19% vs 19%, respectively; p = 1.00). Post-procedure pain occurred in 12% of treatment-naive and 9% of non-naïve patients (p = 0.76). The median length of hospital stay was 3 days in both groups (p = 0.17). Symptomatic gastroesophageal reflux occurred in 25% of POEM1 patients and 16% of POEM2 patients (p = 0.24). CONCLUSION Efficacy, feasibility and safety of POEM are not different between treatment-naïve and non-naïve patients. POEM is a valuable second-line approach in patients with persistent symptoms of achalasia after surgical or endoscopic treatments.
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Affiliation(s)
- Raphael Olivier
- Service de Gastroentérologie, CHU de Poitiers, Poitiers, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, 1 place Ricordeau, 44093, Nantes cedex, France
| | - Charlène Brochard
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
- Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France
- CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Stanislas Bruley des Varannes
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, 1 place Ricordeau, 44093, Nantes cedex, France
| | - Alain Ropert
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
- Service d'Explorations Fonctionnelles Digestives, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Timothée Wallenhorst
- Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Noémi Reboux
- Service de Gastroentérologie, CHRU de Brest, Brest, France
| | - Lucille Quénéhervé
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, 1 place Ricordeau, 44093, Nantes cedex, France
- Service de Gastroentérologie, CHRU de Brest, Brest, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, 1 place Ricordeau, 44093, Nantes cedex, France.
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), rue Gabrielle Perret- Gentil 4, Genève, 1205-1211, Switzerland.
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Quénéhervé L, Vauquelin B, Berger A, Coron E, Olivier R. Risk factors for clinical failure of peroral endoscopic myotomy in achalasia. Front Med (Lausanne) 2022; 9:1099533. [PMID: 36569161 PMCID: PMC9773253 DOI: 10.3389/fmed.2022.1099533] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
The recent development of per oral endoscopic myotomy (POEM) has been a game changer in the management of patients with achalasia. However, approximately 1 in 10 patients will not experience clinical success. The aim of this mini-review is to describe the current state of knowledge about the risk factors associated with POEM failure for the treatment of achalasia. Suspected risk factors are detailed into pre-, intra-, and post-procedural factors and put into perspective. Pre-procedural factors have been described, such as pre-treatment Eckardt score, previous treatments for achalasia, sigmoid type esophagus, significant esophageal dilatation, non-type II achalasia, young age and long duration of symptoms. An intra-procedural factor, mucosal injury during POEM, has also been associated with POEM failure. The occurrence of post-POEM GERD was identified as a controversial post-procedural factor associated with failure. The presumed mechanisms of POEM failure are incomplete myotomy or ineffective LES disruption, as confirmed by high-resolution manometry. However, when manometry confirms a significant decrease in LES pressure, it is likely that either impaired peristalsis or a morphologic abnormality such as extreme esophageal dilatation or severe tortuosity, which are not treated by POEM, should be suspected. Notably, a recently described adverse effect of POEM is the formation of a pseudo-diverticulum at the site of the myotomy (blown out myotomy). We finally stress the importance of performing a complete workup in case of POEM failure as different mechanisms of POEM failure should lead to different management.
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Affiliation(s)
- Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France,*Correspondence: Lucille Quénéhervé,
| | - Blandine Vauquelin
- Gastroenterology Department, Centre Medico-Chirurgical Magellan, INSERM CIC 1401, CHU de Bordeaux, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France
| | - Arthur Berger
- Gastroenterology Department, Centre Medico-Chirurgical Magellan, INSERM CIC 1401, CHU de Bordeaux, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France
| | - Emmanuel Coron
- Service de Gastro-Entérologie et Hépatologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Raphael Olivier
- Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
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10
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Ouazana S, Coron E, Le Rhun M, Le Rhun M, Dray X, Quénéhervé L. Endoscopic sigmoidopexy for recurrent sigmoid volvulus in inoperable patients: a retrospective series of 15 patients. Endoscopy 2022; 54:1205-1210. [PMID: 35451039 DOI: 10.1055/a-1831-4177] [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: 12/29/2022]
Abstract
BACKGROUND Recurrent sigmoid volvulus is frequent and sometimes occurs in frail patients with contraindications to surgical sigmoidectomy. Percutaneous endoscopic sigmoidopexy (PES) has recently been proposed as an alternative to elective sigmoidectomy. We aimed to describe the efficacy and safety of PES. METHODS All consecutive patients who underwent PES for recurrent sigmoid volvulus at two French centers between January 2017 and March 2021 were included in this retrospective case series. Recurrent sigmoid volvulus was defined as at least two symptomatic episodes treated by endoscopic decompression. Under endoscopic guidance, anchors were placed to attach the sigmoid to the anterior abdominal wall, allowing the placement of pigtail Chait catheters. RESULTS 15 patients (60 % female; median age 74 years [range 49-96]) were included. Median number of previous sigmoid volvulus episodes was 3 (range 2-6). Procedures were technically successful with no intraprocedural adverse events for 14 patients (93 %). Peritonitis occurred at Day 2 in one patient (serious adverse event rate 7 %). Median follow-up time was 10 months (range 1-30). No sigmoid volvulus recurrence occurred during follow-up. CONCLUSION PES using Chait catheters was feasible and effective for recurrent sigmoid volvulus and should be considered as an alternative to sigmoidectomy in inoperable patients.
