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Sirmai L, Benusiglio PR, Svrcek M, Dray X. Magnifying chromoendoscopy with targeted biopsies of intramucosal signet cell adenocarcinomas in a CDH1 pathogenic variant asymptomatic carrier. Clin Res Hepatol Gastroenterol 2022; 46:101914. [PMID: 35341992 DOI: 10.1016/j.clinre.2022.101914] [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: 01/27/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Affiliation(s)
- L Sirmai
- Sorbonne University & Saint Antoine University Hospital, Department of endoscopy, Paris, France.
| | - P R Benusiglio
- Sorbonne University & Saint Antoine and Pitié Salpétrière University Hospitals, Department of Genetics, Paris, France
| | - M Svrcek
- Sorbonne University & Saint Antoine University Hospital, Department of pathology, Paris, France
| | - X Dray
- Sorbonne University & Saint Antoine University Hospital, Department of endoscopy, Paris, France
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Baltes P, Dray X, Riccioni M, Pérez-Cuadrado-Robles E, Fedorov E, Wiedbrauck F, Chetcuti Zammit S, Cadoni S, Bruno M, Rondonotti E, Wurm Johansson G, Mussetto A, Beaumont H, Perrod G, McNamara D, Plevris J, Spada C, Pinho R, Rosa B, Hervás N, Carretero C, Tontini G, Keuchel M. CAPSULE ENDOSCOPY IN PATIENTS WITH MECKEL`S DIVERTICULUM- CLINICAL FEATURES AND DIAGNOSTIC FINDINGS – A EUROPEAN MULTICENTRE STUDY. ESGE Days 2022 2022. [DOI: 10.1055/s-0042-1744627] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- P. Baltes
- Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - X. Dray
- Hospital Saint Antoine, Sorbonne University, Paris, France
| | - M.E. Riccioni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - E. Fedorov
- Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | | | | | | | - M. Bruno
- University Hospital City of Science and Health Turin, Turin, Italy
| | | | | | - A. Mussetto
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - H. Beaumont
- Amsterdam University Medical Center, location VU, Amsterdam, Netherlands
| | - G. Perrod
- Georges Pompidou European Hospital, Paris, France
| | - D. McNamara
- Tallaght University Hospital, Dublin, Ireland
| | - J. Plevris
- The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C. Spada
- Fondazione Poliambulanza, Brescia, Italy
| | - R. Pinho
- Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - B. Rosa
- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - N. Hervás
- Complejo Hospitalario Navarra, Pamplona, Spain
| | | | - G.E. Tontini
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Keuchel
- Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
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Leenhardt R, Koulaouzidis A, McNamara D, Keuchel M, Sidhu R, McAlindon ME, Saurin JC, Eliakim R, Fernandez-Urien Sainz I, Plevris JN, Rahmi G, Rondonotti E, Rosa B, Spada C, Toth E, Houdeville C, Li C, Robaszkiewicz M, Marteau P, Dray X. A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire. Clin Res Hepatol Gastroenterol 2021; 45:101637. [PMID: 33662785 DOI: 10.1016/j.clinre.2021.101637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/26/2020] [Revised: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.
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Affiliation(s)
- R Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - A Koulaouzidis
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - D McNamara
- TAGG Research Centre, Department of Clinical Medicine Tallaght Hospital, Trinity College Dublin, Ireland
| | - M Keuchel
- Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | - R Sidhu
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - M E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J C Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - R Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - J N Plevris
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - G Rahmi
- Université de Paris, Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - E Rondonotti
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - B Rosa
- Universidade do Minho, Hospital Senhora da Oliveira, Departamento de Gastroenterologia, Guimarães, Portugal
| | - C Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - E Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Houdeville
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France; Drexel University, College of Arts & Sciences, Philadelphia, USA
| | - M Robaszkiewicz
- La Cavale Blanche University Hospital, Endoscopy Unit, Brest, France
| | - P Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - X Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France.
