Outcome of endoscopic vacuum therapy for duodenal perforation.

BACKGROUND: Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. METHODS: We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. RESULTS: Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT was used as a first-line treatment in seven patients and as a second-line treatment in three patients. EVT was successfully applied in all interventions (n = 10, 100%). Overall, EVT lead to definitive closure of the defects in eight out of ten patients (80%). No severe EVT-related adverse events occurred. CONCLUSION: EVT is safe and technically feasible, so it emerges as a promising endoscopic treatment option for duodenal leaks. However, multidisciplinary collaboration and management are important to reduce the occurrence of postoperative complications, and to improve recovery rates.

[Screening for preneoplastic lesions of the upper gastrointestinal tract]. / Dépistage des lésions prénéoplasiques du tube digestif haut.

Preneoplastic lesions of the esophagus and stomach are cellular abnormalities that have the potential to develop into cancer over time. They are detected during endoscopy and can be classified according to their specific cellular characteristics. Their treatment depends on the severity of the lesion and the individual factors of each patient. Treatment options may include regular endoscopic monitoring, treatment to reduce the risk of progression to cancer (anti-reflux therapy, antibiotics for H. pylori eradication), or endoscopic removal of the lesion. It is important to discuss any concerns about these lesions with a gastroenterologist and to follow recommendations for proper screening and treatment.

Les lésions prénéoplasiques de l'œsophage et de l'estomac sont des anomalies cellulaires ayant le potentiel de se développer en cancer au fil du temps. Elles sont détectées lors d'une endoscopie et peuvent être classées en fonction de leurs caractéristiques cellulaires spécifiques. Leur traitement dépend de la gravité de la lésion et des facteurs individuels de chaque patient. Les options de traitement peuvent inclure la surveillance endoscopique régulière, la prise de traitement permettant de réduire le risque de progression vers le cancer (traitement antireflux, antibiotique pour l'éradication de H. pylori) ou l'ablation endoscopique de la lésion afin de prévenir sa progression vers un cancer. Il est important de discuter avec un gastroentérologue de toute préoccupation concernant ces lésions et de suivre les recommandations de dépistage et de traitement appropriées.

[Acute diarrhea: updates for primary care medicine in 2023]. / Diarrhées aiguës : nouveautés 2023 pour la médecine de premier recours.

Acute diarrheal disease is a frequent primary care reason for consultation, leading to direct and indirect health costs in high-income countries. Most patients presenting with acute diarrhea will have a favorable clinical course with just a symptomatic treatment. The challenge for the general practitioner is to identify the patients who need paraclinical exams and/or antibiotics. Molecular identification of pathogens in stool samples has developed over the past years and presents both advantages and limitations. Because of increasing microbial resistance to quinolones in Campylobacter and Shigella strains, azithromycin is now the first choice for an empiric antimicrobial therapy. This article will discuss these latest developments in the management of acute diarrhea in the primary care setting.

Les diarrhées aiguës sont un motif de consultation fréquent en médecine générale et engendrent des coûts directs et indirects importants dans les pays industrialisés. Les cas sont majoritairement bénins et évoluent de manière favorable avec un traitement symptomatique. Le défi pour le médecin généraliste est d'identifier les patient-e-s nécessitant des examens complémentaires et/ou un traitement antibiotique. Ces dernières années, les examens microbiologiques moléculaires des selles se sont développés ; ils ont des avantages, mais également des limitations. Sur le plan thérapeutique, l'azithromycine est désormais à privilégier comme antibiothérapie empirique en raison de l'accroissement du nombre de souches de Campylobacter et Shigella résistantes aux quinolones. Cet article discute ces nouveautés dans la prise en charge des diarrhées aiguës du point de vue du généraliste.

Study protocol of a phase II study to evaluate safety and efficacy of neo-adjuvant pembrolizumab and radiotherapy in localized rectal cancer.