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Affiliation(s)
- Salome Ouazana
- Hepatogastroenterology Department, University Hospital Centre Reims, Reims, France.,Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP Paris, Paris, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland.,University of Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Nantes, France
| | - Marc Le Rhun
- Digestive Disease Institute, University Hospital Centre, Nantes, France
| | | | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP Paris, Paris, France
| | - Lucille Quénéhervé
- Gastroenterology Department, University and Regional Hospital Centre Brest, Brest, France
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11
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Reboux N, Cadieu E, Pruvost-Couvreur M, Cariou M, Kermarrec M, Kermarrec T, Bouzeloc S, Nousbaum JB, Robaszkiewicz M, Quénéhervé L. Factors associated with non-presentation in a multidisciplinary team meeting for colon cancer: A matched retrospective cohort study in a French area. Clin Res Hepatol Gastroenterol 2022; 46:101950. [PMID: 35609825 DOI: 10.1016/j.clinre.2022.101950] [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: 02/12/2022] [Revised: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Survival of patients with colon cancer has increased in recent years due to advances in treatment and the implementation of multidisciplinary team meetings (MDTm). However, the organization of MDTm can be improved. The objectives of this work were to characterize patients with colon cancer who were not presented in MDTm and to analyse the reasons for their non-presentation. METHODS The study was based on a retrospective cohort including patients with colon cancer diagnosed between 2014 and 2016. Risk factors for non-presentation in MDTm were investigated after 1:1 matching on age, gender and tumour location, using multivariate analysis. RESULTS amongst 1616 patients diagnosed with colon cancer, 20.5% were not presented in MDTm. The most common reasons for non-presentation were 'advanced age or poor general condition' (22.6%) and 'superficial tumour' (20.5%), while 20.8% of non-presentation remained unexplained. Non-presentation in MDTm was associated with ECOG PS of 2 (OR 0.51, 95%CI 0.32-0.81, p = 0.005), best supportive care (OR 0.05, 95%CI 0.00-0.38, p = 0.016) and early death (OR 0.09, 95%CI 0.04-0.19, p<0.001). By contrast, patients with symptomatic tumours were more likely to be presented in MDTm than patients participating in mass screening (OR 2.16, 95%CI 1.09-4.32, p = 0.028). Presentation was significantly associated with diagnosis by a digestive surgeon (OR 2.16, 95%CI 1.22-3.92, p = 0.01) and a high UICC stage. CONCLUSIONS This study identified factors associated with non-presentation in a multidisciplinary team meeting for colon cancer such as an advanced age or a superficial tumour, paving the way for targeted improvements.
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Affiliation(s)
- Noémi Reboux
- Gastroenterology department, University hospital of Brest, 29200 Brest, France.
| | - Estelle Cadieu
- Gastroenterology department, University hospital of Brest, 29200 Brest, France
| | - Manon Pruvost-Couvreur
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Melanie Cariou
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Morgane Kermarrec
- OncoBretagne, 19 Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Tiphaine Kermarrec
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Servane Bouzeloc
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Jean-Baptiste Nousbaum
- Gastroenterology department, University hospital of Brest, 29200 Brest, France; Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Michel Robaszkiewicz
- Gastroenterology department, University hospital of Brest, 29200 Brest, France; Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Lucille Quénéhervé
- Gastroenterology department, University hospital of Brest, 29200 Brest, France.
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12
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Dray X, Rahmi G, Riccioni ME, Vanbiervliet G, Johansson GW, Leandri C, Baltes P, Duburque C, Cholet F, Koulaouzidis A, Quénéhervé L. Small bowel capsule endoscopy in obscure gastrointestinal bleeding: A matched cohort comparison of patients with normal vs surgically altered gastric anatomy. Clin Res Hepatol Gastroenterol 2022; 46:101921. [PMID: 35390539 DOI: 10.1016/j.clinre.2022.101921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about small bowel capsule endoscopy (SBCE) outcomes in patients with surgically altered anatomy. AIMS To assess the feasibility and diagnostic yield of orally ingested SBCE to investigate obscure gastrointestinal bleeding (OGIB) in patients with surgically altered gastric anatomy, compared to native gastric anatomy. METHODS 207 patients with OGIB were selected from an open, multicenter, retrospective cohort (SAGA study) and match-paired according to age, gender and bleeding type (overt/occult) to 207 control patients from a randomized controlled trial (PREPINTEST). Primary outcomes were the diagnostic yield (P1 or P2 findings), completion rate, adverse events rate, and small bowel transit time (SBTT). RESULTS The diagnostic yield was not statistically different between groups (44.9% in SAGA vs 42.5% in control patients). Inflammatory/ulcerated lesions were significantly more frequent in patients with SAGA (43.0% vs 29.3%). The median SBTT was significantly longer in the SAGA group than in control patients (283 vs 206 minutes), with a significantly lower completion rate (82.6% vs 89.9%); Adverse events were scarce (0.5% vs 0.0%). CONCLUSION Patients with surgically altered gastric anatomy should benefit from SBCE investigation for OGIB as much as non-operated patients.
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Affiliation(s)
- Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Saint Antoine Hospital, APHP, Paris, France.
| | - Gabriel Rahmi
- Hôpital Européen Georges Pompidou. Department of Gastroenterology, Paris, France
| | | | | | | | - Chloé Leandri
- Cochin University Hospital, Gastroenterology, Paris, France
| | - Peter Baltes
- Agaplesion Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | | | - Franck Cholet
- Brest University Hospital, Hepatogastroenterology unit, Brest, France
| | - Anastasios Koulaouzidis
- Department of Medicine, Odense University Hospital (OUH), Svendborg Sygehus, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark; Surgical Research Unit, OUH, Odense, Denmark; Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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13
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Gondran H, Musquer N, Perez-Cuadrado-Robles E, Deprez PH, Buisson F, Berger A, Cesbron-Métivier E, Wallenhorst T, David N, Cholet F, Perrot B, Quénéhervé L, Coron E. Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients. Therap Adv Gastroenterol 2022; 15:17562848221090820. [PMID: 35480299 PMCID: PMC9036320 DOI: 10.1177/17562848221090820] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear. OBJECTIVE The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. METHODS All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy. RESULTS A total of 227 patients were included. The resections were en bloc in 64.8% of cases. The mean lesion size was 20 mm (range: 3-80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size > 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%. CONCLUSION Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size > 2 cm were associated with local recurrence.