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Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
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Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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Bernardini D, Bulois P, Barthet M, Chaussade S, Gronier O, Lecomte T, Laquière A, Lapuelle J, Quentin V, Tarrerias AL, Vaillant E, Gincul R, Dalbies P, Ponchon T, Dray X, Bories E, Koch S, Robaszkiewicz M. « Une semaine de coloscopie en France » : résultats 2017 de l’enquête annuelle de la Société française d’endoscopie digestive. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s10190-017-0613-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Dohan A, Faraoun S, Barral M, Guerrache Y, Boudiaf M, Dray X, Hoeffel C, Allez M, Farges O, Beaugerie L, Aparicio T, Marteau P, Fishman E, Lucidarme O, Eveno C, Pocard M, Dautry R, Soyer P. Extra-intestinal malignancies in inflammatory bowel diseases: An update with emphasis on MDCT and MR imaging features. Diagn Interv Imaging 2015; 96:871-83. [DOI: 10.1016/j.diii.2015.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/24/2015] [Indexed: 12/11/2022]
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Silva J, Histace A, Romain O, Dray X, Granado B, Pinna A. Towards real-time in situ polyp detection in WCE images using a boosting-based approach. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:5711-4. [PMID: 24111034 DOI: 10.1109/embc.2013.6610847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper presents a new embeddable method for polyp detections in Wireless Capsule Endoscopic - WCE images. this approach consists first of extracting candidate polyps within the image using geometric considerations about related shape, and second, in classifying (polyp/non-polyp) obtained candidates by a boosting-based method using texture features. The proposed approach has been designed in accordance with the hardware constraints related to FPGA implementation for integration within WCE imaging device. The classification performance of the method have been evaluated on a large dataset of 300 polyps, and 1200 non-polyps images. Experiments show interesting and promising performance: the boosting-based classification is characterized by a sensitivity of 91%, a specificity of 95% and a false detection rate of 4.8%, the detection rate of the overall processing chain being of 68%. The performance of the boosting-based classification are in accordance with the most recent reference on this particular topic using the same dataset. Building of a dedicated WCE image database should permit the improvement of the global detection rate.
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Abstract
Endoscopy has an ever-increasing role in the treatment of complications in digestive surgery. Endoscopic treatment is essentially used for (i) fistula or intra-abdominal collection secondary to anastomotic dehiscence and (ii) anastomotic stricture, especially esophagogastric, but also sometimes after colorectal surgery. First intention treatment of fistula following esophagogastric surgery is the insertion of an extractable self-expandable metallic stent (partially or entirely covered); this is supported by a low level of scientific evidence, but clinical experience has been satisfactory. Other techniques for treatment of anastomotic leak have also been reported anecdotally (clip placement, sealing with glue). There are few data available in the literature on endoscopic management (stents essentially) of postoperative colonic fistula. Whatever the approach chosen to treat a postoperative digestive tract fistula, management is medico-surgical and cannot be limited to simple closure of the digestive tube wall defect. Drainage of any collections by endoscopic, radiologic or surgical approach, systemic treatment of infection and nutritional support are essential adjuvant treatment modalities. Treatment of postoperative esophageal or colonic strictures is essentially endoscopic and is based on initial dilatation (endoscopic with hydrostatic balloon or bougie), and placement of extractable metallic stents (partially or entirely covered) in case of refractory outcome.
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Affiliation(s)
- X Dray
- Université Paris Diderot, Paris 7, AP-HP, Service d'Hépatogastroentérologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Camus M, Marteau P, Pocard M, Bal Dit Sollier C, Lavergne-Slove A, Thibault A, Lecleire S, Vienne A, Coffin B, Drouet L, Dray X. Validation of a live animal model for training in endoscopic hemostasis of upper gastrointestinal bleeding ulcers. Endoscopy 2013; 45:451-7. [PMID: 23733728 DOI: 10.1055/s-0032-1326483] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The management of upper gastrointestinal bleeding requires training of the endoscopist. We aimed to validate a live animal model of bleeding ulcers for training in endoscopic hemostasis. MATERIALS AND METHODS Bleeding ulcers were created by repeated grasp-and-snare gastric mucosectomies in pigs rendered "bleeders" by preadministration of clopidogrel, aspirin, and unfractionated heparin. The feasibility and reproducibility of the model (proportion of bleeding ulcers, number of ulcers per animal, and time needed to produce a bleeding ulcer) were prospectively evaluated in six animals. Ten endoscopic experts assessed the similarity of this pig model to human bleeding ulcers (four-point Likert scale). The training capabilities of the model for hemostatic techniques (needle injection, bipolar electrocoagulation, and hemoclipping) were evaluated in 46 fellows (four-point Likert scale). RESULTS A total of 53 gastric ulcers were created in 6 animals (8.8 ± 1.5 ulcers/animal). Successful active ulcer bleeding (Forrest Ib) was achieved in 96.2 % of cases. Bleeding was moderate to abundant in 79 % of cases. Ulcerations consistently reached the submucosal layer. The mean (± SD) time taken to create a bleeding ulcer was 3.8 ± 0.6 minutes. Endoscopic experts assessed the realism of the ulcers and bleeding at 3.2 ± 0.7 and 3.6 ± 0.7 respectively on a four-point Likert scale. The training significantly improved the endoscopic skills of the 46 fellows (P < 0.0001) in all hemostatic techniques. CONCLUSIONS The live porcine model of bleeding ulcers was demonstrated to be realistic, reproducible, feasible, time efficient, and easy to perform. It was favorably assessed as an excellent model for training in endoscopic treatment of bleeding ulcers.
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Affiliation(s)
- M Camus
- Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France.
