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Spota A, Cereatti F, Granieri S, Antonelli G, Dumont JL, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Tranchart H, Lainas P, Danan D, Tuszynski T, Pacini F, Arienzo R, Trelles N, Soprani A, Lazzati A, Torcivia A, Genser L, Derhy S, Fazi M, Bouillot JL, Marmuse JP, Chevallier JM, Donatelli G. Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm. Obes Surg 2021; 31:4327-4337. [PMID: 34297256 DOI: 10.1007/s11695-021-05577-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE. PATIENTS AND METHODS We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment. Clinical success (CS) was evaluated considering referral delay, healing time, surgery, and complications type. Logistic regression was performed to identify variables of CS. RESULTS In the study period, we treated 339 fistulae (33.2%), 324 leaks (31.8%), 198 post-sleeve gastrectomy twist/stenosis (19.4%), 95 post-RYGB stenosis (9.3 %), 37 collections (3.6%), 15 LAGB migrations (1.5%), 7 weight regains (0.7%), and 2 hemorrhages (0.2%). Main endoscopic treatments were as follows: pigtail-stent positioning under endoscopic view for both leaks (CS 86.1%) and fistulas (CS 77.2%), or under EUS-guidance for collections (CS 88.2%); dilations and/or stent positioning for sleeve twist/stenosis (CS 80.6%) and bypass stenosis (CS 81.5%). After a median (IQR) follow-up of 18.5 months (4.29-38.68), complications rate was 1.9%. We found a 1% increased risk of redo-surgery every 10 days of delay to the first endoscopic treatment. Endoscopically treated patients had a more frequent regular diet compared to re-operated patients. CONCLUSIONS Endoscopic treatment of BS-AEs following a standardized algorithm is safe and effective. Early endoscopic treatment is associated with an increased CS rate.
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Affiliation(s)
- Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milan, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Giulio Antonelli
- Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint - Denis, Saint - Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Maurizio Fazi
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Jean-Luc Bouillot
- Service de Chirurgie Digestive et Obésité, Hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
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Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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Donatelli G, Cereatti F, Spota A, Danan D, Tuszynski T, Dumont JL, Derhy S. Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb. Endoscopy 2021; 53:293-297. [PMID: 32767287 DOI: 10.1055/a-1223-2302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/12/2022]
Abstract
BACKGROUND Management of biliary disorders in patients with altered anatomy may be challenging. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis using a lumen-apposing metal stent (LAMS) was introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However, the appropriate stent indwelling time remains uncertain. We report long-term LAMS deployment after duodenojejunal or jejunojejunal anastomosis (EUS-DJA) to allow endoscopic reinterventions in cases of recurrences. METHODS 11 consecutive patients underwent EUS-DJA with long-standing LAMS between January 2017 and December 2018. Over a 12-month period, ERC treatment was carried out with multiple endoscopic sessions across the DJA. RESULTS Technical success was 91 % (10/11) for EUS-DJA and 100 % for ERC. Four patients presented stricture recurrence at a mean of 489 days (standard deviation [SD] 31.7) after the end of ERC treatment. A novel ERC across the LAMS anastomosis was feasible in all cases. At a mean of 781 days (SD 253.1), all LAMS remained in place with no evidence of complications. CONCLUSION Long-term LAMS placement after EUS-DJA may be feasible and safe for direct access to the excluded limb.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
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Donatelli G, Cereatti F, Spota A, Tuszynski T, Danan D, Dumont JL. Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass. Obes Surg 2020; 30:4130-4137. [PMID: 32661953 DOI: 10.1007/s11695-020-04857-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Treatment of pancreato-biliary disorders after gastric bypass is challenging due to altered anatomy. Several techniques have been proposed to overcome this condition; however, none has emerged as the gold standard treatment. Furthermore, a decision-making algorithm evaluating when and why apply one technique over another is still lacking. OBJECTIVES To describe a novel trans-gastric approach to allow endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass (RYGB) anatomy soon after prior laparoscopic cholecystectomy (LC) and to propose a decision-making algorithm for selection of the most suitable technique according a tailored approach. SETTING Private hospital. METHODS Between January and March 2020, patients with Roux-en-Y gastric bypass anatomy referred to our tertiary center to undergo ERCP after recent laparoscopic cholecystectomy were retrospectively evaluated. A 20 french (Fr) gastrostomy was performed during cholecystectomy. A single-stage ERCP was carried out by means of temporary trans-gastric stent deployment over a 20 Fr gastrostomy. RESULTS A total of 5 patients (mean age 41; mean body mass index 48.3) were enrolled. ERCP was performed after an average of 2 days from surgery. Technical and clinical success was achieved in 100%. No adverse events occurred. Spontaneous closure of the gastrostomy after its bedside removal was observed in all cases. CONCLUSIONS Our approach allows to perform a single-stage ERCP in RYGB patients, early after LC, with no need of any other re-interventions. Any surgeon facing unexpected biliary disorders, during LC, can easily perform a 20 Fr gastrostomy thus allowing the patient to undergo early ERCP without any delay.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.,Scuola di Specializzazione in Chirurgia Generale, Università degli studi di Milano, Milan, Italy