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Affiliation(s)
- Hannah Gondran
- Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Nantes, France
| | - Nicolas Musquer
- Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Nantes, France
| | - Enrique Perez-Cuadrado-Robles
- Service de gastroentérologie, Hôpital européen Georges Pompidou, Assistance publique des hôpitaux de Paris, Paris, France,Service d’hépato-gastro-entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Henri Deprez
- Service d’hépato-gastro-entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Arthur Berger
- Service d’hépato-gastro-entérologie, CHU Angers, Angers, France
| | | | - Timothee Wallenhorst
- Service des Maladies de l’Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Nicolas David
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
| | - Franck Cholet
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
| | - Bastien Perrot
- Biostatistics and Methodology Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Lucille Quénéhervé
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
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14
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Dray X, Houist G, Le Mouel JP, Saurin JC, Vanbiervliet G, Leandri C, Rahmi G, Duburque C, Kirchgesner J, Leenhardt R, Cholet F, Quénéhervé L. Prospective evaluation of third-generation small bowel capsule endoscopy videos by independent readers demonstrates poor reproducibility of cleanliness classifications. Clin Res Hepatol Gastroenterol 2021; 45:101612. [PMID: 33740610 DOI: 10.1016/j.clinre.2020.101612] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The detection of lesions during small bowel (SB) capsule endoscopy (CE) depends on the cleanliness of the intestine. Quality reporting and comparison of different preparation methods require reliable scores. Three scores known as quantitative index (QI), qualitative evaluation (QE), and overall adequacy assessment (OAA), have been proposed to assess SB cleanliness, and are sometimes used in clinical practice and in clinical trials. However, none of these scores has received any external validation. The aim of our study was to re-assess the reproducibility of these three specific scores. METHODS One-hundred-and-fifty-five complete third-generation SB-CE video recordings were extracted from a multicenter randomized controlled trial (PREPINTEST) which evaluated three modalities of SB preparation for CE. Three experts independently read the 155 SB-CE video recordings twice, in a random order, over 48 -h periods at 6-week intervals, using the QI, QE and OAA scores. Cohen's linearly weighted kappa coefficients were calculated to assess intra-observer and inter-observer agreements. RESULTS Intra-observer reproducibility was fair to moderate, with kappa coefficients between 0.37 and 0.46 for QI, 0.41 and 0.51 for QE, 0.41 and 0.50 for OAA. Inter-observer reproducibility was fair to substantial according to kappa coefficients between experts varying from 0.40 to 0.64, 0.29 to 0.65, and 0.52 to 0.71, for QI, QE and OAA, respectively. CONCLUSIONS QI, QE and OAA scores, currently used for evaluation of the quality of the preparation of SB-CE, are not sufficiently reproducible. Other scores or methods are therefore needed for SB-CE cleanliness assessment.
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Affiliation(s)
- Xavier Dray
- Sorbonne University, Center for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Guy Houist
- Department of Hepato-Gastroenterology, Centre Hospitalier du Sud Francilien, 40 Avenue Serge Dassault, 91100 Corbeil-Essonnes, France
| | | | - Jean-Christophe Saurin
- Department of Hepato-gastroenterology, E. Herriot Hospital, Hospices Civils de Lyon, France
| | - Geoffroy Vanbiervliet
- Department of Hepato-Gastroenterology, L'Archet 2 Hospital, Nice University Hospital, Nice, F-06202 Cedex 3, France
| | - Chloé Leandri
- Department of Hepato-Gastroenterology, Cochin Hospital, AP-HP, 75014, Paris, France
| | - Gabriel Rahmi
- Department of Hepato-Gastroenterology, Georges Pompidou European Hospital, AP-HP, Paris Descartes University, France
| | - Clotilde Duburque
- Delegations for Clinical Research and Innovation - Department of Gastroenterology Lille Catholic Hospitals - Lille Catholic University, Lille, France
| | - Julien Kirchgesner
- Sorbonne University and Department of Gastroenterology, Hôpital Saint-Antoine, Paris, France
| | - Romain Leenhardt
- Sorbonne University, Center for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Franck Cholet
- Department of Hepato-Gastroenterology, Brest University Hospital, Bd Tanguy Prigent, 29200 BREST, France
| | - Lucille Quénéhervé
- Department of Hepato-Gastroenterology, Brest University Hospital, Bd Tanguy Prigent, 29200 BREST, France
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15
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Perrot A, Bocciarelli C, Cadieu E, Quénéhervé L, Uguen A. [A rare infectious gastritis]. Ann Pathol 2021; 41:568-570. [PMID: 34563401 DOI: 10.1016/j.annpat.2021.09.003] [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: 05/14/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Adélie Perrot
- Service d'anatomie et cytologie pathologiques, CHRU de Brest, 29220 Brest, France
| | - Claire Bocciarelli
- Service d'anatomie et cytologie pathologiques, CHRU de Brest, 29220 Brest, France
| | - Estelle Cadieu
- Service d'hépato-gastro-entérologie, CHRU de Brest, 29220 Brest, France
| | | | - Arnaud Uguen
- Service d'anatomie et cytologie pathologiques, CHRU de Brest, 29220 Brest, France; LBAI, UMR1227, Inserm, université de Brest, CHU de Brest, Brest, France.
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16
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Coron E, Esnaud E, Chevallier P, Bessard A, Perez Cuadrado-Robles E, David G, Bossard C, Brégéon J, Jarry A, Neunlist M, Quénéhervé L. Early remodeling of the colonic mucosa after allogeneic hematopoietic stem cells transplantation: An open-label controlled pilot study on 19 patients. United European Gastroenterol J 2021; 9:955-963. [PMID: 34431618 PMCID: PMC8498402 DOI: 10.1002/ueg2.12128] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Graft‐versus‐host disease (GVHD), particularly acute digestive GVHD (aDGVHD), is a severe complication of allogeneic hematopoietic stem cell transplantation (allo‐HSCT). It is necessary to identify predictive factors of GVHD to adapt prophylactic treatment. Objective In this context, our pilot study aimed (i) to determine whether an early remodeling of the colonic mucosa occurred after allo‐HSCT and (ii) to identify potential predictive mucosal markers of aDGVHD after allo‐HSCT. Methods Between day 21 and day 28 after the allo‐HSCT, 19 allo‐HSCT patients were included and had a rectosigmoidoscopy with probe‐based confocal laser endomicroscopy (pCLE) recording and biopsies. Sixteen patients were included in the control group. Morphological (pCLE), functional (intestinal permeability), and inflammatory parameters (cytokine multiplex immunoassay) were assessed. Results Among allo‐HSCT patients, 11 patients developed GVHD, and 6 of them developed aDGVHD. Morphological and functional changes of the colonic mucosa occurred after allo‐HSCT. Indeed, the perimeter of colonic crypts was significantly increased in allo‐HSCT patients compared to controls as well as crypt lumen fluorescein leakage (53% vs. 9%), whereas crypts sphericity, roundness, Feret diameter, and mean vessel area were significantly decreased in allo‐HSCT patients compared to the control group. In addition, interleukin‐6 (IL‐6), IL‐33, and IL‐15 levels in the supernatants of 24 h explant cultures of colonic biopsies were significantly increased in allo‐HSCT patients compared to controls. Finally, there was no difference in pCLE parameters, intestinal permeability, and inflammatory cytokines between patients who developed aDGVHD and those who did not. Conclusion This pilot study identified early colonic mucosa remodeling after allo‐HSCT conditioning therapy, that is morphological and functional mucosal alterations as well as mucosal inflammation. As to whether these changes are first steps in GVHD initiation and could be considered as predictive biomarkers of aDGVHD need to be determined in a larger cohort of patients.