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Affiliation(s)
- A Thibault
- Department of Digestive Diseases, APHP, Lariboisière Hospital and Paris Diderot Paris 7 University, Paris, France
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Ladjici Y, Dray X, Marteau P, Valleur P, Pocard M. Flexible versus rigid single-port peritoneoscopy: a randomized controlled trial in a live porcine model followed by initial experience in human cadavers. Surg Endosc 2012; 26:2651-7. [DOI: 10.1007/s00464-012-2218-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 11/26/2011] [Indexed: 12/15/2022]
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Giday SA, Kim Y, Krishnamurty DM, Ducharme R, Liang DB, Shin EJ, Dray X, Hutcheon D, Moskowitz K, Donatelli G, Rueben D, Canto MI, Okolo PI, Kalloo AN. Long-term randomized controlled trial of a novel nanopowder hemostatic agent (TC-325) for control of severe arterial upper gastrointestinal bleeding in a porcine model. Endoscopy 2011; 43:296-9. [PMID: 21384319 DOI: 10.1055/s-0030-1256125] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM Endoscopic therapy of brisk upper gastrointestinal bleeding remains challenging. A proprietary nanopowder (TC-325) has been proven to be effective in high pressure bleeding from external wounds. The efficacy and safety of TC-325 were assessed in a survival gastrointestinal bleeding animal model. METHOD 10 animals were randomized to treatment or sham. All animals received intravenous antibiotics, H2-blockers and heparin (activated clotting time 2 × normal). In a sterile laparotomy the gastroepiploic vessels were dissected, inserted through a 1-cm gastrotomy, and freely exposed in the gastric lumen, and the exposed vessel lacerated by needle knife. The treatment group received TC-325 by a modified delivery catheter while the sham group received no endoscopic treatment. Time to hemostasis, and mortality at 60 minutes, 24 hours, 48 hours, and 7 days were noted. Necropsy was performed in all animals. RESULTS Spurting arterial bleeding was achieved in all animals. No control animal showed hemostasis within the first hour compared with 100 % (5 / 5) in the treatment arm (mean 13.8 minutes, P < 0.0079). Durable hemostasis was achieved with no evidence of rebleeding after 1 and 24 hours in 80 % (4 / 5) of the treated animals compared with none in the control group ( P < 0.0098). None of the control animals survived more than 6 hours. Necropsy at 1 week in treated animals revealed healed gastrotomy without foreign body granuloma or embolization to the lung or brain. CONCLUSION TC-325 is safe and highly effective in achieving hemostasis in an anticoagulated severe arterial gastrointestinal bleeding animal model.
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Affiliation(s)
- S A Giday
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore 21205, USA.
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Duboc H, Kianmanesh R, Dray X. Ingested pin penetrating stomach wall and liver. Endoscopy 2010; 42 Suppl 2:E208. [PMID: 20845275 DOI: 10.1055/s-0030-1255711] [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)
- H Duboc
- Emergency Endoscopy Ward, Department of Digestive Diseases, APHP, Hopital Lariboisière, Paris, France.
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Dray X. Natural orifice transluminal endoscopic surgery. Endoscopy 2010; 42:950-4. [PMID: 21072713 DOI: 10.1055/s-0030-1255794] [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)
- X Dray
- Department of Digestive Diseases, Lariboisière Hospital APHP and Paris 7 University, Paris, France.
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Abstract
The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.
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Affiliation(s)
- M Chirica
- Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Dubcenco E, Assumpcao L, Dray X, Gabrielson KL, Ruben DS, Pipitone LJ, Donatelli G, Krishnamurty DM, Baker JP, Marohn MR, Kalloo AN. Adhesion formation after peritoneoscopy with liver biopsy in a survival porcine model: comparison of laparotomy, laparoscopy, and transgastric natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 2009; 41:971-8. [PMID: 19866395 DOI: 10.1055/s-0029-1215229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Minimizing the invasiveness of operations by using natural orifice transluminal endoscopic surgery (NOTES) may reduce adhesion formation. The aim of the study was to compare rates of adhesion formation after peritoneoscopy with liver biopsy by laparotomy, laparoscopy, and transgastric NOTES. MATERIALS AND METHODS Experimental comparative survival study, at a university hospital. using 18 female pigs weighing 35 - 40 kg. Peritoneoscopy with liver biopsy was randomized to one of three groups: laparotomy, laparoscopy, and transgastric NOTES. Preoperative, operative, and postoperative care was standardized. Main outcome measures were: (i) survival and complication rates; (ii) assessment of adhesion formation using the Hopkins Adhesion Formation Score at necropsy (day 14). RESULTS 100 % of pigs with laparotomy and 33.3 % with laparoscopy had adhesions compared with 16.7 % who underwent transgastric NOTES. Documented adhesion bands totals for each group were: transgastric NOTES 1; laparoscopy 4; laparotomy 17. Median adhesion formation scores were: laparotomy 2.5 (range 2 - 4), compared with laparoscopy 0.0 (0 - 2), and transgastric NOTES 0.0 (0 - 1) ( P < 0.001). Spearman coefficient analysis revealed that correlation between adhesion scores assigned by two investigators was excellent (r = 0.99, P < 0.001, 95 % confidence interval [CI] 0.9978 - 0.9996). CONCLUSIONS Although this was a short-term study, with a low number of animals, it showed that transgastric NOTES and laparoscopy are associated with statistically significantly lower rates of adhesion formation than open surgery when peritoneoscopy with liver biopsy is performed. Incidence and severity of adhesions were lowest with transgastric NOTES.