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France
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Zulli C, Dumont JL, Cereatti F, Ceci V, Tuszynski T, Fazi M, Donatelli G. Rescue ERCP after delayed migration of a lumen-apposing metal stent following endoscopic ultrasound-guided choledochoduodenostomy. Endoscopy 2020; 52:E215-E216. [PMID: 31863439 DOI: 10.1055/a-1073-7317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Claudio Zulli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, ASST Ospedale Cremona, Cremona, Italy
| | - Vincenzo Ceci
- Emergency Department, Ospedale Santo Spirito, Roma, Italy
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Maurizio Fazi
- Digestive Endoscopy Unit, Ospedale M.G. Vannini Figlie di San Camillo, Roma, Italy
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
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Donatelli G, Cereatti F, Tuszynski T, Vergeau BM, Dumont JL. Clip-assisted minor pancreatic duct cannulation to manage pancreatic duct leak. VideoGIE 2019; 4:426-427. [PMID: 31517170 PMCID: PMC6728872 DOI: 10.1016/j.vgie.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Donatelli G, Dumont JL, Dhumane P, Dritsas S, Tuszynski T, Vergeau BM, Meduri B. Double Pigtail Stent Insertion for Healing of Leaks Following Roux-en-Y Gastric Bypass. Our Experience (with Videos). Obes Surg 2017; 27:530-535. [PMID: 27878755 DOI: 10.1007/s11695-016-2465-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is complicated by a leak in 0-4.3% of cases. Treatment by fully covered stents has been reported to be associated with some life-threatening complications. We report our experience of insertion of double pigtail stents. METHODS Thirty-three patients (20M, 43 years-20/65), presenting with a leak at an average of 10 days after RYGB (4-35), were treated by double pigtail stent insertion and a nasojejunal feeding tube. Sixty percent of these patients had undergone surgical drainage prior to stenting for control of sepsis. Thirty leaks were located at the top of staple line and three at the gastro-jejunal anastomosis. At a 4-weekly follow-up, ablation or re-stenting was performed depending on status of fistula closure and patients were placed on normal diet. RESULTS At the first follow-up, 10/33 fistulae healed, one patient presented with clinical failure (3%) and needed surgery, and 22/33were re-stented. Twenty-one out of these 22 developed a secondary sub-clinical gastro-gastric fistula and one, instead, developed complex (gastro-gastric, gastro-colic) fistula. All (22) primary fistulae healed following four more weeks of treatment. Average treatment duration was of 61 days (28-99). Thirty-two patients (97%) at a follow-up of 1-33 months are asymptomatic. CONCLUSIONS Leaks following RYGB can be successfully and safely managed by double pigtail stents. Upper gastric staple line leaks are responsible for the formation of a secondary sub-clinic gastro-gastric fistula which needs no additional treatment.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France.
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra (w), Mumbai, India
| | - Stavros Dritsas
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France
| | - Bertrand Marie Vergeau
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France
| | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 75013, Paris, France
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Donatelli G, Fuks D, Cereatti F, Pourcher G, Perniceni T, Dumont JL, Tuszynski T, Vergeau BM, Meduri B, Gayet B. Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery. Surg Endosc 2017; 32:2281-2287. [DOI: 10.1007/s00464-017-5922-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022]
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Donatelli G, Dumont JL, Cereatti F, Tuszynski T, Vergeau BM, Meduri B. Revision of biliary sphincterotomy by re-cut, balloon dilation or temporary stenting: comparison of clinical outcome and complication rate (with video). Endosc Int Open 2017; 5:E395-E401. [PMID: 28512648 PMCID: PMC5432657 DOI: 10.1055/s-0043-106183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background and study aims Revision of endoscopic retrograde cholangiopancreatography (ERCP) may be necessary following previous biliary endoscopic sphincterotomy for recurrent biliary symptoms related to biliary stone recurrence, cholangitis or post-biliary endoscopic sphincterotomy (bEST) papillary stenosis and cholestasis. The aim of this retrospective study was to evaluate the clinical outcome and complication rate associated with re-cut, balloon dilation and biliary metal stenting in revision ERCP. Patients and methods From January 2010 to January 2015, 139 subjects with stigma of a previous sphincterotomy required a revision ERCP (64 Men/75 Women; mean age 71 years; range 32 - 101 years). The most appropriate technique (re-cut, balloon dilation or fully covered self-expandable metal stent [FCSEMS] placement) was tailored according to underlying pathologies and anatomical features. Results Technical success was achieved in all cases (100 %). Clinical success (definitive clearance of common bile duct stones and liver test normalization) was achieved in 127 out of 139 patients (91.4 %) with a mean follow up of 12 months. 