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Affiliation(s)
- Emmanuel Coron
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - Elise Esnaud
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - Patrice Chevallier
- Service d'Hématologie, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Anne Bessard
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France
| | - Enrique Perez Cuadrado-Robles
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Grégoire David
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France
| | - Céline Bossard
- Service d'Anatomie et Cytologie Pathologique, Université de Nantes, CHU Nantes, Inserm, CRCINA, Nantes, France
| | - Jérémy Brégéon
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France
| | - Anne Jarry
- Université de Nantes, Inserm, CRCINA, Nantes, France
| | - Michel Neunlist
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - Lucille Quénéhervé
- Université de Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
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17
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Quénéhervé L, Imbert A, Douane F, Archambeaud I, Gournay J, Coron E. Iatrogenic bilhemia after transjugular portal stent placement. Clin Res Hepatol Gastroenterol 2021; 45:101597. [PMID: 33639360 DOI: 10.1016/j.clinre.2020.101597] [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: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Lucille Quénéhervé
- Institut des Maladies de l'Appareil Digestif, IMAD, University Hospital of Nantes, Nantes, France
| | - Astrid Imbert
- Institut des Maladies de l'Appareil Digestif, IMAD, University Hospital of Nantes, Nantes, France
| | - Frédéric Douane
- Radiology Department, University Hospital of Nantes, Nantes, France
| | - Isabelle Archambeaud
- Institut des Maladies de l'Appareil Digestif, IMAD, University Hospital of Nantes, Nantes, France
| | - Jérôme Gournay
- Institut des Maladies de l'Appareil Digestif, IMAD, University Hospital of Nantes, Nantes, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, IMAD, University Hospital of Nantes, Nantes, France.
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18
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Badic B, Oguer M, Cariou M, Kermarrec T, Bouzeloc S, Nousbaum JB, Robaszkiewicz M, Quénéhervé L. Ostomy prevalence and survival in elderly patients with stage III and IV rectal cancer. Geriatr Gerontol Int 2021; 21:670-675. [PMID: 34189871 DOI: 10.1111/ggi.14225] [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: 01/04/2021] [Revised: 05/02/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
AIM Oncological strategies in the elderly population are often debated. The objective of this study was to investigate the survival rates and prevalence of ostomy in elderly patients operated on for stage III and IV rectal cancers. METHODS This retrospective multicentric population-based study included 151 patients aged ≥75 years with stage III and IV rectal adenocarcinoma who underwent surgery between 2007 and 2014. Multivariable logistic regression was used to assess the impact of different prognostic factors. RESULTS The median age of the patients was 81 years (range: 75-97 years) with 40 patients >85 years of age. Age was significantly correlated with overall survival (OS) in both stage III and IV cancers (P < 0.001). For patients ≥80 years the presence of comorbid conditions was associated with a lower chance of survival (P = 0.02). A digestive stoma was created in 67 (76.1%) patients with stage III cancer and 26 (29.54%) had a stoma reversal. A palliative derivative stoma was performed in half of patients with stage IV cancer. Adjuvant chemotherapy was independently associated with improved 5-year OS (P < 0.001). CONCLUSIONS Age, comorbidities and adjuvant chemotherapy were independent predictors for OS. Resection of rectal tumors in fit elderly patients should be promoted; however, patients should be aware of the high risk of stoma. Geriatr Gerontol Int 2021; 21: 670-675.
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Affiliation(s)
- Bogdan Badic
- CHRU Brest, Service de Chirurgie Viscérale, Brest, France.,INSERM, UMR 1101, LaTIM, Brest, France
| | - Maude Oguer
- CHRU Brest, Service de Chirurgie Viscérale, Brest, France.,INSERM, UMR 1101, LaTIM, Brest, France
| | - Melanie Cariou
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Tiphaine Kermarrec
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Servane Bouzeloc
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Jean-Baptiste Nousbaum
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Michel Robaszkiewicz
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Lucille Quénéhervé
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
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19
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Rahmi G, Coron E, Perrod G, Levy M, Moreau J, Moussata D, Perez-Cuadrado-Robles E, Chupin A, Quénéhervé L, Bourreille A, Marchal A, Cellier C, Peyrin-Biroulet L. Probe-based Confocal Laser Endomicroscopy for In Vivo Assessment of Histological Healing in Ulcerative Colitis: Development and Validation of the ENHANCE Index. J Crohns Colitis 2021; 15:994-999. [PMID: 33336249 DOI: 10.1093/ecco-jcc/jjaa255] [Citation(s) in RCA: 3] [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: 12/14/2022]
Abstract
BACKGROUND AND AIMS Histological healing may represent the ultimate therapeutic goal in ulcerative colitis [UC], but it requires biopsies. Our aim was to develop a non-invasive index able to assess histological disease activity in ulcerative colitis, using probe-based confocal laser endomicroscopy [pCLE]. METHODS One hundred patients with quiescent UC were prospectively included in five French centres. After fluorescein intravenous injection, during colonoscopy, the colorectal mucosa was analysed by white light imaging and pCLE, and then biopsied in different locations. Five endoscopists performed central reading of pCLE images blinded to clinical, endoscopic, and histological data. One expert pathologist performed a central histological reading [Nancy index: gold standard]. Univariate and multivariate analyses were performed to identify the endomicroscopic items associated with the presence of histologically active disease. RESULTS Over 1000 pCLE videos sequences performed in 100 UC patients in endoscopic remission [Mayo 0 and 1] were evaluated. We observed that vessel diameter >20 µm, dilated crypt lumen, fluorescein leakage, and irregular crypt architecture were statistically associated with histologically proven inflammation according to the Nancy index. Hence, we built a pCLE index of mucosal inflammation with overall accuracy of 79.6% and overall sensitivity and specificity of, respectively, 57.8% and 82.8%. Negative predictive value, especially when a pCLE index ≤1 was observed, was high [93.1%]. CONCLUSIONS Using a robust methodology, large vessel diameter, dilated crypt lumen, fluorescein leakage,and irregular crypt architecture are reliable endomicroscopic items defining the ENHANCE index for real-time assessment of histological disease activity in UC.