BACKGROUND: Reshaping the tumor microenvironment by novel immunotherapies represents a key strategy to improve cancer treatment. Nevertheless, responsiveness to these treatments is often correlated with the extent of T cell infiltration at the tumor site. Remarkably, microsatellite stable rectal cancer is characterized by poor T cell infiltration and, therefore, does not respond to immune checkpoint blockade. To date, the only available curative option for these patients relies on extensive surgery. With the aim to broaden the application of promising immunotherapies, it is necessary to develop alternative approaches to promote T cell infiltration into the tumor microenvironment of these tumors. In this regard, recent evidence shows that radiotherapy has profound immunostimulatory effects, hinting at the possibility of combining it with immunotherapy. The combination of long-course chemoradiotherapy and immune checkpoint inhibition was recently shown to be safe and yielded promising results in rectal cancer, however short-course radiotherapy and immune checkpoint inhibition have never been tested in these tumors. METHODS: Our clinical trial investigates the clinical and biological impact of combining pembrolizumab with short-course radiotherapy in the neo-adjuvant treatment of localized rectal cancer. This phase II non-randomized study will recruit 25 patients who will receive short-course preoperative radiotherapy (5 Gy × 5 days) and four injections of pembrolizumab starting on the same day and on weeks 4, 7 and 10. Radical surgery will be performed three weeks after the last pembrolizumab injection. Our clinical trial includes an extensive translational research program involving the transcriptomic and proteomic analysis of tumor and blood samples throughout the course of the treatment. DISCUSSION: Our study is the first clinical trial to combine short-course radiotherapy and immune checkpoint inhibition in rectal cancer, which could potentially result in a major breakthrough in the treatment of this cancer. Additionally, the translational research program will offer insights into immunological changes within the tumor and blood and their correlation with patient outcome. Taken together, our work will help optimizing future treatment combinations and, possibly, better selecting patients. TRIAL REGISTRATION: This study was registered with www. CLINICALTRIAL: gov : NCT04109755 . Registration date: June, 2020.

[Endoscopic submucosal dissection: advances and perspectives]. / Dissection sous-muqueuse endoscopique : avancées et perspectives.

Endoscopic submucosal dissection (ESD) is a mini-invasive technique allowing to resect superficial lesions of the digestive tract and maintaining organ function. High technical expertise is required as well as a network approach with referring physicians, pathologists, radiologists, surgeons and oncologists. Rigorous selection of cases as well as endoscopic management of potential complications (hemorrhage, perforation) is mandatory. Therefore, ESD should preferably be performed in expert centers with high volumes of cases, in order to maintain competency and offer optimal patient's management. Most frequent indications in the Western world are early cancers of the esophagus, stomach and colon as well as non-non-lifting polyps and gastrointestinal stromal tumors (GIST).

La dissection sous-muqueuse (DSM) est une technique permettant la résection des lésions superficielles du tube digestif, de façon mini-invasive, afin de conserver la fonction de l'organe atteint. L'expertise technique aboutissant à ce geste doit s'accompagner d'un travail en réseau associant médecins référents, pathologistes, radiologues, chirurgiens et oncologues. Elle nécessite une sélection rigoureuse des indications, ainsi que la maîtrise des complications éventuelles (hémorragie, perforation) et doit préférablement être réalisée en centre expert, avec un volume suffisant de cas afin de maintenir la compétence. Les indications les plus fréquentes en Occident concernent les cancers super­ficiels de l'œsophage, de l'estomac et du côlon ainsi que les polypes ne se soulevant pas lors de l'injection sous-muqueuse et les tumeurs stromales gastro-intestinales (GIST).

[Management of a cystic lesion of the pancreas discovered incidentally]. / Prise en charge d'une lésion kystique du pancréas de découverte fortuite.

Pancreatic cysts (PC) are common and often discovered incidentally. The distinction between PC is essential, because of the potential malignancy of some lesions requiring surgical resection. The clinical orientation will depend on the clinical history and the radiological characteristics. Indeed, in front of all PCs, it is essential to characterize them using cross-sectional imaging (MRI) in order to highlight the worrisome features requiring further examinations by endoscopic ultrasonography and fine needle aspiration of the cysts to guide the diagnosis. Referral to an expert center will allow to propose to each patient an adequate approach: surgical resection, surveillance according to the recommendations or therapeutic abstention.