12 clinical failures occurred: 11 patients required a new ERCP after an average of 9 months meanwhile 1 patient required surgery for definite treatment. The overall complication rate was 9 % (13 /139) with 5 acute complications (intra-procedural) and 8 short-term complications (before 1 month). Group specific overall complication rates were as follow: re-cut 11.5 % (8 bleeds and 3 perforations), balloon dilation 25 % (4 mild PEP [post-ERCP pancreatitis]), FCSEMS 14.3 % (1 moderate PEP), re-cut + balloon dilation and re-cut + FCSEMS 0 %. A statistically significant higher risk of post-ERCP pancreatitis was highlighted in the balloon dilation group meanwhile re-cut was burdened by a higher risk of bleeding and perforation. Conclusions Revision ERCP following previous bEST is a feasible procedure enabling clinical success in most cases. Different approaches are available and must be considered according to underlying pathologies. Re-cut is burdened by a higher risk of perforation and bleeding compared to balloon dilation and SEMS meanwhile balloon dilation is associated to increased risk of PEP.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé
des Peupliers, Paris, France,Corresponding author Gianfranco Donatelli Unité d’Endoscopie InterventionnelleRamsay Générale de Santé, Hôpital Privé des Peupliers8 Place de l’ Abbé G. Hénocque75013, ParisFrance+ 33 01 44 16 56 15
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé
des Peupliers, Paris, France
| | - Fabrizio Cereatti
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di
Cremona, Cremona, Italy
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé
des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé
des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé
des Peupliers, Paris, France
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Donatelli G, Dumont JL, Dritsas S, Tuszynski T, Vergeau BM, Meduri B. Portography: a potentially fatal complication during endoscopic ultrasound-guided choledochoduodenostomy. Endoscopy 2017; 49:E16-E17. [PMID: 28068689 DOI: 10.1055/s-0042-119396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Gianfranco Donatelli
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Jean-Loup Dumont
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Stavros Dritsas
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Thierry Tuszynski
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Interventional Endoscopy Unit, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Dumont JL, Cereatti F, Tuszynski T, Calogero G, Vergeau BM, Meduri B. Emergency endoscopic exploration of a pancreatic pseudocyst to retrieve a migrated pigtail stent. Endoscopy 2017; 49:E51-E53. [PMID: 28068704 DOI: 10.1055/s-0042-122143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Fabrizio Cereatti
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Giovanni Calogero
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand M Vergeau
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Airinei G, Poupardin E, Tuszynski T, Wind P, Benamouzig R, Meduri B. Double-pigtail stent migration invading the spleen: rare potentially fatal complication of endoscopic internal drainage for sleeve gastrectomy leak. Endoscopy 2016; 48 Suppl 1 UCTN:E74-5. [PMID: 26951469 DOI: 10.1055/s-0042-102446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Gheorghe Airinei
- Unité d'Endoscopie Interventionnelle, Avicenne Hopital, Paris-13 University Bobigny France
| | - Eric Poupardin
- Service de Chirurgie Viscerale, GHI Le Raincy-Montfermeil, Montfermeil, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Philippe Wind
- Service de Chirurgie Digestive, Avicenne Hopital, Paris-13 University Bobigny, France
| | - Robert Benamouzig
- Unité d'Endoscopie Interventionnelle, Avicenne Hopital, Paris-13 University Bobigny France
| | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Dumont JL, Pourcher G, Tranchart H, Tuszynski T, Dagher I, Catheline JM, Chiche R, Marmuse JP, Dritsas S, Vergeau BM, Meduri B. Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos). Surg Obes Relat Dis 2016; 13:943-950. [PMID: 27955962 DOI: 10.1016/j.soard.2016.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 07/01/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%-4% of cases. OBJECTIVES To report our experience, results, and long-term follow-up after pneumatic dilation of late functional helix stenosis after laparoscopic sleeve gastrectomy. SETTING Multicenter study led by an endoscopic tertiary referral center. METHODS Thirty-five patients were dilated initially at 30 mm. Thirteen out of 35 patients underwent a second dilation up to 35 mm. Only 8 patients underwent a third pneumatic dilation up to 40 mm. The stricture was localized in the mid-body of the sleeve in 32 patients overall; 3 had narrowing adjacent to the cardia. Eleven twists formed an acute angle between the 2 segments of the stomach, whereas 24 angles were obtuse. Seven out of 35 patients presented with persistent dilated pouch above the twist. Two patients were lost to follow-up. Overall outcome at an average follow-up of 15.5 months after primary surgery (range 7-49 mo) was as follows: 12 clinical failures and 1 technical failure (40%) and 60% (20 out of 33) clinical success. CONCLUSION Pneumatic dilation of late functional helix stricture is an effective technique for treatment of dysphagia in the majority of patients treated. Complete helix stricture, defined in function of the angle within twist, as well as the presence of a persistently dilated gastric pouch above the kinking, seems to be correlated with higher failure rates.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France.