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Affiliation(s)
- Gabriel Rahmi
- Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France
| | - Emmanuel Coron
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], University of Nantes, Nantes, France
| | - Guillaume Perrod
- Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France
| | - Michael Levy
- Department of Hepato-Gastroenterology, Henri Mondor Hospital, Université Paris Est, Paris, France
| | - Jacques Moreau
- Department of Hepato-Gastroenterology, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology, CHU Tours, Tours, France
| | - Enrique Perez-Cuadrado-Robles
- Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France
| | - Antoine Chupin
- Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France
| | - Lucille Quénéhervé
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], University of Nantes, Nantes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], University of Nantes, Nantes, France
| | - Aude Marchal
- Department of Pathology, CHU Reims, Reims, France
| | - Christophe Cellier
- Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy-Brabois, Lorraine University, Vandœuvre-lès-Nancy, France
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20
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Quénéhervé L, Drui D, Blin J, Péré M, Coron E, Barbara G, Barbaro MR, Cariou B, Neunlist M, Masson D, Bach-Ngohou K. Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms. Sci Rep 2021; 11:8077. [PMID: 33850177 PMCID: PMC8044180 DOI: 10.1038/s41598-021-87158-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association "Adrenals" (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.
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Affiliation(s)
- L Quénéhervé
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - D Drui
- Department of Endocrinology, l'Institut du Thorax, CHU Nantes, 44400, Nantes, France
| | - J Blin
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France
| | - M Péré
- Biostatistics Unit, Research Board, CHU Nantes, Nantes, France
| | - E Coron
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - G Barbara
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, IRCCS S. Orsola, Bologna, Italy
| | - M R Barbaro
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, IRCCS S. Orsola, Bologna, Italy
| | - B Cariou
- Department of Endocrinology, CNRS, INSERM, l'Institut du Thorax, CHU Nantes, Université de Nantes, 44400, Nantes, France
| | - M Neunlist
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - D Masson
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France
| | - K Bach-Ngohou
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France.
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France.
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21
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Quénéhervé L, Olivier R, Gora MJ, Bossard C, Mosnier JF, Benoit A la Guillaume E, Boccara C, Brochard C, Neunlist M, Coron E. Full-field optical coherence tomography: novel imaging technique for extemporaneous high-resolution analysis of mucosal architecture in human gut biopsies. Gut 2021; 70:6-8. [PMID: 32447309 DOI: 10.1136/gutjnl-2020-321228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Full-field optical coherence tomography (FFOCT) is an imaging technique of biological tissue based on tissue light reflectance analysis. We evaluated the feasibility of imaging fresh digestive mucosal biopsies after a quick mounting procedure (5 min) using two distinct modalities of FFOCT. In static FFOCT mode, we gained high-resolution images of general gut tissue-specific architecture, such as oesophageal papillae, gastric pits, duodenal villi and colonic crypts. In dynamic FFOCT mode, we imaged individual epithelial cells of the mucosal lining with a cellular or subcellular resolution and identified cellular components of the lamina propria. FFOCT represents a promising dye-free imaging tool for on-site analysis of gut tissue remodelling.
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Affiliation(s)
- Lucille Quénéhervé
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Raphael Olivier
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France.,Gastroenterology Department, CHU Poitiers, Poitiers, France
| | - Michalina J Gora
- ICube Laboratory, CNRS, Strasbourg University, Strasbourg, France
| | - Céline Bossard
- Service d'Anatomie et Cytologie Pathologique, INSERM, CRCINA, Université de Nantes, CHU Nantes, F44000 Nantes, France
| | - Jean-François Mosnier
- Service d'Anatomie et Cytologie Pathologique, INSERM, CRCINA, Université de Nantes, CHU Nantes, F44000 Nantes, France
| | | | - Claude Boccara
- LLTech, LLTech SAS, Paris, France.,Institut Langevin, ESPCI Paris, PSL University, CNRS, 1 rue Jussieu, Paris, France
| | - Charlène Brochard
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France.,Service d'Explorations Fonctionnelles Digestives, CHU Rennes, Rennes, France
| | - Michel Neunlist
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France .,Institut des Maladies de l'Appareil Digestif, IMAD, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Emmanuel Coron
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, Hôtel Dieu, CHU Nantes, Nantes, France
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22
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Chapelle N, Jirka I, Péron M, Quénéhervé L, Cauchin E, Touchefeu Y, Coron E, Mosnier JF, Matysiak-Budnik T. Evaluation of a Phone Call Reminder Strategy in the Surveillance of Patients with Gastric Precancerous Lesions Lost to Follow-Up. Gastrointest Tumors 2020; 7:110-116. [PMID: 33173774 DOI: 10.1159/000508873] [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: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background Surveillance of gastric precancerous lesions (GPL) may reduce gastric cancer (GC)-related mortality, but some patients with GPL are lost to follow-up. Objective The aim of this study was to evaluate the feasibility and efficacy of a "phone-call" strategy in surveillance of the lost to follow-up patients. Patients and Methods Among all the patients diagnosed with GPL (atrophic gastritis, intestinal metaplasia, low-grade dysplasia) between 2000 and 2015, we identified those who should undergo surveillance endoscopy according to the current guidelines. They were contacted by telephone and invited to undergo endoscopy with gastric biopsies for histological analysis. Results Among 535 patients with GPL, 134 were contacted. Sixty-two (46%) could not be joined, 36 did not have endoscopy for other reasons, and finally, 36 patients (22 males, median age 65 years) were included. After the median time interval of 57 months between 2 endoscopies, 18 patients showed stability, 11 regression, and 7 progression of GPL, including 1 patient who developed GC. Conclusion Despite several telephone calls, only one-third of the contacted patients could be brought to surveillance endoscopy. Most of the patients showed stability of GPL, but 1 progressed to GC and could be successfully treated.