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Affiliation(s)
- E Dubcenco
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland 21231, USA
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17
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Sokol H, Polin V, Lavergne-Slove A, Panis Y, Treton X, Dray X, Bouhnik Y, Valleur P, Marteau P. Plexitis as a predictive factor of early postoperative clinical recurrence in Crohn's disease. Gut 2009; 58:1218-25. [PMID: 19625280 DOI: 10.1136/gut.2009.177782] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS A previous study suggested that the presence of myenteric plexitis in the proximal resection margins could be predictive of early endoscopic recurrence after ileocolonic or ileal resection for Crohn's disease (CD). The aim of the present study was to assess the predictive value of plexitis for early clinical CD recurrence. METHODS All consecutive patients with ileocolonic or ileal resection for active CD in Lariboisière Hospital (Paris) between 1995 and 2006 were included. Clinical, surgical, histological and follow-up data were extracted from medical charts. Early clinical recurrence was defined as the reappearance of CD clinical manifestations requiring a specific treatment within 2 years postsurgery. The proximal resection margin was analysed using haematein eosin saffron (HES) staining and immunochemistry targeting mastocytes (anti-CD117 antibody) and lymphocytes (anti-CD3 antibody). Eosinophils were detected by HES staining. Ten cases of ileocolonic resections for caecal carcinoma served as controls. RESULTS Data were available from 171 postoperative follow-up periods in 164 patients with CD. Early clinical recurrence of CD occurred in 28.1%. In multivariate analysis, factors associated with postoperative recurrence were active smoking (hazard ratio (HR) = 1.94; 95% CI 1.06 to 3.60; p = 0.033), submucosal plexitis with >or=3 mastocytes (HR = 1.87; 95% CI 1.00 to 3.46; p = 0.048) and a disease-free resection margin <5 cm (HR = 0.52; 95% CI 0.27 to 1.02; p = 0.059). CONCLUSIONS Submucosal plexitis is associated with early clinical recurrence and could be taken into account in studies searching for new treatment strategies in the immediate postoperative period.
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Affiliation(s)
- H Sokol
- AP-HP, Saint-Antoine Hospital, Gastroenterology and Nutrition Department, Paris, France
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18
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Abstract
Natural orifice translumenal endoscopic surgery (NOTES) allows access into the peritoneal cavity with a flexible endoscope, through the wall of the digestive or urogenital tracts. NOTES can be combined to laparoscopic surgery in so-called << hybrid >> techniques. In the absence of any incision of the abdominal wall, NOTES procedures provide perfect cosmetic results, with virtually no risk of parietal complications, and with decreased postoperative pain. NOTES could particularly benefit to overweight patients and to patients receiving intensive or palliative care. Most NOTES studies have been performed on animal models, with great interest for both transgastric and transpelvic approaches. Successful NOTES peritoneoscopy, hysterectomy, oophorectomy, tubal ligation, gastrojejunal anastomosis, cholecystectomy, splenectomy, nephrectomy, and abdominal-wall hernia repair have been described. In human studies, the transvaginal route is preferred. NOTES clinical research focuses on low-morbidity procedures, such as cholecystectomy, appendectomy, and peritoneoscopy. Indirect benefits are expected from this research, with possible technological innovations in the field of endoscopic instrumentation (including sutures, anastomosis, traction and triangulation). Overall, NOTES is believed to make evolve both interventional endoscopy and minimally invasive surgery.
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Affiliation(s)
- X Dray
- Conservatoire National des Arts et Métiers, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris-7, Paris, France.