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Guillame Pourcher
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Hadrien Tranchart
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Ibrahim Dagher
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Jean-Marc Catheline
- Service de Chirurgie Viscérale, Centre Hôspitalier de Saint-Denis, Saint-Denis, France
| | - Renaud Chiche
- Service de Chirurgie Viscérale, Clinique Geoffry Sant Hilaire, Ramsay Générale de Santé, Paris, France
| | - Jean-Pierre Marmuse
- Service de Chirurgie Digestive et Viscérale, Hôpital Universitaire Bichat - Claude Bernard - AP-HP, Paris, France
| | - Stavros Dritsas
- Service de Gastroenterologie, Hôpital René Dubos, Pontoise, France
| | | | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Cereatti F, Dhumane P, Vergeau BM, Tuszynski T, Marie C, Dumont JL, Meduri B. Closure of gastrointestinal defects with Ovesco clip: long-term results and clinical implications. Therap Adv Gastroenterol 2016; 9:713-21. [PMID: 27582884 PMCID: PMC4984331 DOI: 10.1177/1756283x16652325] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Over-The-Scope Clip (OTSC®, Ovesco Endoscopy GmbH, Tübingen, Germany) is an innovative clipping device that provides a strong tissue grasp and compression without provoking ischemia or laceration. In this retrospective study we evaluated immediate and long-term success rates of OTSC deployment in various pathologies of the gastrointestinal (GI) tract. METHODS A total of 45 patients (35 female, 10 male) with an average age of 56 years old (range, 24-90 years) were treated with an OTSC for GI defects resulting from a diagnostic or interventional endoscopic procedure (acute setting group) or for fistula following abdominal surgery (chronic setting group). All procedures were performed with CO2 insufflation. RESULTS From January 2012 to December 2015 a total of 51 OTSCs were delivered in 45 patients for different kinds of GI defects. Technical success was always achieved in the acute setting group with an excellent clip adherence and a clinical long-term success rate of 100% (15/15). Meanwhile, considering the chronic setting group, technical success was achieved in 50% of patients with a long-term clinical success of 37% (11/30); two minor complications occurred. A total of three patients died due to causes not directly related to clip deployment. Overall clinical success rate was achieved in 58% cases (26/45 patients). A mean follow-up period of 17 months was accomplished (range, 1-36 months). CONCLUSION OTSC deployment is an effective and minimally-invasive procedure for GI defects in acute settings. It avoids emergency surgical repair and it allows, in most cases, completion of the primary endoscopic procedure. OTSC should be incorporated as an essential technique of today's modern endoscopic armamentarium in the management of GI defects in acute settings. OTSCs were less effective in cases of chronic defects.
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Affiliation(s)
| | - Fabrizio Cereatti
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra (w), Mumbai, India
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Christian Marie
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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15
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Donatelli G, Cereatti F, Dumont JL, Dhumane P, Tuszynski T, Derhy S, Meduri A, Vergeau BM, Meduri B. Temporary duodenal stenting as a bridge to ERCP for inaccessible papilla due to duodenal obstruction: a retrospective study. Endosc Int Open 2016; 4:E957-63. [PMID: 27652301 PMCID: PMC5025317 DOI: 10.1055/s-0042-107070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/18/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Duodenal obstruction may prevent performance of endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage (PTBD) or Endoscopic ultrasonograhy-guided biliary access (EUS-BD) are alternative treatments but are associated with a higher morbidity and mortality rate. The aim of the study is to report overall technical success rate and clinical outcome with deployment of temporary fully or partially covered self-expanding duodenal stent (pc/fcSEMS) as a bridge to ERCP in case of inaccessible papilla due to duodenal strictures. PATIENTS AND METHODS This retrospective study included 66 consecutive patients presenting with a duodenal stricture impeding the ability to perform an ERCP. Provisional duodenal stenting was performed as a bridge to ERCP. A second endoscopic session was performed to remove the provisional stent and to perform an ERCP. Afterward, a permanent duodenal stent was delivered if necessary. RESULTS Sixty-six duodenal stents (17 pcSEMS and 49 fcSEMS) were delivered with a median indwelling time of 3.15 (1 - 7) days. Two migrations occurred in the pcSEMS group, 1 of which required lower endoscopy for retrieval. No other procedure-related complications were observed. At second endoscopy a successful ERCP was performed in 56 patients (85 %); 10 patients (15 %) with endoscopic failure underwent PTBD or EUS-BD. Forty patients needed permanent duodenal stenting. CONCLUSIONS Provisional removable covered duodenal stenting as a bridge to ERCP for duodenal obstruction is safe procedure and in most cases allows successful performance of therapeutic ERCP. This technique could be a sound option as a step up approach before referring such cases for more complex techniques such as EUS-BD or PTBD.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Fabrizio Cereatti