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Affiliation(s)
- Nicolas Chapelle
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Iva Jirka
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Matthieu Péron
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,Université de Nantes, Nantes, France
| | - Lucille Quénéhervé
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Estelle Cauchin
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,INSERM, U1235, Nantes, France
| | - Yann Touchefeu
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,INSERM, U1235, Nantes, France
| | - Emmanuel Coron
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Jean-François Mosnier
- Université de Nantes, Nantes, France.,Service d'Anatomie Pathologique, CHU de Nantes, Nantes, France
| | - Tamara Matysiak-Budnik
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
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Quénéhervé L, Le Bras P, Le Rhun M, Coron E. Endoscopic sigmoidopexy with placement of a Chait catheter: a new procedure to prevent recurrent sigmoid volvulus? Endoscopy 2020; 52:409-410. [PMID: 31810094 DOI: 10.1055/a-1022-4358] [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)
- Lucille Quénéhervé
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes, Nantes, France
| | - Pierrine Le Bras
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes, Nantes, France
| | - Marianne Le Rhun
- Pôle de Gérontologie Clinique, University Hospital of Nantes, Nantes, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes, Nantes, France
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24
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Chapelle N, Péron M, Mosnier JF, Quénéhervé L, Coron E, Bourget A, Cauchin E, Touchefeu Y, Matysiak-Budnik T. Prevalence, Characteristics and Endoscopic Management of Gastric Premalignant Lesions in France. Dig Dis 2019; 38:286-292. [PMID: 31655807 DOI: 10.1159/000503748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/24/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. DESIGN All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). RESULTS Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. CONCLUSION In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.
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Affiliation(s)
- Nicolas Chapelle
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France, .,Université de Nantes, Nantes, France, .,INSERM, U1235, Nantes, France,
| | - Matthieu Péron
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Jean-François Mosnier
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France.,Service d'Anatomie Pathologique, CHU de Nantes, Nantes, France
| | - Lucille Quénéhervé
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Emmanuel Coron
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
| | - Alice Bourget
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France
| | - Estelle Cauchin
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France
| | - Yann Touchefeu
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,INSERM, U1235, Nantes, France
| | - Tamara Matysiak-Budnik
- CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France.,Université de Nantes, Nantes, France.,INSERM, U1235, Nantes, France
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Quénéhervé L, Duchalais E, Le Rhun M, Coron E. Author's reply: Outcomes of first-line endoscopic management for patients with sigmoid volvulus. Dig Liver Dis 2019; 51:1066. [PMID: 31171485 DOI: 10.1016/j.dld.2019.05.021] [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: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Lucille Quénéhervé
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes place Alexis Ricordeau, Nantes, 44000, France.
| | - Emilie Duchalais
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes place Alexis Ricordeau, Nantes, 44000, France
| | - Marianne Le Rhun
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes place Alexis Ricordeau, Nantes, 44000, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes place Alexis Ricordeau, Nantes, 44000, France
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Quénéhervé L, Dagouat C, Le Rhun M, Perez-Cuadrado Robles E, Duchalais E, Bruley des Varannes S, Touchefeu Y, Chapelle N, Coron E. Outcomes of first-line endoscopic management for patients with sigmoid volvulus. Dig Liver Dis 2019; 51:386-390. [PMID: 30377062 DOI: 10.1016/j.dld.2018.10.003] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. AIM The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. METHODS The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. RESULTS Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. CONCLUSION Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.
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Affiliation(s)
- Lucille Quénéhervé
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
| | - Caroline Dagouat
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Marianne Le Rhun
- Clinical Gerontology Department, University Hospital of Nantes, France
| | | | - Emilie Duchalais
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | | | - Yann Touchefeu
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Nicolas Chapelle
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Emmanuel Coron
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
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Quénéhervé L, David G, Bourreille A, Hardouin JB, Rahmi G, Neunlist M, Brégeon J, Coron E. Quantitative assessment of mucosal architecture using computer-based analysis of confocal laser endomicroscopy in inflammatory bowel diseases. Gastrointest Endosc 2019; 89:626-636. [PMID: 30120955 DOI: 10.1016/j.gie.2018.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Confocal laser endomicroscopy (CLE) might discriminate mucosal lesions between Crohn's disease (CD) and ulcerative colitis (UC). However, the analysis of CLE images requires time-consuming methods, a long training time, and potential impediments, such as significant interobserver variability. Therefore, we developed a computer-based method to analyze mucosal architecture from CLE images and discriminate between healthy subjects and patients with inflammatory bowel disease (IBD) as well as between UC and CD patients. METHODS We retrospectively screened patients who had undergone CLE either for an evaluation of IBD in remission or for colorectal cancer screening (control subjects) between 2009 and 2016. We assessed 14 morphologic and functional parameters in each CLE recording from 23 CD patients, 27 UC patients, and 9 control patients. Next, we constructed 2 scores, 1 for the IBD diagnosis and 1 for the differential diagnosis between UC and CD. RESULTS In IBD patients, the mean intercrypt distance, wall thickness, and fluorescein leakage through the colonic mucosa were significantly increased compared with control patients by 155%, 188%, and 297%, respectively (P < .05). In UC patients, the same parameters were significantly increased by 109%, 117%, and 174%, respectively (P < .05), compared with CD patients. IBD diagnosis had 100% (95%CI, 93%; 100%) sensitivity and 100% (95%CI, 66%; 100%) specificity. IBD differential diagnosis provided discrimination of UC from CD patients with 92% (95%CI, 75%; 99%) sensitivity and 91% (95%CI, 72%; 99%) specificity. CONCLUSIONS Confirming these results using prospective validation cohorts can substantiate that computer-based analysis of CLE images may provide new biomarkers for the diagnosis and characterization of IBD.
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Affiliation(s)
- Lucille Quénéhervé
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - Grégoire David
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - Arnaud Bourreille
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | | | - Gabriel Rahmi
- Service d'Hépatogastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Michel Neunlist
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - Jérémy Brégeon
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - Emmanuel Coron
- Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France; Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
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Gora MJ, Quénéhervé L, Carruth RW, Lu W, Rosenberg M, Sauk JS, Fasano A, Lauwers GY, Nishioka NS, Tearney GJ. Tethered capsule endomicroscopy for microscopic imaging of the esophagus, stomach, and duodenum without sedation in humans (with video). Gastrointest Endosc 2018; 88:830-840.e3. [PMID: 30031805 PMCID: PMC8176642 DOI: 10.1016/j.gie.2018.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Received: 01/28/2018] [Accepted: 07/11/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with many different digestive diseases undergo repeated EGDs throughout their lives. Tethered capsule endomicroscopy (TCE) is a less-invasive method for obtaining high-resolution images of the GI mucosa for diagnosis and treatment planning of GI tract diseases. In this article, we present our results from a single-center study aimed at testing the safety and feasibility of TCE for imaging the esophagus, stomach, and duodenum. METHODS After being swallowed by a participant without sedation, the tethered capsule obtains cross-sectional, 10 μm-resolution, optical coherence tomography images as the device traverses the alimentary tract. After imaging, the device is withdrawn through the mouth, disinfected, and reused. Safety and feasibility of TCE were tested, focusing on imaging the esophagus of healthy volunteers and patients with Barrett's esophagus (BE) and the duodenum of healthy volunteers. Images were compared with endoscopy and histopathology findings when available. RESULTS Thirty-eight patients were enrolled. No adverse effects were reported. The TCE device swallowing rate was 34 of 38 (89%). The appearance of a physiologic upper GI wall, including its microscopic pathology, was visualized with a tissue coverage of 85.4% ± 14.9% and 90.3% ± 6.8% in the esophagus of BE patients with and without endoscopic evidence of a hiatal hernia, respectively, as well as 84.8% ± 7.4% in the duodenum. A blinded comparison of TCE and endoscopic BE measurements showed a strong to very strong correlation (r = 0.7-0.83; P < .05) for circumferential extent and a strong correlation (r = 0.77-0.78; P < .01) for maximum extent (Prague classification). TCE interobserver correlation was very strong, at r = 0.92 and r = 0.84 (P < .01), for Prague classification circumferential (C) and maximal (M) length measurements, respectively. CONCLUSIONS TCE is a safe and feasible procedure for obtaining high-resolution microscopic images of the upper GI tract without endoscopic assistance or sedation.
