[Management of complicated Barrett's esophagus. Observational study carried out in a regional hospital]. / Prise en charge de l'œsophage de Barrett compliqué. Étude observationnelle réalisée dans un centre hospitalier régional.

The incidence of Barrett's esophagus, complication of gastroesophageal reflux disease, is rising in western countries. It is the same for esophageal adenocarcinoma, of which it is the main contributing factor. This retrospective study seeks to report the incidence of these pathologies observed in a regional hospital center and to describe their management. In 5 years, 354 Barrett's esophagus are detected and 34 of them are complicated by high-grade dysplasia or adenocarcinoma. Endoscopic resection is performed in 24 of these patients. The histological analysis of which leads to the conclusion of adenocarcinoma in 20 patients and high-grade dysplasia in the 14 others. The complications of endoscopic and surgical resections are detailed. Their frequency and severity remain low, comparable to data in the literature.

L'incidence de l'œsophage de Barrett, complication du reflux gastro-œsophagien, est en croissance dans les pays occidentaux. Il en est de même de l'adénocarcinome œsophagien dont il est le principal facteur favorisant. Cette étude rétrospective s'attache à rapporter l'incidence de ces pathologies, observées dans un centre hospitalier régional, et à détailler leur prise en charge. En 5 ans, 354 œsophages de Barrett sont détectés et 34 d'entre eux sont compliqués de dysplasie de haut grade ou d'adénocarcinome. Une résection endoscopique est réalisée chez 24 de ces malades. Les analyses histologiques permettent de conclure à un adénocarcinome chez 20 malades et une dysplasie de haut grade chez les 14 restants. Les complications des résections endoscopiques et chirurgicales sont détaillées. Leur fréquence et leur gravité restent faibles, comparables aux données de la littérature.

[Efficacy of macro-clips for perforations and fistulas following endoscopic or surgical procedures. Retrospective analysis of 25 consecutive cases]. / Les macro-clips utilisés dans la suture endoscopique des perforations et fistules compliquant des procédures chirurgicales et endoscopiques Résultats d'une étude monocentrique, rétrospective des 25 premiers cas.

OBJECTIVE: The aim of our retrospective study is to analyse the results of endoscopic macro-clips used for closing intestinal breaches in the real life. Post-endoscopic, spontaneous perforations and surgical fistulas are included. Our results are compared with principal published series. METHODS: Between 2010 and 2015, 25 consecutive patients underwent an endoscopic suture with macro-clips to seal a breach resulting from endoscopic perforation, surgical fistula, invasive medical procedure or spontaneous perforation. RESULTS: The endoscopic efficacy was immediate for all patients whose perforation was of endoscopic aetiology. None of them required surgery. Secondary complementary endoscopic treatment was only used in 6/25 patients. All of them had non-endoscopic aetiology for their perforation. The survival at 1 month was 84 % and at 3 months of 76 %. CONCLUSION: Our results confirm the high efficiency of macro-clips in the treatment of endoscopic breaches in a regional hospital center. The use of macro-clips seems less convincing for the closure of some postoperative fistula. The suture with macro-clips associated with endoscopic and medical treatments allowed to avoid surgical redo in some cases.

Objectifs : Le but de notre étude est d'analyser rétrospectivement les résultats obtenus en utilisant les macro-clips pour réaliser des sutures endoscopiques dans la vie réelle. Les perforations spontanées, postendoscopiques et post-chirurgicales sont incluses. Nos résultats sont comparés à ceux des principales séries publiées. Méthodes : Entre 2010 et 2015, 25 patients consécutifs ont bénéficié d'une suture endoscopique à l'aide de macro-clips utilisés pour fermer des larges brèches transmurales apparues après procédures endoscopiques, procédures chirurgicales ou invasives et, également, lors d'une perforation spontanée. Résultats : La fermeture endoscopique a été immédiate chez tous les patients dont la perforation avait pour origine une procédure endoscopique. Aucun de ces patients n'a requis d'intervention chirurgicale. Un second traitement endoscopique, complémentaire, a été réalisé chez 6/25 patients pour lesquels l'origine de la perforation n'était pas endoscopique. La survie globale à 1 mois était de 84 % et à 3 mois de 76 %. Conclusion : Nos résultats confirment l'efficacité remarquable des macro-clips dans le traitement des perforations endoscopiques rencontrées dans un centre hospitalier régional. Leurs résultats sont moins convaincants lorsqu'ils sont utilisés dans la fermeture des fistules post-chirurgicales. Ces macro-clips, utilisés dans une stratégie associant des traitements médicaux, radiologiques et endoscopiques complémentaires, permettent de réduire le recours à la reprise chirurgicale à de très rares cas.