Les lésions kystiques du pancréas (LKP) sont fréquentes et souvent découvertes de manière fortuite. La distinction entre les différentes LKP est primordiale, en raison du potentiel dégénératif de certaines lésions. L'orientation clinique dépendra des antécédents personnels, du profil clinique et des caractéristiques radiologiques. Devant tout kyste du pancréas, il est primordial de caractériser les LKP à l'aide d'une imagerie en coupe (IRM) afin de mettre en évidence les signes péjoratifs nécessitant un complément d'examen par écho-endoscopie digestive (EED) avec ponction du liquide intrakystique afin de guider le diagnostic. L'orientation vers un centre expert permettra de proposer une attitude adaptée à la lésion et au patient : résection chirurgicale, surveillance selon les recommandations ou abstention thérapeutique.

[Advances in gastroenterology and hepatology 2021]. / Gastroentérologie et hépatologie.

Among the recent advances in gastroenterology, colonoscopy with artificial intelligence is associated with a better quality of screening. In refractory UC, Ozanimod seems to be an interesting salvage treatment, which still needs to be validated by Swissmedic. Among the direct-acting anticoagulants, Rivaroxaban is more frequently associated with GI bleeding. The classification of oesophageal motor disorders has been recently revised, the Chicago v4.0 classification should be applied in diagnostic management. The use of Semaglutide seems to show very promising results in the management of metabolic steatosis. SARS-CoV-2 infection can be complicated by biliary tract disease, which can progress to hepatocellular failure.

Parmi les récentes avancées en gastroentérologie, la coloscopie couplée à une intelligence artificielle est associée à un dépistage de meilleure qualité. Lors de rectocolite hémorragique réfractaire, l'ozanimod semble être un traitement de sauvetage intéressant, qui doit encore être validé par Swissmedic. Parmi les anticoagulants à action directe, le rivaroxaban est plus fréquemment associé aux hémorragies digestives. La classification des troubles moteurs de l'œsophage a fait l'objet d'une révision récente, la classification de Chicago v4.0 doit être appliquée dans la prise en charge diagnostique. L'utilisation du sémaglutide semble montrer des résultats très prometteurs dans la prise en charge de la stéatose métabolique. L'infection par le virus à SARS-CoV-2 peut se compliquer d'une atteinte des voies biliaires, pouvant évoluer jusqu'à l'insuffisance hépatocellulaire.

[The video capsule endoscopy]. / Vidéocapsule endoscopique.

The video capsule endoscopy allows the exploration or the unreachable part of the small intestine by a standard bidirectional endoscopy. It requires a specific device and a bowel preparation but it's an outpatient examination with an acceptable tolerance of the patients. There are several indications including an obscure gastrointestinal bleeding, an iron deficit anemia, Crohn's disease extension and phenotype, hereditary polyposis and coeliac disease. It doesn't include therapeutic options itself requiring an assisted enteroscopy if any lesion is detected. The use of a dissolvable Patency Capsule lowers the risk of a mechanical intestinal occlusion if a stenosis is suspected. The colon capsule endoscopy is very promising for the colorectal cancer screening and follow-up of inflammatory bowel diseases but it's not currently validated nor recommended.

La vidéocapsule endoscopique permet l'examen de l'intestin grêle, inaccessible par un bilan endoscopique bidirectionnel. C'est un examen ambulatoire peu contraignant nécessitant toutefois un dispositif spécifique et certaines consignes d'utilisation. Plusieurs indications sont reconnues, comme le saignement gastro-intestinal obscur, l'anémie ferriprive, la recherche de tumeur de l'intestin grêle et les maladies de Crohn ou cœliaque. Elle ne permet pas de geste thérapeutique et peut être complétée par une entéroscopie en cas de lésion décelée. Le risque d'occlusion intestinale par rétention de la capsule est restreint par l'essai d'une Patency Capsule soluble. La capsule colique semble prometteuse dans le dépistage du cancer colorectal ou le suivi de maladie inflammatoire chronique mais l'évidence est insuffisante pour la recommander.

Mapping of aetiologies of gastroenteritis: a systematic review and meta-analysis of pathogens identified using a multiplex screening array.