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Affiliation(s)
- Michalina J. Gora
- ICube Laboratory, CNRS, Strasbourg University, Strasbourg, France.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucille Quénéhervé
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Institut des Maladies de l’Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - Robert W. Carruth
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Weina Lu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jenny S. Sauk
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Alessio Fasano
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory Y. Lauwers
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Norman S. Nishioka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard-MIT Division of Health Sciences Technology, Cambridge, MA, USA
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Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W, Shaza L, Ivekovic H, Moreels TG, Yeung R, Piessevaux H, Coron E, Jouret-Mourin A, Deprez PH. Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors. Endosc Int Open 2018; 6:E1008-E1014. [PMID: 30083592 PMCID: PMC6075950 DOI: 10.1055/a-0577-7546] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions. PATIENTS AND METHODS This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding. RESULTS One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 - 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min, P = 0.007) and tumor size (25 vs. 20 mm, P = 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %, P = 0.115), complete resection (19.4 % vs. 35.5 %, P = 0.069), and local recurrence (14.7 % vs. 16.7 %, P = 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm, P = 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %, P = 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %, P < 0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR ( P = 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation. CONCLUSIONS ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lucille Quénéhervé
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Walter Margos
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Leila Shaza
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hrvoje Ivekovic
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G. Moreels
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ralph Yeung
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuel Coron
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Anne Jouret-Mourin
- Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium,Corresponding author Pierre H. Deprez Department of Hepato-GastroenterologyCliniques universitaires Saint-LucUniversité Catholique de LouvainBrusselsBelgium
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30
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Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W, Moreels TG, Yeung R, Piessevaux H, Coron E, Jouret-Mourin A, Deprez PH. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open 2018; 6:E998-E1007. [PMID: 30083591 PMCID: PMC6075947 DOI: 10.1055/a-0579-9050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. METHODS This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. RESULTS A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I 2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I 2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I 2 : 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I 2 : 59 %), but there was no risk difference in the risk of local recurrence (RD: - 0.03 [CI95 %: - 0.07, 0.01], P = 0.15, I 2 : 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I 2 : 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. CONCLUSIONS Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lucille Quénéhervé
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Walter Margos
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G. Moreels
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ralph Yeung
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuel Coron
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Anne Jouret-Mourin
- Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Lilli NL, Quénéhervé L, Haddara S, Brochard C, Aubert P, Rolli-Derkinderen M, Durand T, Naveilhan P, Hardouin JB, De Giorgio R, Barbara G, Bruley des Varannes S, Coron E, Neunlist M. Glioplasticity in irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13232. [PMID: 29027719 DOI: 10.1111/nmo.13232] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/05/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Growing evidence indicates a wide array of cellular remodeling in the mucosal microenvironment during irritable bowel syndrome (IBS), which possibly contributes to pathophysiology and symptom generation. Here, we investigated whether enteric glial cells (EGC) may be altered, and which factors/mechanisms lead to these changes. METHODS Colonic mucosal biopsies of IBS patients (13 IBS-Constipation [IBS-C]; 10 IBS-Diarrhea [IBS-D]; 11 IBS-Mixed [IBS-M]) and 24 healthy controls (HC) were analyzed. Expression of S100β and GFAP was measured. Cultured rat EGC were incubated with supernatants from mucosal biopsies, then proliferation and Ca2+ response to ATP were analyzed using flow cytometry and Ca2+ imaging. Histamine and histamine 1-receptor (H1R) involvement in the effects of supernatant upon EGC was analyzed. KEY RESULTS Compared to HC, the mucosal area immunoreactive for S100β was significantly reduced in biopsies of IBS patients, independently of the IBS subtype. IBS-C supernatants reduced EGC proliferation and IBS-D and IBS-M supernatants reduced Ca2+ response to ATP in EGC. EGC expressed H1R and the effects of supernatant upon Ca2+ response to ATP in EGC were blocked by pyrilamine and reproduced by histamine via H1R. IBS supernatants reduced mRNA expression of connexin-43. The S100β-stained area was negatively correlated with the frequency and intensity of pain and bloating. CONCLUSION AND INFERENCES Changes in EGC occur in IBS, involving mucosal soluble factors. Histamine, via activation of H1R-dependent pathways, partly mediates altered Ca2+ response to ATP in EGC. These changes may contribute to the pathophysiology and the perception of pain and bloating in patients with IBS.
