Evaluation of the efficacy of octreotide LAR in the treatment of Crohn's disease associated refractory diarrhea.

OBJECTIVES: Diarrhea is one of the main symptoms of Crohn's disease (CD). It is usually significantly improved with specific CD treatments, loperamide or cholestyramine. However, in some cases, diarrhea becomes refractory. The aim of this study was to assess the safety and efficacy of octreotide in this situation. MATERIALS AND METHODS: Fifteen patients with CD refractory diarrhea defined by at least an average of five smooth or liquid stools per day despite an optimized CD treatment were included from three Belgian centers. Two patients were lost to follow-up. A subcutaneous injection of 100 µg octreotide was performed three times a day during three days. When the drug had been well tolerated, an intramuscular injection of 30 mg octreotide (Sandostatin® LAR 30) was realized. Evaluation was done at day 31. The primary endpoint was to assess the effect on the mean number of smooth or liquid stools per day. RESULTS: A significant reduction (p = 0.0001) of the average number of smooth or liquid stools over the last seven days was observed between baseline and day 31. The maximum number of smooth or liquid stools also significantly decreased (p = 0.0009). Four patients (26.7%) presented mild nonspecific adverse events but no serious one. We also observed a significant decrease (p = 0.0006) of the Harvey-Bradshaw Index (HBI) and a significant improvement (p = 0.0012) of the inflammatory bowel disease questionnaire (IBDQ). CONCLUSIONS: In this uncontrolled open-label study, octreotide appeared safe and effective in CD refractory diarrhea, in addition to CD treatments. It significantly improved the number of liquid or smooth stools, the HBI and the IBDQ.

First-time use of a porcine small intestine submucosal plug device to close an acquired tracheo-esophageal fistula.

BACKGROUND: Acquired tracheo-esophageal fistula (TEF) is a rare, life-threatening pathology, responsible for severe comorbidities. Its management is a real therapeutic challenge and remains controversial. CASE PRESENTATION: We report the first case of endoscopic treatment of TEF by using a porcine small intestine submucosal (SIS) plug device in a young quadriplegic patient after failed surgical closure by cervicotomy. After 1 year of follow-up, oral feeding of the patient was resumed and no clinical signs of fistula recurrence were evident. CONCLUSION: To our knowledge, we obtained for the first time, a satisfactory result for TEF closure with the use of a porcine SIS plug.

[Pseudopapillary tumor of the pancreas revealed by rupture of esophageal and gastric varices secondary to biliary cirrhosis due to bile duct compression]. / Tumeur pseudo-papillaire pancréatique révélée par la rupture de varices oeso-gastriques secondaire à une cirrhose biliaire par une compression cholédocienne.

Pseudo-papillary tumors of the pancreas are rare and usually occur in young women. We report a case with a very rare presentation (rupture of esogastric varices complicating biliary cirrhosis secondary to bile duct compression by a pancreatic tumor). After biological and radiological explorations, a duodenopancreatectomy was performed. Diagnosis was confirmed by conventional histology and immunohistochemistry. One year later, the patient remained asymptomatic.

Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation.

We report on two cases of type I glycogen storage disease (GSD) complicated by malignant tumors. A 23-year-old man had GSD Ia with adenomatosis. He underwent transplantation for rapidly growing and radiologically changing adenomata. At histological examination, one adenoma had become a hepatocellular carcinoma. A 22-year-old, HBV-infected woman had GSD type Ib with adenomatosis. At follow-up, several tumors showed changing morphological characteristics. Pre-transplant laparotomy confirmed the presence of a metastatic cholangiocarcinoma. Liver transplantation should be considered in GSD type I patients with adenomatosis, especially when tumor characteristics change. Regular detailed Doppler ultrasound and magnetic nuclear resonance screening during childhood and adolescence are, therefore, mandatory in order for the timing of transplantation to be optimized.