Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members.

BACKGROUND/AIMS: Sedation rates may vary among countries, depending on patients' and endoscopists' preferences. The aim of this survey was to investigate the rate of using premedication for routine diagnostic upper gastrointestinal (UGI) endoscopy in endoscopy societies, members of the European Society of Gastrointestinal Endoscopy (ESGE). METHODS: We evaluated a multiple-choice questionnaire which was e-mailed to representatives of national endoscopy societies, which are members of the ESGE. The questionnaire had 14 items referring to endoscopy practices in each country and the representatives' endoscopy units. RESULTS: The response rate was 76% (34/45). In 47% of the countries, less than 25% of patients undergo routine diagnostic UGI endoscopy with conscious sedation. In 62% of the responders' endoscopy units, patients are not asked their preference for sedation and do not sign a consent form (59%). Common sedatives in use are midazolam (82%), diazepam (38%) or propofol (47%). Monitoring equipment is not available 'in most of the endoscopy units' in 46% (13/28) of the countries. Though they were available in 91% of the national representatives' endoscopy units, they are rarely (21%) used to monitor unsedated routine diagnostic UGI endoscopy. CONCLUSIONS: In about 50% of ESGE-related countries, less than 25% of patients are sedated for routine diagnostic UGI endoscopy. Major issues to improve include availability of monitoring equipment and the use of a consent form.

[Primary digestive tract Kaposi sarcoma with idiopathic CD4+ lymphocytopenia, HIV negative, HHV8 positive]. / Sarcome de Kaposi digestif primitif avec lymphocytopénie CD4 idiopathique, VIH négatif, HHV8 positif.

A 52-year-old Tunisian patient had fever, impaired health and several opportunistic infections (Campylobacter jejuni, Mycobacterium hominis, Herpes virus, Giardia intestinalis, Vibrio metschnikovii). Lymphocytopenia was noted (348/mm3; CD4+: 2.2%; CD4+/CD8+: 0.1). Polymerase chain rection search for HIV was negative in serum and in tumor tissue. Diagnosis of primary digestive Kaposi sarcoma was established at autopsy due to the deep location of the lesions. There was an ulcerofungating tumor spreading over 1.3 m of the duodenojejunum. This is the fourth reported case of CD4+ lymphocytopenia, a new and very rare immunodeficiency syndrome recently defined by the Centers for Disease Control. We detected human herpes virus 8 by immunohistochemistry of tumor tissue. Human herpes virus 8 is implicated in the pathogenesis of Kaposi sarcoma.

Gastric MALT lymphoma. A clinico-pathological study of 65 cases. Relationship to Helicobacter pylori.

We report 65 cases of MALT gastric lymphomas. HP was looked for with Giemsa and Whartin Starry stains. Immunohistochemistry was done with PAP method. Anti-HP treatment was used in 9 cases. 38 were of low grade of malignancy, 23 were high grade, 4 were high grade with a low grade component. The mean age was 51.5 years, the sex ratio 1.5. Epigastric pain was the most frequent feature (87.7% of cases). Endoscopically, low grade lymphomas presented as unique or multiple ulcerations (55.3% of cases) with antral localisation (52.6% of cases). 60% of our patients were stage IE, of which 61% had low grade lymphoma, 18% were at stage II2E, 10% at stage III and 10% at stage IV. From 23 operated patients, 29% had early lymphoma which was low grade malignant in 71.5% of cases, and 71% had lymphomas which were widely spread beyond the submucosa. HP was found in 63% of cases. Histologic regression of two early lymphomas of low grade malignancy was achieved after HP eradication.

[Detection of Epstein-Barr virus in Malt type gastric malignant lymphoma using in situ hybridization]. / Recherche du virus d'Epstein Barr dans les lymphomes malins de type Malt gastriques par hybridation in situ.

The aim of our study was to look for Epstein Barr virus (EBV) genome by in situ hybridization in 23 MALT gastric lymphomas. 15 cases were of low grade, and 8 were of high grade malignancy. We obtained a positive result in 3 cases (13%) of low grade lymphomas. EBV was present in few centrocyte-like and centroblastic cells. Literature review shows an EBV infection rate varying between 8 and 12% with variables results which don't allow strong and reliable conclusion. An etiopathogenic role for EBV in Malt gastric lymphoma remain yet hypothetic.