- Unit of Interventional Endoscopy, Department of General Surgery “P. Stefanini”, “Sapienza” University of Rome, Rome, Italy
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Alexandre Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Meduri B, Derhy S, Dhumane P, Dumont JL, Tuszynski T, Vergeau BM, Donatelli G. Extra-anatomical intraduodenal endoscopic-radiologic biliary rendezvous for treatment of iatrogenic complete stenosis of the common bile duct. Endoscopy 2016; 47 Suppl 1:E565-6. [PMID: 26610086 DOI: 10.1055/s-0034-1393383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra West, Mumbai, India
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Vergeau BM, Tuszynski T, Meduri B. Giant, deep, well-circumscribed esophageal ulcers. Dis Esophagus 2016; 29:684-5. [PMID: 23895443 DOI: 10.1111/dote.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - B Meduri
- Hôpital Privé des Peupliers, Paris, France
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18
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Donatelli G, Dumont JL, Cereatti F, Dhumane P, Tuszynski T, Vergeau BM, Meduri B. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series. Endosc Int Open 2016; 4:E647-51. [PMID: 27556072 PMCID: PMC4993870 DOI: 10.1055/s-0042-105206] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/21/2016] [Indexed: 02/07/2023] Open
Abstract
Leaks following gastrointestinal surgery are a dreadful complication burdened by high morbidity and not irrelevant mortality. Endoscopic internal drainage (EID) has showed optimal results in the treatment of leaks following bariatric surgery. We report our experience with EID as first-line treatment for fistulas following surgery along all gastrointestinal tract.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France,Corresponding author Gianfranco Donatelli Unité d’Endoscopie InterventionnelleRamsay Générale de Santé, Hôpital Privé des Peupliers8 Place de l’Abbé G. Hénocque75013, ParisFrance+33-01-44-16-56-15
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Fabrizio Cereatti
- Unit of Interventional Endoscopy, Department of General Surgery “P. Stefanini”, “Sapienza” University of Rome, Rome, Italy
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Cereatti F, Dumont JL, Dhumane P, Tuszynski T, Vergeau BM, Meduri B. Post-biliary sphincterotomy bleeding despite covered metallic stent deployment. SAGE Open Med Case Rep 2016; 4:2050313X16645756. [PMID: 27489716 PMCID: PMC4927213 DOI: 10.1177/2050313x16645756] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/24/2016] [Indexed: 12/31/2022] Open
Abstract
Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
- Gianfranco Donatelli, Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l’ Abbé G. Hénocque, 75013 Paris, France.
| | - Fabrizio Cereatti
- Department of General Surgery Paride Stefanini, Interventional Endoscopy Unit, Sapienza University of Rome, Rome, Italy
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Mumbai, India
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
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Cereatti F, Fiocca F, Dumont JL, Ceci V, Vergeau BM, Tuszynski T, Meduri B, Donatelli G. Fully covered self-expandable metal stent in the treatment of postsurgical colorectal diseases: outcome in 29 patients. Therap Adv Gastroenterol 2016; 9:180-8. [PMID: 26929780 PMCID: PMC4749852 DOI: 10.1177/1756283x15610052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Self-expandable metal stent (SEMS) placement is a minimally invasive treatment for palliation of malignant colorectal strictures and as a bridge to surgery. However, the use of SEMS for benign colorectal diseases is controversial. The purpose of this retrospective study is to evaluate the efficacy and safety of fully covered SEMS (FCSEMS) placement in postsurgical colorectal diseases. METHODS From 2008 to 2014, 29 patients with 32 FCSEMS deployment procedures were evaluated. The indications for stent placement were: 17 anastomotic strictures (3/17 presented complete closure of the anastomosis); four anastomotic leaks; seven strictures associated with anastomotic leak; and one rectum-vagina fistula. RESULTS Clinical success was achieved in 18 out of 29 patients (62.1%) being symptom-free at an average of 19 months. In the remaining 11 patients (37.9%), a different treatment was needed: four patients required multiple endoscopic dilations, 4 patients colostomy confection, one patient definitive ileostomy and three patients revisional surgery. The FCSEMS were kept in place for a mean period of 34 (range: 6-65) days. Major complications occurred in 12 out of 29 patients (41.4%) and consisted of stent migration. Minor complications included two cases of transient fever, eight cases of abdominal or rectal pain, and one case of tenesmus. CONCLUSION FCSEMS are considered a possible therapeutic option for treatment of postsurgical strictures and leaks. However, their efficacy in guaranteeing long-term anastomotic patency and leak closure is moderate. A major complication is migration. The use of FCSEMS for colonic postsurgical pathologies should be carefully evaluated for each patient.