OBJECTIVE: Emergence of molecular methods to screen stools could provide a more complete picture of pathogens causing gastroenteritis, allowing to adequately treat patients whenever required but, so far, no aggregate data have been released. Our objective was to report pathogens identified in patients suffering from gastroenteritis using a multiplex molecular array. DESIGN: Medline and Embase were searched for original publications reporting pathogens identified with FilmArray GI panel in patients suffering from gastroenteritis. Proportions of pathogens were extracted and pooled using a model with random effects. RESULTS: Fourteen studies (17,815 patients) were included in the analysis. Among the 7,071 patients (39.7%) with positive FilmArray, identified pathogens were EPEC (27.5%), Clostridium difficile (19.3%), Norovirus (15.1%), EAEC (15%), Campylobacter spp (11.8%), Salmonella spp (8.1%), ETEC (7.3%), Rotavirus (7.3%), Sapovirus (7.1%), STEC (5.2%), Shigella/EIEC (4.9%), Giardia lamblia (4%), Adenovirus (3.8%), Cryptosporidium spp (3.8%), Astrovirus (2.8%), Yersinia enterocolitica (1.7%), Escherichia coli O157 (1.1%), Plesiomonas shigelloides (1.1%), Cyclospora cayetanensis (0.7%), Vibrio spp (0.5%), Vibrio cholerae (0.3%) and Entamoeba histolytica (0.3%). When considering only studies with control group (microbiological examination of the stools performed by other methods), FilmArray identified at least one pathogen in 48.2% of patients versus 16.7% when using comparative diagnostic methods. CONCLUSIONS: FilmArray GI panel was positive in 39.7% of patients suffering from gastroenteritis. This proportion has to be mitigated by the carriage rates of identified organisms. Ultimately, restricted ordering of molecular panels to those patients who might benefit from specific treatment could provide medical value by swift identification of the pathogen and more targeted therapy.

Novel Autoantibody Signatures in Sera of Patients with Pancreatic Cancer, Chronic Pancreatitis and Autoimmune Pancreatitis: A Protein Microarray Profiling Approach.

Identification of disease-associated autoantibodies is of high importance. Their assessment could complement current diagnostic modalities and assist the clinical management of patients. We aimed at developing and validating high-throughput protein microarrays able to screen patients' sera to determine disease-specific autoantibody-signatures for pancreatic cancer (PDAC), chronic pancreatitis (CP), autoimmune pancreatitis and their subtypes (AIP-1 and AIP-2). In-house manufactured microarrays were used for autoantibody-profiling of IgG-enriched preoperative sera from PDAC-, CP-, AIP-1-, AIP-2-, other gastrointestinal disease (GID) patients and healthy controls. As a top-down strategy, three different fluorescence detection-based protein-microarrays were used: large with 6400, intermediate with 345, and small with 36 full-length human recombinant proteins. Large-scale analysis revealed 89 PDAC, 98 CP and 104 AIP immunogenic antigens. Narrowing the selection to 29 autoantigens using pooled sera first and individual sera afterwards allowed a discrimination of CP and AIP from PDAC. For validation, predictive models based on the identified antigens were generated which enabled discrimination between PDAC and AIP-1 or AIP-2 yielded high AUC values of 0.940 and 0.925, respectively. A new repertoire of autoantigens was identified and their assembly as a multiplex test will provide a fast and cost-effective tool for differential diagnosis of pancreatic diseases with high clinical relevance.

[Gastroenterology and hepatology in 2019]. / Gastroentérologie et hépatologie.

This article aims to review the most important innovations and updates in gastroenterology and hepatology in 2019. The role of ursodesoxycholic acid is questioned in cholestasis during pregnancy. Aspirin appears to prevent fibrotic lesions in NALFD. Tenofovir remains the gold standard in the treatment (TT) of HBV during pregnancy. The role of carvedilol is confirmed in the TT of portal hypertension. The risk of degeneration of TIPMP lesions suggests increased surveillance. Colonoscopy should be systematic after an episode of acute diverticulitis. The surveillance of celiac disease is specified. Tofacitinib is an effective molecule in ulcerative colitis but precautions are needed. Budesonide tablet is validated for the TT of eosinophilic esophagitis.