[A prospective histologic and immunohistochemical study of the liver in blood donors who are asymptomatic chronic carriers of HBs antigens. Apropos of 34 cases]. / Etude histologique et immuno-histochimique prospective du foie chez des donneurs de sang porteurs chroniques asymptomatiques de l'antigène HBs. A propos de 34 cas.

The authors report a prospective study of 34 chronic HBs Ag carriers detected among a cohort of 9029 blood donors. Liver biopsy performed in all cases revealed a normal liver in 5 cases (14.7%), non-specific lesions in the form of fatty infiltration or mild portal inflammation in 3 cases (8.8%), chronic persistent hepatitis (CPH) in 21 cases (61.7%) (mild in 19 and moderate in 2) and chronic active hepatitis (CAH) in 5 cases (14.6%) (mild in 1 and moderate in 4). Liver function tests were abnormal in 28.8% of patients with CPH and 20% of those with CAH. Histologic activity index was calculated and was more than 6 in 40% of CAH and 6 or less in CPH and non-specific lesions. Immunohistochemical study revealed cytoplasmic labelling for HBs Ag in 82.4 per cent of cases and nuclear labelling for HBc Ag in 11.4% of cases with a heterogeneous and non-regular pattern affecting all or part of the cytoplasm, single or clusters of hepatocytes or even sheets of hepatocytes.

[Value of immunohistochemistry with paraffin in malignant lymphoma of the lymphoid tissue associated to the mucosa (MALT) of the digestive tract. Apropos of 8 cases with complete review of the literature]. / Apport de l'immunohistochimie en paraffine dans les lymphomes malins du tissu lymphoïde associé aux muqueuses (MALT) de l'appareil digestif. A propos de huit observations avec revue complète de la littérature.

The authors report eight cases of MALT malignant lymphomas arising in the stomach in four cases, small intestine in two cases and salivary glands in two cases. The gastric lymphomas presented in the form of persistent epigastric pain sometimes lasting for several years, in patients with a mean age of 50.5 years. Gastroscopy revealed recurrent ulcerations in two cases and ulcerated or ulcero-fungating tumours in two cases. The two patients with alpha heavy chain disease, both 21 years of age, presented with chronic diarrhoea. The endoscopic appearance consisted of a pseudopolypoid tumour in one case and a mosaic appearance in the other case. The two salivary gland lymphomas involved the submandibular gland in two patients aged 30 years and 50 years. They presented in the form of nodules 1 and 2 cm in diameter, first detected by the patients two months and four months previously. Histological examination demonstrated the presence of typical lesions of MALT lymphoma with, in particular, the presence of constant lympho-epithelial lesions, various forms of centrocyte-like proliferation, varying degrees of plasma cell differentiation, reactive or residual lymphoid follicles in five cases, which were detected on biopsies in three cases. Immunohistochemistry confirmed the monoclonal nature of the tumour in seven cases, i.e. 87.5% of cases. The application of DBB42 and DNA7 antibodies onto paraffin sections demonstrated the absence of DNA7 labelling of CCL in line with Isaacson's findings in favour of the hypothesis of a non-centrofollicular origin of maltomas. Finally, we observed a single case of recurrence in a women with incomplete resection of the primary gastric tumour.

[Malt digestive system lymphomas and alpha heavy chain diseases. Histological and immunohistochemical study. Apropos of 3 cases]. / Lymphomes digestifs de type malt et maladies des chaînes lourdes alpha. Etude histologique et immunohistochimique. A propos de trois observations.

Malt lymphomas are lymphomas developed from mucosa associated lymphoid tissue and may involve many sites such as the gastrointestinal tract, salivary glands, thyroid gland lung, breast and female genital tract. Histologically, their diagnosis is based upon the existence of four elements: centrocyte-like cells that are responsible for lymphoepithelial lesions that are sometimes very difficult to demonstrate reactive or residual follicles and plasma cells. We study 2 cases of gastric Malt lymphoma and one of alpha heavy chain disease involving the small intestine and the stomach and we try to define the common features of Malt lymphoma, alpha chain disease and non-secretary IPSID, which all present the clinical tetralogy mentioned above.