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Affiliation(s)
- Fabrizio Cereatti
- Emergency Endoscopic Unit, Policlinico Umberto I, ‘SAPIENZA’ University of Rome, Rome, Italy
| | - Fausto Fiocca
- Emergency Endoscopic Unit, Policlinico Umberto I, ‘SAPIENZA’ University of Rome, Rome, Italy
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Vincenzo Ceci
- Emergency Endoscopic Unit, Policlinico Umberto I, ‘SAPIENZA’ University of Rome, Rome, Italy
| | - Bertrand-Marie Vergeau
- Unité d’Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France
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Donatelli G, Dumont JL, Cereatti F, Ferretti S, Vergeau BM, Tuszynski T, Pourcher G, Tranchart H, Mariani P, Meduri A, Catheline JM, Dagher I, Fiocca F, Marmuse JP, Meduri B. Treatment of Leaks Following Sleeve Gastrectomy by Endoscopic Internal Drainage (EID). Obes Surg 2016; 25:1293-301. [PMID: 25913755 DOI: 10.1007/s11695-015-1675-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Leaks are considered one of the major complications of laparoscopic sleeve gastrectomy (LSG) with a reported rate up to 7 %. Drainage of the collection coupled with SEMS deployment is the most frequent treatment. Its success is variable and burdened by high morbidity and not irrelevant mortality. The aim of this paper is to suggest and establish a new approach by endoscopic internal drainage (EID) for the management of leaks. METHODS Since March 2013, 67 patients presenting leak following LSG were treated with deployment of double pigtail plastic stents across orifice leak, positioning one end inside the collection and the other end in remnant stomach. The aim of EID is to internally drain the collection and at the same time promote leak healing. RESULTS Double pigtails stent were successfully delivered in 66 out of 67 patients (98.5 %). Fifty patients were cured by EID after a mean time of 57.5 days and an average of 3.14 endoscopic sessions. Two died for event not related to EID. Nine are still under treatment; five failure had been registered. Six patients developed late stenosis treated endoscopically. CONCLUSIONS EID proved to be a valid, curative, and safe mini-invasive approach for treatment of leaks following SG. EID achieves complete drainage of perigastric collections and stimulates mucosal growth over the stent. EID is well tolerated, allows early re-alimentation, and it is burdened by fewer complications than others technique. Long-term follow-up confirms good outcomes with no motility or feeding alterations.
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Affiliation(s)
- G Donatelli
- Unité d'Endoscopie Interventionnelle, Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Henocque, 75013, Paris, France,
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Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Obes Surg 2015; 24:1400-7. [PMID: 24898719 DOI: 10.1007/s11695-014-1298-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved. METHODS In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4-98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation. RESULTS Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26-45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25-42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26- 180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20-276). CONCLUSIONS EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, 8 Place de l'Abbé G. Henocque, 75013, Paris, France,
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Dray X, Samaha E, Tuszynski T. Pouch outlet obstruction by psyllium-based bulk laxative bezoar in a patient with gastric banding. Surg Obes Relat Dis 2015; 11:483-4. [PMID: 25771442 DOI: 10.1016/j.soard.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 01/21/2015] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Xavier Dray
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, Paris, France.
| | - Elia Samaha
- Department of Gastroenterology and Hepatology, Paris Descartes University APHP & European George Pompidou Hospital, Paris, France
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Donatelli G, Vergeau BM, Dumont JL, Tuszynski T, Dritsas S, Dhumane P, Meduri B. Late presentation of a giant gastrogastric fistula following gastric bypass, treated with a colic over-the-scope clip after unsuccessful surgical repair. Endoscopy 2014; 46 Suppl 1 UCTN:E128-9. [PMID: 24676824 DOI: 10.1055/s-0034-1364889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/25/2023]
Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand M Vergeau
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Jean L Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Stavros Dritsas
- Department of Hepatology, Hôpital Universitaire Jean Minjoz, Besançon, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra (West), Mumbai, India
| | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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Donatelli G, Dumont JL, Vergeau BM, Chiche R, Quioc JJ, Tuszynski T, Meduri B. Colic and gastric over-the-scope clip (Ovesco) for the treatment of a large duodenal perforation during endoscopic retrograde cholangiopancreatography. Therap Adv Gastroenterol 2014; 7:282-4. [PMID: 25364387 PMCID: PMC4212472 DOI: 10.1177/1756283x14551672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, 8 Place de l’Abbé G. Hénocque 75013, Paris, France
| | - Jean-Loup Dumont
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand Marie Vergeau
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Renaud Chiche
- Service de Chirurgie Viscérale et Digestive, Clinique Geoffroy Saint-Hilaire, Générale de Santé, Paris, France
| | - Jean-Jacques Quioc
- Service de Gastro-entérologie, Hôpital Privé de l’Ouest Parisien, Générale de Santé, Trappes, France
| | - Thierry Tuszynski
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bruno Meduri
- Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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Donatelli G, Vergeau BM, Dumont JL, Altmann C, Dritsas S, Dhumane P, Tuszynski T, Meduri B. Delayed successful treatment of iatrogenic colon perforation using an over-the-scope clip. Endoscopy 2014; 46 Suppl 1 UCTN:E285-6. [PMID: 24906103 DOI: 10.1055/s-0034-1365796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand M Vergeau