Cet article a pour but de revenir sur les nouveautés et les mises à jour les plus marquantes de 2019 en hépato-gastroentérologie. L'acide ursodésoxycholique est remis en cause dans la cholestase gravidique. L'aspirine semble prévenir les lésions de fibrose au cours de la NAFLD (stéatose hépatique non alcoolique). Le ténofovir reste le gold standard dans le traitement (TT) du VHB (virus de l'hépatite B) lors de la grossesse. Le rôle du carvédilol est confirmé dans le TT de l'hypertension portale. Le risque de dégénérescence des lésions de TIPMP (tumeurs intracanalaires papillaires et mucineuses du pancréas) implique une surveillance accrue. La coloscopie doit être systématique après un épisode de diverticulite aiguë. La surveillance de la maladie cœliaque est précisée. Le tofacitinib est une molécule efficace dans la colite ulcéreuse malgré certaines précautions d'utilisation. Le budésonide en comprimé est validé pour le TT d'une œsophagite à éosinophiles.

[Management of foreign bodies ingestion]. / Prise en charge des corps étrangers digestifs.

Foreign bodies ingestion is a common event, with a potential morbidity and mortality. In the majority of cases, the foreign bodies pass through the digestive tract without any complication. An endoscopy for removal of the foreign body is necessary in 10 to 20 % of cases and a surgical intervention is required in < 1 % of cases. In this article, we describe the clinical presentation, the potential complications, as well as the timing and endoscopic technics of foreign bodies retrieval, essentially based on the European Society of Gastrointestinal Endoscopy recommendations.

L'ingestion de corps étrangers est un événement fréquent, potentiellement grevée d'une morbi-mortalité et engendrant des coûts importants. Dans la majorité des cas, les corps étrangers suivent le tube digestif sans complication. Une endoscopie est nécessaire dans 10 à 20 % des cas et une intervention chirurgicale pour extraction du corps étranger/complications dans moins de 1 % des cas. Dans cet article, nous traitons de la prise en charge des corps étrangers chez l'adulte et passons en revue leur présentation clinique, leurs complications potentielles, ainsi que les délais et modalités de la prise en charge endoscopique basée essentiellement sur les recommandations de la Société européenne d'endoscopie digestive.

[Esophageal and esophago-gastric junction cancer†: management and multimodal treatment]. / Cancer de l'œsophage et de la jonction œsogastrique†: prise en charge et traitement multidisciplinaire.

Esophageal cancer remains an oncological burden with a low survival rate. Multidisciplinary management is essential to offer an adjusted treatment to the patient general condition and the tumor stage. New minimally invasive surgical treatments help to reduce the surgical trauma and improve post-operative patient recovery. Oncological treatments have also evolved and definitive treatment by radio-chemotherapy can be proposed in specific cases.

Le cancer de l'œsophage reste un fardeau oncologique avec un taux de survie bas. Une prise en charge multidisciplinaire est primordiale afin d'offrir un traitement adapté à l'état général du patient et au stade de la tumeur. De nouvelles prises en charge minimalement invasives chirurgicales permettent de diminuer le traumatisme d'une chirurgie majeure et améliorent la récupération des patients en postopératoire. Les traitements oncologiques ont également évolué et un traitement définitif par radiochimiothérapie peut être proposé dans des cas précis.

Identifying True Celiac Disease and Wheat Allergy in the Era of Fashion Driven Gluten-Free Diets.

