Survey on Clinical Practice of Primary Prophylaxis in Portal Hypertension in Children.

Primary prophylaxis in portal hypertension in children is controversial, because there are few studies documenting its efficacy on the risk of bleeding. Twenty-eight centres out of the 38 we contacted returned a completed questionnaire about their clinical practices. More than 75% of the centres use endoscopy to screen patients diagnosed with portal cavernoma, biliary atresia, cystic fibrosis, and other fibrotic chronic liver diseases with suspected portal hypertension. In cases of grade 2 varices with red marks and grade 3 varices >90% of centres perform sclerotherapy or endoscopic variceal ligation. Noncardioselective beta-blockers were used by approximately 20% of centres. In conclusion, despite the absence of scientific recommendations there is a tacit consensus concerning the need to screen children with clinical signs of portal hypertension, and to provide primary prophylaxis in cases of endoscopic patterns of high-risk varices.

Short-term results of 42 endoscopic ampullectomies: a single-center experience.

OBJECTIVE: Benign lesions of the major papilla are rare but raise the problem of their medical care. We studied the efficacy, safety, and histology of the endoscopic ampullectomy. PATIENTS AND METHODS: Forty-two endoscopic resections of the major papilla were undertaken in 23 males and 19 females of a mean age of 63. Five patients (12%) presented with a familial adenomatous polyposis. The assessment of resectability included preoperative histology, and endoscopic ultrasound (EUS) in 26 patients (62%) always showing intra-mucosal lesion. The resection was performed with a duodenoscope, using a diathermic loop with a pure current section. RESULTS: The resection was realized in one piece for 34 patients, in 2-4 fragments for 8 patients. A plastic pancreatic stent was inserted in 26 patients (62%), a plastic biliary stent in 10 patients (24%). There were no deaths but nine complications (21%): six acute pancreatitis (four patients with a pancreatic stent, contrary to the literature), three delayed gastrointestinal bleeding. The final histological result was fibrosis and inflammatory tissue in 7 patients, low-grade dysplasia in 20 patients, high-grade dysplasia or in situ carcinoma in 10 patients, invasive adenocarcinoma in 1 patient, and somatostatinoma in 2 patients (concordance of 72% with the initial histology). The resection was complete in 39 patients (93%). Three patients had additional surgery because of positive margin of resection or bad histology criteria. The median of follow-up in 33 patients with a complete resection was of 15 months, and we did not note any recurrence in 29 patients (88%). CONCLUSION: Endoscopic ampullectomy is an efficient treatment for superficial lesions of the papilla, despite a significant but rarely severe morbidity. Preoperative EUS is mandatory, preoperative histology is advisable. Long-term follow-up is necessary.

Three cases of severe ulcerative esophagitis induced by SUTENT®.

INTRODUCTION: The development of SUTENT® revolutionized the care of metastatic renal carcinoma and of non-operable GIST. The tolerance is quite good with mostly mild side effects grade 1 or 2. OBSERVATION: We report the case of three severe esophagitis stage 4 responsible for digestive bleeding. Two patients were taking anti-coagulant that could worsen the bleeding, but none were taking either antiplatelet or non-steroidal anti-inflammatory or corticosteroid that could favour erosion or ulceration of the digestive mucosa. It seems that SUTENT® is responsible for the digestive bleeding. DISCUSSION: Cases of esophagitis induced by SUTENT® have already been reported but are rare and of mild severity. Our three cases of esophagitis are severe with SUTENT® treatment as only risk factor and worsened by anti-coagulant treatment for two patients. It might be of interest preventively to treat these patients with inhibitors of proton pump.