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Claude Altmann
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | | | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra (W), Mumbai, India
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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Meduri B, Vergeau BM, Dumont JL, Tuszynski T, Dritsas S, Dhumane P, Donatelli G. Endoscopic ultrasound-guided fine needle aspiration and endoscopic biliary drainage following closure of a duodenal perforation with an over-the-scope clip. Endoscopy 2014; 46 Suppl 1 UCTN:E69-70. [PMID: 24523190 DOI: 10.1055/s-0033-1359186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Bruno Meduri
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand Marie Vergeau
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Stavros Dritsas
- Department of Hepatology, Hôpital Universitaire Jean Minjoz, Besançon, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Mumbai, India
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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Donatelli G, Dhumane P, Vergeau BM, Dumont JL, Tuszynski T, Meduri B. Successful removal from the esophagus of a self-expandable metal stent that had shriveled up into a tangled ball. Endoscopy 2014; 45 Suppl 2 UCTN:E410-1. [PMID: 24285075 DOI: 10.1055/s-0033-1344992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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]
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Donatelli G, Vergeau BM, Dritsas S, Dumont JL, Tuszynski T, Meduri B. Closure with an over-the-scope clip allows therapeutic ERCP to be safely performed after acute duodenal perforation during diagnostic endoscopic ultrasound. Endoscopy 2014; 45 Suppl 2 UCTN:E392-3. [PMID: 24285065 DOI: 10.1055/s-0033-1344872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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]
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Donatelli G, Vergeau BM, Derhy S, Dumont JL, Tuszynski T, Dhumane P, Meduri B. Combined endoscopic and radiologic approach for complex bile duct injuries (with video). Gastrointest Endosc 2014; 79:855-64. [PMID: 24556053 DOI: 10.1016/j.gie.2013.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 09/29/2013] [Accepted: 12/23/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Gianfranco Donatelli
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand Marie Vergeau
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Serge Derhy
- Service de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Jean Loup Dumont
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Thierry Tuszynski
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India
| | - Bruno Meduri
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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Donatelli G, Vergeau BM, Dhumane P, Cereatti F, Fiocca F, Tuszynski T, Meduri B. Endoscopic partial sphincterotomy coupled with large balloon papilla dilation – Single stage approach for management of extra-hepatic bile ducts macro-lithiasis. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.vjgien.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Donatelli G, Marie Vergeau B, Tuszynski T, Meduri B. Bilio-pancreatic endoscopic ultrasonography for diagnosis of biliary parasitosis. Ann Gastroenterol 2013; 26:165. [PMID: 24714820 PMCID: PMC3959945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/25/2012] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gianfranco Donatelli
- Service d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France,
Correspondence to: Gianfranco Donatelli, MD, Hôpital Privé des Peupliers, Service d’Endoscopie Interventionnelle, 8 Place Abbé G. Henocque, 75013, Paris, France, Tel.: +33 664 9500 70, Fax: +33 144 1652 12, e-mail:
| | | | - Thierry Tuszynski
- Service d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Bruno Meduri
- Service d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
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Trompette ML, Nahon S, Tuszynski T, Poupardin C, Jouannaud V, Lesgourgues B. [Treatment of a gastric telangiectasia with endoscopic band ligation]. Gastroenterol Clin Biol 2009; 33:1070-2. [PMID: 19864097 DOI: 10.1016/j.gcb.2009.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 08/05/2009] [Accepted: 08/07/2009] [Indexed: 11/30/2022]
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Tarko T, Duda-Chodak A, Tuszynski T. Simulation of Phenolic Compounds Transformations and Interactions in an in Vitro Model of the Human Alimentary Tract. FOOD SCI TECHNOL INT 2009. [DOI: 10.1177/1082013209339861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nahon S, Patey-Mariaud De Serre N, Lejeune O, Huchet FX, Lahmek P, Lesgourgues B, Traissac L, Bodiguel V, Adotti F, Tuszynski T, Delas N. Duodenal intraepithelial lymphocytosis during Helicobacter pylori infection is reduced by antibiotic treatment. Histopathology 2006; 48:417-23. [PMID: 16487363 DOI: 10.1111/j.1365-2559.2006.02358.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM To evaluate clinical, biological and immunological features of patients with increased duodenal intraepithelial lymphocytes (IELs), and its relation to Helicobacter pylori (HP) and coeliac disease (CD). METHODS We have studied all patients accrued over a 4-year period with increased duodenal IELs. Those patients were recalled for biological and immunological evaluation and a second endoscopy. RESULTS Twenty-three from a total of 639 patients were identified and 17 of them were included in the study. The median duodenal IEL count was 59 per 100 epithelial cells. Twelve (71%) patients were HP+; eight of them received HP eradication. At the second endoscopy the duodenal IEL count was significantly lower 2 months after HP eradication (73 versus 28), while the IEL count was unchanged in those patients seronegative for HP (n = 5) or those in whom it was not eradicated (n = 4) (55 versus 55). No patient had coeliac antibodies, four expressed HLA-DQ2, lower than in the general population, and the prevalence of CD was 2% (12/639 patients). CONCLUSION In some cases an increased duodenal IEL count may be due to an inappropriate host response to HP. HP screening and eradication should be considered before recommending a gluten-free diet.