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Jomni T, Dray X, Merrouche M, Costil V, Vahedi K, Marteau P. Achalasie chez une patiente obèse porteuse d’un anneau gastrique ajustable. ACTA ACUST UNITED AC 2008; 32:973-5. [DOI: 10.1016/j.gcb.2008.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Buscaglia JM, Shin EJ, Clarke JO, Giday SA, Ko CW, Thuluvath PJ, Magno P, Dray X, Kantsevoy SV. Endoscopic retrograde cholangiopancreatography, but not esophagogastroduodenoscopy or colonoscopy, significantly increases portal venous pressure: direct portal pressure measurements through endoscopic ultrasound-guided cannulation. Endoscopy 2008; 40:670-4. [PMID: 18561105 DOI: 10.1055/s-2008-1077341] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Changes in portal pressure during endoscopy have not been previously evaluated. The aims of this study were to assess the effect of esophagogastroduodenoscopy (EGD), colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP) on portal vein, inferior vena cava (IVC), and systemic pressures. PATIENTS AND METHODS Five acute experiments were performed on 50-kg pigs utilizing endoscopic ultrasound (EUS)-guided catheterization of the portal vein and IVC. Systemic, intra-abdominal, IVC, and portal vein pressures were monitored during colonoscopy, EGD, and ERCP with endoscopic sphincterotomy. After endoscopy the animals were sacrificed for necropsy. The main outcome measure was pressure change during each type of endoscopic procedure. RESULTS There were no significant changes in heart rate or systemic pressure during all endoscopic procedures. Intra-abdominal pressure increased during colonoscopy ( P = 0.02) and ERCP ( P = 0.007). However, mean portal venous pressure was significantly elevated only after the injection of contrast into the common bile duct, reaching its peak value at the time of biliary sphincterotomy (39.0 +/- 15.2 mm Hg vs. 13.4 +/- 3.6 mm Hg at baseline, P = 0.006). Mean peak IVC pressure was also elevated during ERCP, but it did not reach statistical significance (24.0 +/- 10.7 mm Hg vs. 12.6 +/- 4.1 mm Hg at baseline, P = 0.06). CONCLUSION EGD and colonoscopy did not cause significant changes in portal vein, IVC, or systemic pressures. ERCP with biliary sphincterotomy increased portal pressure with only limited effect on IVC and systemic pressures. These new data indicate a possible connection between ERCP with sphincterotomy and portal pressure, and may be clinically important for patients with liver disease and other causes of portal hypertension who undergo this procedure.
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Affiliation(s)
- J M Buscaglia
- Department of Medicine, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Poupeney S, Dray X, Reignier S, Vahedi K, Alhenc M, Belluci S, Marteau P. Decrease in factor V activity: a new adverse effect of purine analogs in inflammatory bowel diseases? Inflamm Bowel Dis 2008; 14:1024-5. [PMID: 18286642 DOI: 10.1002/ibd.20411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Meireles OR, Kantsevoy SV, Assumpcao LR, Magno P, Dray X, Giday SA, Kalloo AN, Hanly EJ, Marohn MR. Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device. Surg Endosc 2008; 22:1609-13. [PMID: 18401658 DOI: 10.1007/s00464-008-9750-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 10/27/2007] [Accepted: 11/28/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reliable closure of the translumenal incision is one of the main challenges facing natural orifice translumenal endoscopic surgery (NOTES). This study aimed to evaluate the use of an automated flexible stapling device (SurgASSIST) for closure of the gastrotomy incision in a porcine model. METHODS A double-channel gastroscope was advanced into the stomach. A gastric wall incision was made, and the endoscope was advanced into the peritoneal cavity. After peritoneoscopy, the endoscope was withdrawn into the stomach. The SurgASSIST stapler was advanced orally into the stomach. The gastrotomy edges were positioned between the opened stapler arms using two endoscopic grasping forceps. Stapler loads with and without a cutting blade were used for gastric closure. After firing of the stapler to close the gastric wall incision, x-ray with contrast was performed to assess for gastric leakage. At the end of the procedure, the animals were killed for a study of closure adequacy. RESULTS Four acute animal experiments were performed. The delivery and positioning of the stapler were achieved, with technical difficulties mostly due to a short working length (60 cm) of the device. Firing of the staple delivered four rows of staples. Postmortem examination of pig 1 (when a cutting blade was used) demonstrated full-thickness closure of the gastric wall incision, but the cutting blade caused a transmural hole right at the end of the staple line. For this reason, we stopped using stapler loads with a cutting blade. In the three remaining animals (pigs 2-4), we were able to achieve a full-thickness closure of the gastric wall incision without any complications. CONCLUSIONS The flexible stapling device may provide a simple and reliable technique for lumenal closure after NOTES procedures. Further survival studies are currently under way to evaluate the long-term efficacy of gastric closure with the stapler after intraperitoneal interventions.
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Affiliation(s)
- O R Meireles
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 608, Baltimore, MD 21287, USA
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23
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Affiliation(s)
- X Dray
- Dept. of Digestive Diseases, Assistance Publique - Hôpitaux de Paris,Lariboisière Hospital, Paris, France
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Affiliation(s)
- Y Fargeaudou
- Service de Radiologie viscérale et vasculaire, Hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris Cedex 10.