[Incidence and treatment of complications observed after endoscopic mucosal resection of superficial digestive tumours in a regional general hospital]. / Incidence et traitement des complications observées après résections endoscopiques muqueuses des tumeurs digestives superficielles dans un Centre Hospitalier Régional.

Superficial digestive tumours resection by endoscopic mucosal resection and sub-mucosal dissection causes very few complications according to the results obtained in expert centers. This work reports the rate of complications observed in a regional hospital, also comparing the results of their therapeutic management. The first 100 patients treated by endoscopic mucosal resection and sub-mucosal dissection, conducted by conventional techniques, were studied. The usual complications (stenosis, bleeding, perforation) were identified and details of their treatment reported. The overall complication rate was 16 %. Symptomatic stenoses are observed in 4 % of patients. Secondary bleeding occurs in 5 % of cases. Endoscopic management of these complications is effective in all cases, when it is attempted. Perforations complicate 7 % of the procedures. Two patients were assigned to surgery, successfully, the other 5 patients were treated by endoscopic sutures without damage. The complication rates observed in our department are comparable with results reported by the reference western centers. Their endoscopic management is usually successful and rescue surgery is unfrequent.

La résection par mucosectomie et dissection sous-muqueuse des tumeurs digestives superficielles n'entraîne que très peu de complications selon les résultats obtenus dans les centres experts. Ce travail rapporte le taux de complications observé dans un centre hospitalier régional, comparant également les résultats de leur prise en charge. Les 100 premiers patients ayant été traités par mucosectomie et dissection sous-muqueuse, effectuées selon les techniques classiques, ont été étudiés. Les complications habituelles (sténoses, hémorragies et perforations) ont été répertoriées ainsi que les détails de leur traitement. Le taux global de complications est de 16 %. Les sténoses symptomatiques affectent 4 % des patients. Les hémorragies secondaires surviennent dans 5 % des cas. La prise en charge endoscopique de ces complications est efficace dans tous les cas, lorsqu'elle est tentée. Les perforations compliquent 7 % des procédures. Deux patients ont été confiés à la chirurgie, avec succès, les 5 autres patients ont été traités par sutures endoscopiques sans séquelle. Le taux de complications observé dans notre service est comparable aux résultats rapportés par les centres occidentaux de référence. Leur prise en charge endoscopique est régulièrement efficace et le recours à la chirurgie est peu fréquent.

[Clinical case of the month. Liver transplantation for hepatic epithelioid hemangioendothelioma]. / Transplantation hépatique pour un hémangio-endothéliome épithélioïde du foie.

The epithelioid hemangioendothelioma is a rare malignant vascular lesion that may occur within the liver. In the hepatic multifocal and bilobar forms, liver transplantation is indicated as the curative management. In this case report, the authors describe the diagnosis and the management of a 52-year-old woman who was diagnosed with hepatic epithelioid hemangioendothelioma and who underwent successful liver transplantation.

Mitigating the burden of hepatitis C virus among people who inject drugs in Belgium.

BACKGROUD AND AIMS: In 2010, there were an estimated 10 100 PWID in Belgium and 43% (34%-57%) were HCV infected. Understanding HCV transmission dynamics in high-risk populations and assessing the potential impact of improved HCV treatment strategies requires robust epidemiological data and mathematical modeling. METHODS: CV transmission was modeled using cohorts to track HCV incidence and prevalence among active PWID in the general PWID population, OST and NSP. Model assumptions were derived from published literature and expert consensus. The relative impact of increasing the number of PWID treated with new oral DAAs was considered. RESULTS: If the current transmission paradigm continues, there will be 2645 HCV-infected PWID in 2030. Annually treating 30 (1% of 2015 population) or 120 (4% of 2015 population) HCV-infected PWID with oral DAAs will result in 5% and 25% reductions, respectively, in HCV-infected PWID by 2030. Treating 370 PWID annually (12.5% of 2015 population) will result in a > 90% reduction by 2030. CONCLUSION: Treating a small number of PWID can result in substantial reduction in HCV prevalence in this population ; however, high levels of treatment are necessary to reduce the viral pool and thus the risk of secondary infections. This analysis supports implementation of a screening and treatment strategy among PWID when combined with an expansion of harm reduction programs.

Hepatic granulomas following liver transplantation. Clinicopathologic features in 42 patients.