BACKGROUND: Diagnosing both celiac disease (CD) and wheat allergy (WA) might be challenging due to the increasingly popular gluten-free diets. OBJECTIVES: This study investigates the value of anti-tissue transglutaminase IgA (tTGIgA) and wheat-specific IgE (WIgE), and identifies clinical and serological features associated with CD and WA. METHOD: Serological markers of autoimmunity and allergy along with medical charts of patients assessed for tTGIgA and WIgE between 2010 and 2016 were evaluated. RESULTS: During the last years, an increasing number of patients have been tested for tTGIgA, while the number of positive results decreased linearly. Among the 2,965 patients included, 128 patients showed at least once a positive tTGIgA. All patients with tTGIgA levels higher than the 12-fold upper normal limit had CD. The ratio of tTGIgA/total IgA did not perform better as a diagnostic test for CD compared to tTGIgA. tTGIgA and anti-nuclear antibodies were significantly associated. WA was only rarely investigated, particularly in adults. However, positive WIgE were found in nearly 50% of the cases. WIgE and tTGIgA values were negatively correlated. CONCLUSIONS: tTGIgA were increasingly tested, while the rate of positive results decreased in recent years, possibly reflecting the impact of current alimentary trends on clinical practice. Associated autoimmune disease was frequently found in CD. High levels of tTGIgA accurately predicted CD diagnosis. WA was rarely investigated and deserves more attention, in particular in children with atopic background. WA does not seem to be associated with CD.

[Optimal and endoscopic management of upper gastrointestinal bleeding]. / Gestion optimale et endoscopique lors d'hémorragie digestive haute.

Upper gastrointestinal bleeding is an urgent entity associated with a high mortality of about 10 %. Its urgent management includes medical interventions such as volume repletion, blood transfusions, the use of proton pump inhibitors, as well as upper gastrointestinal endoscopy. Whilst the benefit of esophago-gastro-duodenoscopy is clearly demonstrated, the ideal timing for this intervention is less well established. Initial management and pharmacological interventions are important and well-integrated into protocols.

L'hémorragie digestive haute est une entité urgente bien connue du gastroentérologue avec une mortalité élevée avoisinant les 10 %. Sa prise en charge inclut des moyens médicaux, comme la réanimation liquidienne, les transfusions sanguines ou les inhibiteurs de la pompe à protons, et l'endoscopie digestive. Alors que le bénéfice de l'œsophago-gastro-duodénoscopie a depuis longtemps été démontré, le délai idéal pour sa réalisation reste peu clair. La prise en charge initiale et les interventions médicamenteuses sont également importantes et intégrées dans des protocoles.

[First line eradication treatment of Helicobacter pylori in 2019]. / Traitement d'éradication d'Helicobacter pylori en 2019.

Helicobacter pylori infection is associated with chronic gastric inflammation, peptic ulcer and an increased risk of gastric cancer. Helicobacter eradication traditionally consists of an empirical therapy combining clarithromycine, amoxicillin and proton pump inhibitors. However, this classic therapy needs to be reassessed because of the raising prevalence of clarithromycine resistance. Various alternative eradication treatments have been studied. This article aims to review the recommended alternatives and the different factors to guide the most appropriate first line eradication therapy.

L'infection à Helicobacter pylori est associée à un risque augmenté de gastrite chronique, d'ulcère gastro-duodénal et de cancer gastrique. Le traitement d'éradication classique consiste en une association de clarithromycine, d'amoxicilline et d'inhibiteurs de la pompe à protons. Toutefois, cette association est remise en question en raison de la prévalence croissante de souches résistantes à la clarithromycine. Cet article a pour objectif de présenter les alternatives faisant l'objet de recommandations et les différents facteurs à prendre en compte afin de proposer le traitement d'éradication de première ligne adéquat.

[Gastroenterology and hepatology update 2018]. / Gastroentérologie et hépatologie.

The purpose of this article is to detail the major gastroenterology novelties for 2018. In the field of hepatology we address the monitoring of hepatocellular carcinoma, the Baveno VI extended criteria for the detection of oesophageal varices and the management of cramps in cirrhotic patients. Concerning intestinal inflammatory diseases, two novel treatments have recently been approved by the European Commission, including injection of stem cells for the treatment of complex perianal fistulas and the JAK inhibitor tofacitinib for the RCH (ulcerative colitis). Finally, we provide an update on the diagnostic criteria for eosinophilic esophagitis and a new therapy that's was recently validated for the treatment of primitive biliary cirrhosis.

