Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage.

BACKGROUND: Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage. METHODS: This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage. RESULTS: Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3 years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed. CONCLUSION: EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn's Disease.

BACKGROUND AND AIMS: Length of diagnostic delay is associated with bowel strictures and intestinal surgery in adult patients with Crohn's disease [CD]. Here we assessed whether diagnostic delay similarly impacts on the natural history of paediatric CD patients. METHODS: Data from the Swiss IBD Cohort Study were analysed. Frequency of CD-related complications [bowel stenosis, perianal fistula, internal fistula, any fistula, resection surgery, fistula/abscess surgery, any complication] at diagnosis and in the long term [up to 30 years after CD diagnosis] was compared between paediatric patients [diagnosed <18 years] and adult patients [diagnosed ≥18 years] using multivariate Cox proportional hazard regression modelling. RESULTS: From 2006 to 2016, 387 paediatric and 1163 adult CD patients were included. Median [interquartile range: IQR] diagnostic delay was 3 [1-9] for the paediatric and 6 [1-24] months for the adult group, respectively. Adult onset CD patients presented at diagnosis more frequently with bowel stenosis [p <0.001] and bowel surgery [p <0.001] compared with paediatric CD patients. In the long term, length of diagnostic delay was significantly associated with bowel stenosis [p = 0.001], internal fistula [p = 0.038], and any complication [p = 0.024] in the adult onset CD population. No significant association between length of diagnostic delay and CD-related outcomes in the long term was observed in the paediatric population. CONCLUSIONS: Adult CD patients have longer diagnostic delay compared with paediatric CD patients and present at diagnosis more often with bowel stenosis and surgery. Length of diagnostic delay was found to be predictive for CD-related complications only in the adult but not in the paediatric CD population.

[Endoscopic ultrasound - guided biliary and pancreatic drainage: an update]. / Drainage des voies biliaires et du pancréas par échographie endoscopique : actualités.

Endosonography is an effective diagnostic procedure for intraluminal, parietal and extradigestive pathologies with superior resolution compared to other imaging modalities. The evolution of this technique permits targeted biopsies and offers new therapeutic approaches, initially for the drainage of abdominal collections, and now also for the drainage of bile ducts and the pancreas. These procedures offer a wide range of minimal invasive curative or palliative therapeutic options. The safety profile of these procedures is good and equivalent to a percutaneous approach. They provide a greater comfort and are associated with lower overall cost.

L'échographie endoscopique est une méthode reconnue et efficace dans le processus diagnostique des pathologies digestives intraluminales, pariétales et extradigestives, avec une résolution inégalée par rapport aux autres modalités d'imagerie. L'évolution de cette technique a non seulement permis de faire des biopsies ciblées, mais a aussi offert de nouveaux abords thérapeutiques tels que le drainage des collections abdominales puis des voies biliaires et du pancréas. Ces procédures ont l'avantage d'offrir un large panel d'options thérapeutiques grâce à de nombreuses possibilités d'abord, avec un caractère minimalement invasif. Le profil de sécurité de ces interventions est bon, équivalent à un abord percutané, et présente l'avantage d'un confort supérieur pour les patients, à un coût global inférieur.

[Functional gastrointestinal disorders: update on the Rome IV criteria]. / Maladies fonctionnelles digestives: mise au point concernant la classification Rome IV.

Functional gastrointestinal disorders are highly prevalent worldwide and may have an important impact on the quality of life of affected patients. In addition, they are associated with a major socio-economic impact. In 2016 the Rome IV criteria were published that provided an update of the 2006 published Rome III criteria for functional gastrointestinal disorders. This article provides an overview of the current classification of functional gastrointestinal disorders and highlights the most important changes incorporated into the Rome IV criteria.

Les maladies fonctionnelles digestives représentent des entités fréquentes dans la pratique clinique du gastroentérologue. Elles sont associées à une baisse de la qualité de vie des patients concernés et ont un impact socio-économique important. Les critères du groupe de travail de Rome permettent de les classifier selon l'atteinte principale et le symptôme prédominant. Cet article résume les changements les plus importants dans les critères diagnostiques Rome IV qui ont été publiés en 2016.

Angiotensin Converting Enzyme Inhibitor-related Angioedema: A Case of an Unexpected Death.

Angioedema is an asymmetric non-pitting oedema on face, lips, tongue and mucous membranes; any delay in diagnosis and treatment can be fatal. Treatment with lisinopril as an angiotensin converting enzyme (ACE) inhibitor, can be a reason of angioedema. Here we report a case who developed oral-facial edema four years after using lisinopril/hydrochlorothiazide. Laryngeal oedema is a main cause of death in angioedema. The treatment of choice in angioedema including fresh frozen plasma, C1 inhibitor concentrations and BRK-2 antagonists (bradykinin B2 receptor antagonists) were used. In this case; a 77 years old female patient suffering from hypertension was considered. This patient was suffering two days from swelling on her face and neck. Non- allergic angioedema was distinguished in five major forms; acquired (AAO), hereditary (HAE), renin-angiotensin-aldosterone system (RAAS) blocker-dependent, pseudoallergic angioedema (PAS) and an idiopathic angioedema (IAO). She was admitted to our clinic with the diagnosis of hereditary angioedema. Patient had skin edema and life threatening laryngeal edema. In emergency department treatment was started using intravenous methylprednisolone, diphenydramine as well as inhaled and subcutaneous epinephrine simultaneously. Despite the initial treatment, the patient died due to the insufficient respiration and cardiac arrest. The patient has no history of kidney disease.