Liver granulomas have long been known to pose diagnostic problems for pathologists; however, their prevalence and associated etiologic factors have not been studied in liver transplant patients. We reviewed 3632 liver biopsy specimens from 563 patients at two institutions and identified 42 patients with posttransplant granulomas. A possible or probable etiologic factor was identified in 30 (71%) cases. Most were epithelioid granulomas and microgranulomas located in the parenchyma associated with hepatocyte necrosis (21 cases, 50%). Portal-based granulomas were associated with recurrent primary biliary cirrhosis (5 cases, 12%), acute cellular rejection (2 cases, 4.8%), and a foreign body-type reaction (1 case, 2.4%). One case was associated with tuberculosis (2.4%), 4 cases occurred in a fatty liver (9.5%), and 8 patients had liver granulomas but no other significant abnormality. The granulomas were most frequent in the first 7 months after transplantation when the patients were biopsied more often and underwent episodes of rejection or acute hepatitis. Portal-based granulomas in this period were usually associated with acute cellular rejection. After 7 months, the frequency of granulomas as well as the number of biopsies decreased and portal-based granulomas associated with recurrent primary biliary cirrhosis were most common (5 cases, 12%). Rare, late-appearing parenchymal granulomas were also seen (3 cases) and consisted of 1 lipogranuloma and 2 cases of epithelioid granuloma. The latter were thought, in 1 patient, to be associated with parenchymal hepatocyte necrosis; the others were of unknown etiology.

[Risk of contamination by hepatitis C of endoscopes utilized in gastroenterology hospital service]. / Risques de contamination par le virus de l'hépatite C des endoscopes utilisés dans un service hospitalier de gastroentérologie.

UNLABELLED: Transmission of hepatitis C virus by gastrointestinal endoscopy has been suggested especially therapeutic procedures. The aim of this study was to investigate the frequency of contamination of the endoscopes by hepatitis C virus and to assess the efficacy of a semi-automatic disinfection procedure. METHODS: In 19 patients with chronic replicative hepatitis C, upper gastrointestinal endoscopy with different invasive procedures was performed. Cleaning and disinfection were carried out according to the recommendation of the belgian "Conseil Supérieur de l'Hygiène": cleaning with detergent solution, rinsing, disinfection with a disinfectant solution for 10 minutes and again rinsing. Before the procedure (T0), a blood sample was collected to detect the presence of hepatitis C virus RNA. Immediately after the endoscopic procedure, the operating channel of the endoscope was flushed with water and was sterilely collected (T1); after cleaning (T2) and after disinfection (T3, T3EC), the same procedure was repeated. The collected samples were analysed by PCR in order to detect hepatitis C virus RNA. RESULTS: All the samples were positive at T0. Virus C RNA was found in 10 out the 19 patients at T1 (53%). The results were negative in all the samples both after cleaning (T2) and disinfection (T3-T3 EC). CONCLUSIONS: Our study confirmed the presence of hepatitis C virus in the operating channel after invasive upper gastrointestinal endoscopy. The contamination rate of the endoscope is high. Our cleaning and disinfection procedure seems to be effective in regard of hepatitis C virus RNA clearance.

A non-interventional phase IV Belgian survey to assess the antiviral effectiveness of pegylated interferon-alpha-2b and ribavirin treatment according to the stage of liver fibrosis in previously untreated patients with genotype 1/4/5/6 chronic hepatitis C (PRACTICE).

BACKGROUND AND STUDY AIMS: This was an observational, non-interventional, multicenter, phase IV study, in patients with genotype 1/4/5/6 chronic hepatitis C (CHC). The primary objectives were to evaluate SVR in patients with no or minimal fibrosis (METAVIR F0-F1) versus well established fibrosis (F2-F4), and to estimate response on Weeks 12, 24 and 48 on treatment in previously untreated patients with genotypes 1/4/5/6 CHC. PATIENTS AND METHODS: 538 patients treated with pegylated interferon alfa 2b 1.5 mcg/kg in combination with ribavirin 800-1200 mg/day were enrolled in 55 sites in Belgium and Luxembourg, 505 being considered for the analysis. 40% of the patients were female and 60% male, the average age was 47.5 years, 10.5% were 65 or older. RESULTS: SVR was observed in 35% of the patients, EVR in 68%, of which pEVR in 33% and cEVR in 35%. SVR was observed in 43% of the low fibrosis group (F0, F1) and 30% of the high fibrosis group (F2, F3, F4) (p = 0.005). SVR rates were 34% for genotype 1, 37% for genotype 4, and 47% for genotype 5 (NS). Multivariate analysis showed that EVR and baseline METAVIR score are independent prognostic factors for SVR. CONCLUSIONS: This trial confirms that fibrosis stage and early viral response are the most important key-factors to predict sustained response, suggesting that the earlier patients are treated, the better the outcome. Non-invasive techniques enable us to closely monitor progression of fibrosis, allowing a better selection of patients for antiviral treatment in the DAA-era.