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25
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Drouault-Holowacz S, Bieuvelet S, Burckel A, Cazaubiel M, Dray X, Marteau P. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroentérologie Clinique et Biologique 2008; 32:147-52. [PMID: 18387426 DOI: 10.1016/j.gcb.2007.06.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of a probiotic combination on symptoms in patients with irritable bowel syndrome (IBS). METHODS We investigated the efficiency of a probiotic dietary supplement, containing four strains of lactic acid bacteria, on symptoms of IBS. One hundred and sixteen patients with IBS fulfilling the Rome II criteria were randomized in a parallel group, double-blind study to receive a placebo or a probiotic combination (1 x 10(10) cfu once daily) for four weeks. The symptoms that were monitored weekly included discomfort, abdominal pain, and stool frequency and quality. Quality of life was assessed before and at the end of the treatment using the SF36 and FDD-quality-of-life questionnaires. RESULTS One hundred subjects completed the study (48 probiotic combination, 52 placebo). The probiotic combination was not superior to the placebo in relieving symptoms of IBS (42.6 versus 42.3% improvement). However, the decrease of abdominal pain between the first and the fourth week of treatment was significantly higher in probiotic treated patients (-41.9 versus -24.2%, P=0.048). Interesting findings from the IBS sub-groups were also observed such as a lower pain score at end point in patients with alternating bowel habits (P=0.023) and an increase of stool frequency in the constipated sub-group from the first week of probiotic treatment (P=0.043). CONCLUSIONS The probiotic combination was not significantly superior to the placebo in relieving symptoms of IBS. Despite the apparent high placebo response, interesting findings from IBS sub-groups were observed in the field of abdominal pain and stool frequency.
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Dray X, Kalloo A. Chirurgie endoscopique transviscérale : premières interventions chez l’homme et stratégie de développement. ACTA ACUST UNITED AC 2008; 32:8-10. [DOI: 10.1016/j.gcb.2007.12.004] [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: 10/22/2022]
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27
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Dray X, Medeau V, Qubaja M, Lavergne‐Slove A, Guillausseau PJ, Marteau P. Colonic colonisation with Giardia lamblia in a patient receiving fibrates. Gut 2007; 56:1639-40. [PMID: 17938439 PMCID: PMC2095673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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28
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Magno P, Giday SA, Dray X, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Kalloo AN, Pasricha PJ, White JJ, Assumpcao L, Marohn MR, Gabrielson KL, Kantsevoy SV. A new stapler-based full-thickness transgastric access closure: results from an animal pilot trial. Endoscopy 2007; 39:876-80. [PMID: 17968803 DOI: 10.1055/s-2007-966896] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Reliable closure of the transluminal incision is the crucial step for natural orifice transluminal endoscopic surgery (NOTES) procedures. The aim of this study was to evaluate the feasibility and effectiveness of transgastric access closure with a flexible stapling device in a porcine survival model. PATIENTS AND METHODS We carried out four experiments (two sterile and two nonsterile) on 50 kg pigs. The endoscope was passed through a gastrotomy made with a needle knife and an 18-mm controlled radial expansion dilating balloon. After peritoneoscopy, a flexible linear stapling device (NOLC60, Power Medical Interventions, Langhorne, Pennsylvania, USA) was perorally advanced over a guide wire into the stomach, positioned under endoscopic guidance, and opened to include the site of gastrotomy between its two arms; four rows of staples were fired. One animal was sacrificed 24 hours after the procedure (progression of pre-existing pneumonia). The remaining animals were survived for 1 week and then underwent repeat endoscopy and postmortem examination. RESULTS Peroral delivery and positioning of the stapling device involved some technical difficulties, mostly due to the short length (60 cm) of the stapling device. The stapler provided complete leak-resistant gastric closure in all pigs. None of the surviving animals had any clinical signs of infection. Necropsy demonstrated an intact staple line with full-thickness healing of the gastrotomy in all animals. Histologic examination confirmed healing, but also revealed intramural micro-abscesses within the gastric wall after nonsterile procedure. CONCLUSIONS Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its use for NOTES procedures.
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Affiliation(s)
- P Magno
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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29
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Abstract
Colosplenic fistula associated to splenic abscesses is a rare condition in Crohn's disease (CD). Diagnosis is difficult and a computed tomography (CT) scan is helpful. Treatment includes surgical procedure. Atypical locations of fistulas and abscesses should not be overlooked in CD.
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Affiliation(s)
- E Pappalardo
- Department of Digestive Diseases, APHP, Lariboisière University Hospital, Paris, France
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30
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Affiliation(s)
- X Dray
- Département de Pathologie Digestive, Hôpital Lariboisière, AP-HP, Paris 7 University, Paris, France.
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Dray X, Vahedi K, Delcey V, Lavergne-Slove A, Raskine L, Bergmann JF, Marteau P. Mycobacterium avium duodenal infection mimicking Whipple's disease in a patient with AIDS. Endoscopy 2007; 39 Suppl 1:E296-7. [PMID: 17957643 DOI: 10.1055/s-2007-966483] [Citation(s) in RCA: 7] [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]
Affiliation(s)
- X Dray
- Département de Pathologie Digestive, APHP, Hôpital Lariboisière, Université Paris 7, Paris, France.