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Affiliation(s)
- S Nahon
- Service d'Anatomopathologie, Centre Hospitalier Intercommunal, Le Raincy-Montfermeil, France
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Nahon S, Lahmek P, Lesgourgues B, Nahon-Uzan K, Tuszynski T, Traissac L, Delas N. Predictive factors of GI lesions in 241 women with iron deficiency anemia. Am J Gastroenterol 2002. [PMID: 11922551 DOI: 10.1111/j.572-0241.2002.05534.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES GI blood loss is the most common cause of iron deficiency anemia (IDA) in postmenopausal women and menstrual blood loss in premenopausal women. We aimed to evaluate the diagnostic yield of endoscopy in women with IDA and to define predictive factors of a GI lesion. METHOD Clinical, biological, endoscopic, and histological data from patients with IDA were systematically collected on a computer. Multivariate analysis (logistic regression) was performed to determine whether these data were associated with a GI lesion. RESULTS Between January, 1989 and June, 1999, 241 consecutive women had endoscopies for IDA (mean age = 52.3 +/- 21.8 yr). A substantial GI lesion was detected in 119 patients (49.4%). Ten patients (4%) had both upper and lower GI lesions. A source of IDA was revealed by upper endoscopy in 86 cases (35.6%) and by colonoscopy in 33 (13.7%). The most common upper lesions were peptic ulceration (42/241 [17.4%]), esophagitis (15/241 [6.2%]), and cancer (9/241 [3.7%]). Colonic cancer (15/241 [6.2%]) and polyps (10/241 [4.1%]) were the most frequent lesions detected by colonoscopy. Predictive factors (odds ratio, 95% CI) of GI lesions diagnosed by endoscopy were abdominal symptoms (8.3, 3.9-17.2), age > 50 yr (4.4, 2.1-9.2), and Hb < 9 g/dl (3, 1.5-6.1). Thirty-one women (13%) had none of these predictive factors; in this group only two lesions were identified (one esophagitis and one duodenal ulcer). The positive predictive value of these three independent predictors was 87%, and the negative predictive value was 93.5%. CONCLUSION Endoscopy revealed a source of IDA in 49.4% of cases. Three predictive factors of GI lesion were identified. Endoscopic investigation should be avoided in women without these three predictive factors. Conversely, these factors are strongly associated with a GI lesion.
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Affiliation(s)
- Stéphane Nahon
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Abstract
OBJECTIVES GI blood loss is the most common cause of iron deficiency anemia (IDA) in postmenopausal women and menstrual blood loss in premenopausal women. We aimed to evaluate the diagnostic yield of endoscopy in women with IDA and to define predictive factors of a GI lesion. METHOD Clinical, biological, endoscopic, and histological data from patients with IDA were systematically collected on a computer. Multivariate analysis (logistic regression) was performed to determine whether these data were associated with a GI lesion. RESULTS Between January, 1989 and June, 1999, 241 consecutive women had endoscopies for IDA (mean age = 52.3 +/- 21.8 yr). A substantial GI lesion was detected in 119 patients (49.4%). Ten patients (4%) had both upper and lower GI lesions. A source of IDA was revealed by upper endoscopy in 86 cases (35.6%) and by colonoscopy in 33 (13.7%). The most common upper lesions were peptic ulceration (42/241 [17.4%]), esophagitis (15/241 [6.2%]), and cancer (9/241 [3.7%]). Colonic cancer (15/241 [6.2%]) and polyps (10/241 [4.1%]) were the most frequent lesions detected by colonoscopy. Predictive factors (odds ratio, 95% CI) of GI lesions diagnosed by endoscopy were abdominal symptoms (8.3, 3.9-17.2), age > 50 yr (4.4, 2.1-9.2), and Hb < 9 g/dl (3, 1.5-6.1). Thirty-one women (13%) had none of these predictive factors; in this group only two lesions were identified (one esophagitis and one duodenal ulcer). The positive predictive value of these three independent predictors was 87%, and the negative predictive value was 93.5%. CONCLUSION Endoscopy revealed a source of IDA in 49.4% of cases. Three predictive factors of GI lesion were identified. Endoscopic investigation should be avoided in women without these three predictive factors. Conversely, these factors are strongly associated with a GI lesion.
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Affiliation(s)
- Stéphane Nahon
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Nahon S, Hoang JM, Tuszynski T, Mariaud De Serre N, Lesgourgues B, Delas N. [Hemangioma of the small bowel manifesting as gastrointestinal bleeding, diagnosed by pushed enteroscopy]. Gastroenterol Clin Biol 1999; 23:1406-7. [PMID: 10642633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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