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Affiliation(s)
- N L Lilli
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - L Quénéhervé
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - S Haddara
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - C Brochard
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France
| | - P Aubert
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - M Rolli-Derkinderen
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - T Durand
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - P Naveilhan
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - J-B Hardouin
- Université de Nantes, INSERM, SPHERE, Université Bretagne Loire, Nantes, France
| | - R De Giorgio
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Barbara
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - S Bruley des Varannes
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - E Coron
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - M Neunlist
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France
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32
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Etchepare N, Bregeon J, Quénéhervé L, Haddara S, Touchefeu Y, Neunlist M, Coron E. Development of a porcine model for assessment of mucosal repair following endoscopic resection of the lower gastrointestinal tract. Endosc Int Open 2017; 5:E1014-E1019. [PMID: 29159277 PMCID: PMC5634855 DOI: 10.1055/s-0043-115383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/23/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Endoscopic mucosal resection (EMR) is widely performed for the treatment of colorectal polyps. However, the pathophysiological mechanisms of mucosal repair, including in situations at high risk of post-polypectomy bleeding, remain largely unknown. The objective of our study was to develop a porcine model of EMR in the lower gastrointestinal tract to monitor mucosal wound healing over time. METHODS Under general anesthesia, five large wounds were created in the lower gastrointestinal tract at different times, i. e. at day 0, 3, 7, 10, and 14, by multiband EMR, in each of the six pigs in the study. A colorectal resection was performed at day 14 and the animal euthanized. Repeated endoscopic and endomicroscopic examination, and histological analysis were performed. RESULTS No complications occurred and all animals reached the study end point. The endoscopic aspect of wound healing evolved into different phases with first a fibrin deposit covering the wounds which then gave way to granulomatous tissue. The size of the wound regressed significantly as early as day 3. Re-epithelialization of the wound started from day 7, and neo-mucosal crypts appeared from day 10. The endomicroscopic analysis described a 'ground glass appearance' from day 3 and irregular crypts from day 10, which was consistent with histological data. Good agreement between macroscopic, endomicroscopic, and histological parameters of mucosal wound healing was observed in vivo. CONCLUSION This study demonstrates for the first time the feasibility of an experimental in vivo porcine model of lower gastrointestinal endoscopic resections to monitor tissue repair. This model might be helpful to document pharmacological approaches for preventing complications of endoscopic procedures performed in humans.
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Affiliation(s)
- Nicolas Etchepare
- Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Jérémy Bregeon
- INSERM U 1235 – TENS, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Lucille Quénéhervé
- Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Sami Haddara
- Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Yann Touchefeu
- Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Michel Neunlist
- INSERM U 1235 – TENS, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Emmanuel Coron
- Institut des Maladies de l’Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France,INSERM U 1235 – TENS, Université de Nantes, Faculté de Médecine, Nantes, France,Corresponding author Emmanuel Coron Institut des Maladies de l’Appareil DigestifCHU de Nantes1 place Alexis Ricordeau44093 Nantes Cedex 1France+33-2-40083333
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Gora MJ, Simmons LH, Quénéhervé L, Grant CN, Carruth RW, Lu W, Tiernan A, Dong J, Walker-Corkery B, Soomro A, Rosenberg M, Metlay JP, Tearney GJ. Tethered capsule endomicroscopy: from bench to bedside at a primary care practice. J Biomed Opt 2016; 21:104001. [PMID: 27689919 PMCID: PMC5043371 DOI: 10.1117/1.jbo.21.10.104001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/12/2016] [Indexed: 05/23/2023]
Abstract
Due to the relatively high cost and inconvenience of upper endoscopic biopsy and the rising incidence of esophageal adenocarcinoma, there is currently a need for an improved method for screening for Barrett’s esophagus. Ideally, such a test would be applied in the primary care setting and patients referred to endoscopy if the result is suspicious for Barrett’s. Tethered capsule endomicroscopy (TCE) is a recently developed technology that rapidly acquires microscopic images of the entire esophagus in unsedated subjects. Here, we present our first experience with clinical translation and feasibility of TCE in a primary care practice. The acceptance of the TCE device by the primary care clinical staff and patients shows the potential of this device to be useful as a screening tool for a broader population.
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Affiliation(s)
- Michalina J. Gora
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, United States
- Strasbourg University, CNRS, ICube Laboratory, 1 Place de l’Hopital, Strasbourg 67091, France
| | - Leigh H. Simmons
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, United States
- Massachusetts General Hospital, Division of General Internal Medicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Lucille Quénéhervé
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Institut des Maladies de l’Appareil Digestif, CHU Nantes, Hôtel Dieu, place Alexis Ricordeau, Nantes 44000, France
| | - Catriona N. Grant
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Robert W. Carruth
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Weina Lu
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Aubrey Tiernan
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Jing Dong
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, United States
| | - Beth Walker-Corkery
- Massachusetts General Hospital, Division of General Internal Medicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Amna Soomro
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Mireille Rosenberg
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, United States
| | - Joshua P. Metlay
- Massachusetts General Hospital, Division of General Internal Medicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Guillermo J. Tearney
- Massachusetts General Hospital, Wellman Center for Photomedicine, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, United States
- Massachusetts General Hospital, Department of Pathology, 55 Fruit Street, Boston, Massachusetts 02114, United States
- Harvard-MIT Division of Health Sciences Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
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Quénéhervé L, Neunlist M, Bruley des Varannes S, Tearney G, Coron E. [Novel endoscopic techniques to image the upper gastrointestinal tract]. Med Sci (Paris) 2015; 31:777-83. [PMID: 26340838 DOI: 10.1051/medsci/20153108017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Novel endoscopic techniques for the analysis of the digestive wall have recently been developed to allow investigating digestive diseases beyond standard "white-light" macroscopic imaging of the mucosal surface. Among innovative techniques under clinical evaluation, confocal endomicroscopy and optical frequency domain imaging (OFDI) are the most promising. Indeed, these techniques allow performing in vivo microscopy with different levels in terms of depths and magnification, as well as functional assessment of structures. Some of these techniques, such as capsule-based OFDI, are also less invasive than traditional endoscopy and might help screening large groups of patients for specific disorders, for instance oesophageal precancerous diseases. In this review, we will focus on the results obtained with these techniques in precancerous, inflammatory and neuromuscular disorders.
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Affiliation(s)
- Lucille Quénéhervé
- Institut des maladies de l'appareil digestif, CHU de Nantes, hôpital Hôtel-Dieu, 1, place Alexis Ricordeau, F-44093 Nantes, France - Inserm U913, F-44093 Nantes, France
| | | | - Stanislas Bruley des Varannes
- Institut des maladies de l'appareil digestif, CHU de Nantes, hôpital Hôtel-Dieu, 1, place Alexis Ricordeau, F-44093 Nantes, France - Inserm U913, F-44093 Nantes, France
| | - Guillermo Tearney
- Harvard medical school et Wellman center for photo-medicine, Massachusetts general hospital, 55 Fruit street, Boston, MA 02114, États-Unis
| | - Emmanuel Coron
- Institut des maladies de l'appareil digestif, CHU de Nantes, hôpital Hôtel-Dieu, 1, place Alexis Ricordeau, F-44093 Nantes, France - Inserm U913, F-44093 Nantes, France
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