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Abstract
Crohn's disease is a chronic, relapsing disease and none of the treatments developed so far can cure it. Artificial nutrition is effective to both treat malnutrition when present and induce remission. However, striking advances in anti-inflammatory and immunomodulating therapies (including infliximab) and low compliance to treatment in the first trials have limited its place in the management of adults to drug-resistant patients. Randomized controlled trials show that artificial nutrition is effective in >50% of the cases in this selected population. Significant progress has recently been made to improve the palatability (and thus acceptability) of some enteral solutions, which can be consumed by the oral route and as pharmaconutrition. We reviewed the literature on enteral nutrition in adults with Crohn's disease. We present herein the results of the studies performed with antioxidants, glutamine, short-chain fatty acids, prebiotics, probiotics, low microparticle diets, and a TGFbeta2 enriched formulation.
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Affiliation(s)
- X Dray
- Service d'Hépato-Gastroentérologie et Assistance Nutritive, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, France
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Mackowiak P, Lemoine M, Dray X, Lavergne-Slove A, Vahedi K. A Man with Periappendicular Ulcerations. Clin Infect Dis 2005. [DOI: 10.1086/432814] [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: 11/03/2022] Open
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Abstract
OBJECTIVE To determine the prevalence and clinical features of malnutrition and its relationship with the CFTR genotype in a cystic fibrosis (CF) adult population. DESIGN Cross-sectional study. SETTING Department of Pulmonology, Cochin Hospital, Paris, France. SUBJECTS 163 CF adults seen between 1997 and 1999. RESULTS Mean age was 28.8 y. Mean body mass index (BMI) was 19.1 kg/m2. Malnutrition (BMI<18.5 kg/m2) was seen in 81 patients (49.7%). Its severity was associated with diagnosis of CF before the age of 18 y (P<0.01), FEV1 values below 30% (P<0.01), the yearly decline of FEV1 (P<0.01), pancreatic insufficiency (P<0.01) and gastro-oesophageal reflux (P<0.01). Malnutrition was observed in 58.7% of patients with a severe CFTR genotype but in 28.6% of patients with a mild genotype (P<0.001). CONCLUSION Malnutrition remains frequent in adults with CF except in patients presenting with a mild CFTR genotype (leading to a mild phenotype and to later diagnosis).
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Affiliation(s)
- X Dray
- Service d'Hépato-Gastro-Entérologie, Hôpital Européen Georges Pompidou, Paris, France
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Dray X, Dray-Spira R, Bronstein JA, Mattera D. [Prevalences of HIV, hepatitis B and hepatitis C in blood donors in the Republic of Djibouti]. Med Trop (Mars) 2005; 65:39-42. [PMID: 15903075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Screening for hepatitis B (HBV) surface antigen (Ag HBs) and for antibodies to hepatitis C (HCV) and human: immunodeficiency virus (HIV) was carried out in 9006 volunteer blood donors at the National Blood Bank in the Republic of Djibouti from 1998 to 2000. Results demonstrated the presence of Ag HBs in 934 patients (10.4%), antibodies to HCV in 21 patients (0.3%), and antibodies to HIV in 175 patients (1.9%). In comparison with neighboring countries the prevalence of HBV, HCV, and HIV infection in Djibouti was low. These findings should be used to guide preventive action against these viral infections in the Republic of Djibouti. Estimations of HIV infection (11.7%) based on modeling by the World Health Organization should be reviewed.
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Affiliation(s)
- X Dray
- Service de Médecine Interne, du Centre National de Transfusion Sanguine de l'Hôpital Général Peltier, Djibouti, République de Djibouti
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Abstract
BACKGROUND Diet has been identified as a major determinant of colorectal cancer (CRC) but little is known of its influence on CRC survival. AIMS To study the influence of dietary factors on survival in patients who had undergone potentially curative CRC surgery. PATIENTS Among 171 patients included in a case control study of CRC aetiological factors, 10 year survival data on 148 patients who underwent resection of the tumour for potential cure were obtained from a Registry of Digestive Tumours. METHODS Tertiles of food and nutrient intakes were entered into Cox proportional hazards survival models, controlling for age, sex, tumour stage, and tumour location. RESULTS Only five year survival was influenced by the pre-diagnosis diet. High energy intake, as a result of high carbohydrate, protein, and lipid intake, was strongly related to increased survival. Five year relative risk of death for the highest versus the two lowest tertiles of energy intake was 0.18 (95% confidence interval 0.07; 0.44). This effect was similar in both sexes, for the colon and for the rectum. It was stronger in patients with N+/M+ tumours (relative risk 0.06) than in those with less advanced tumours (relative risk 0.37; stage-energy interaction term non-significant). No specific food or nutrient could be identified as having prognostic significance. CONCLUSIONS Whether high energy intake selects less severe tumoral clones or modifies antitumoral immunity remains unclear. Larger series need to be investigated before conducting intervention studies but our findings should prompt nutritional follow up in CRC patients.
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Affiliation(s)
- X Dray
- Institut Scientifique et Technique de l’Alimentation et de la Nutrition, INSERM U557, CNAM, 5 rue Vertbois, 75003 Paris, France
| | - M-C Boutron-Ruault
- Institut Scientifique et Technique de l’Alimentation et de la Nutrition, INSERM U557, CNAM, 5 rue Vertbois, 75003 Paris, France
| | - S Bertrais
- Institut Scientifique et Technique de l’Alimentation et de la Nutrition, INSERM U557, CNAM, 5 rue Vertbois, 75003 Paris, France
| | - D Sapinho
- Institut Scientifique et Technique de l’Alimentation et de la Nutrition, INSERM U557, CNAM, 5 rue Vertbois, 75003 Paris, France
| | - A-M Benhamiche-Bouvier
- Registre des Cancers Digestifs, Faculté de Médecine, 7 Bd Jeanne d’Arc, 21709 Dijon cedex, France
| | - J Faivre
- Registre des Cancers Digestifs, Faculté de Médecine, 7 Bd Jeanne d’Arc, 21709 Dijon cedex, France
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Dray X, Dray-Spira R, Mattera D, Bougere J, Garnotel E. [A cholera epidemic in Dijibouti (May 2000-January 2001)]. Med Trop (Mars) 2003; 62:497-502. [PMID: 12616941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The purpose of this report is to describe a cholera outbreak that occurred in the Republic of Djibouti from May 2000 to January 2001. Because the Somalian index cases involved were identified, this outbreak can be used as a model for imported epidemics. Development of the disease in the Djibouti City is promoted by a combination of poor living conditions and inadequate water supply. Unlike in previous epidemics in Djibouti, bacteriological study demonstrated the emergence of Vibrio cholerae strains presenting antibiotic resistance similar to that observed in Somalia. At the only facility available for cholera treatment in the country, 1920 patients were admitted and 36(1.9%) died. An epidemiological study of these patients demonstrated that females accounted for most cases in the 15-to-44-year age group (p < 0.0001) whereas males accounted for most cases in the age groups ranging from 0 to 1 year (p = 0.003) and 5 to 14 years (p = 0.002). These findings suggest that the mode of contamination and access to care vary according to sex and age.
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Affiliation(s)
- X Dray
- INSERM U88, Hôpital National de Saint-Maurice, 14 rue du Val d'Osne, 94410 Saint-Maurice
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Dray X, De Parades V, Lechaux JP, Hubert D, Marteau P. [Is cystic fibrosis an underreported cause of rectal prolapse in adults? ]. Gastroenterol Clin Biol 2001; 25:825-6. [PMID: 11598545] [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: 02/21/2023]
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Dray X, Tainturier MH, De La Lande P, Marty O, Mallet L. [Cirrhosis with non alcoholic steatohepatitis: role of tamoxifen]. Gastroenterol Clin Biol 2000; 24:1122-3. [PMID: 11139682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We report a case of non-alcoholic steatohepatitis with cirrhosis in a woman receiving tamoxifen as adjuvant treatment for breast cancer. Despite the presence of other risk factors for non-alcoholic steatohepatitis (such as diabetes, obesity and hyperlipidemia), the patient developed non-alcoholic steatohepatitis and cirrhosis only after tamoxifen was started. We suggest that patients receiving tamoxifen, especially patients with predisposing metabolic disorders, should be evaluated for non-alcoholic steatohepatitis, because progression to cirrhosis may occur.
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Affiliation(s)
- X Dray
- Service de Gastroentérologie, Proctologie et Médecine Interne, Fondation Hôpital Saint-Joseph, Paris
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Dray X, Zinzindohoué F, Cuillerier E, Cugnenc PH, Barbier JP, Marteau P. [Acute pancreatitis revealing cystic fibrosis in an adult]. Gastroenterol Clin Biol 1999; 23:974-7. [PMID: 10533146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We report a case of pancreatitis as the first symptom of cystic fibrosis in a 22-year-old woman. The diagnosis was suspected upon the history of nasal polyposis and severe episodes of respiratory infections in infancy. The diagnosis was confirmed by sweat test. Genotyping showed a compound heterozygosity for mutations delta F508 and 5T. Acute pancreatitis is a rare manifestation of cystic fibrosis and an exceptional mode of initial presentation of the disease. It occurs in pancreatic sufficient patients, especially in young adults. This exceptional case shows that cystic fibrosis should be suspected in each case of idiopathic pancreatitis. Indications of cholecystectomy in patients with associated gallbladder lithiasis is discussed.
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Affiliation(s)
- X Dray
- Service d'Hépato-Gastroentérologie, Hôpital Georges-Pompidou, Paris
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