Cet article a pour but de détailler les nouveautés majeures survenues en gastroentérologie en 2018. Nous présentons les nouveautés hépatologiques sur la surveillance du carcinome hépatocellulaire, les critères Baveno VI étendus pour le dépistage des varices œsophagiennes et la prise en charge des crampes chez les patients cirrhotiques. Concernant les maladies inflammatoires intestinales, deux nouveaux traitements ont reçu récemment l'autorisation de mise sur le marché de la Commission européenne, notamment l'injection des cellules souches dans le traitement de fistules périanales complexes et l'inhibiteur de JAK tofacitinib pour la rectocolite hémorragique (RCH). Enfin, nous rapportons une mise à jour des critères diagnostiques de l'œsophagite à éosinophiles et un traitement récemment validé pour la cirrhose biliaire primitive.

[Innovations in endoscopy]. / Innovations en endoscopie.

Digestive endoscopy has met an enormous progress over the last decade, both in terms of diagnosis and treatment of gastro-intestinal diseases. This review article presents the role of confocal endomicroscopy in the management of pancreatic cysts. Moreover, it resumes the most important novel therapeutic endoscopic techniques, some already available in expert centers such as G-POEM or biliary drainage by Axios stent system and spiral enteroscopy, as well as techniques undergoing validation such as the radiofrequency ablation of pancreatic tumors and the bariatric and metabolic endoscopy techniques.

L'endoscopie digestive a connu de grandes avancées au cours de la dernière décennie, à la fois sur les plans diagnostique et thérapeutique. Cet article fait le point sur le rôle de l'endomicroscopie confocale dans les kystes pancréatiques et sur plusieurs techniques d'endoscopie thérapeutique, certaines déjà disponibles dans les centres experts comme le G-POEM (pylorotomie endoscopique), le drainage biliaire par prothèse d'apposition et l'entéroscopie spiralée motorisée, ou encore en cours de développement, comme l'ablation par radiofréquence des tumeurs pancréatiques ou l'endoscopie bariatrique et métabolique.

[Gastric intestinal metaplasia and cancer risk: how to follow ?] / Métaplasie intestinale gastrique et risque de cancer: quelle surveillance ?

In 2019, gastric cancer still has high mortality. Gastric intestinal metaplasia (IGM) is an intermediate step in the process of carcinogenesis of intestinal adenocarcinoma. Gastroscopy with biopsies can detect the presence of MIG. Characterization in terms of intensity and distribution allows to stratify the risks and to target the population in which surveillance endoscopies are indicated for the purpose of detecting endoscopic resectable neoplasia in endoscopy.

Le cancer gastrique a encore en 2019 une mortalité élevée. La métaplasie intestinale gastrique (MIG) est une étape intermédiaire dans le processus de cancérogenèse de l'adénocarcinome de type intestinal. La gastroscopie avec biopsies permet de détecter la présence de MIG. Sa caractérisation en termes d'intensité et de distribution permet de stratifier les risques et de cibler la population chez qui des endoscopies de surveillance sont indiquées dans le but de détecter les néoplasies superficielles résécables en endoscopie.

Extracellular Vesicles in Bile as Markers of Malignant Biliary Stenoses.

BACKGROUND & AIMS: Algorithms for diagnosis of malignant common bile duct (CBD) stenoses are complex and lack accuracy. Malignant tumors secrete large numbers of extracellular vesicles (EVs) into surrounding fluids; EVs might therefore serve as biomarkers for diagnosis. We investigated whether concentrations of EVs in bile could discriminate malignant from nonmalignant CBD stenoses. METHODS: We collected bile and blood samples from 50 patients undergoing therapeutic endoscopic retrograde cholangiopancreatography at university hospitals in Europe for CBD stenosis of malignant (pancreatic cancer, n = 20 or cholangiocarcinoma, n = 5) or nonmalignant (chronic pancreatitis [CP], n = 15) origin. Ten patients with CBD obstruction due to biliary stones were included as controls. EV concentrations in samples were determined by nanoparticle tracking analyses. The discovery cohort comprised the first 10 patients with a diagnosis of pancreatic cancer, based on tissue analysis, and 10 consecutive controls. Using samples from these subjects, we identified a threshold concentration of bile EVs that could best discriminate between patients with pancreatic cancer from controls. We verified the diagnostic performance of bile EV concentration by analyzing samples from the 30 consecutive patients with a diagnosis of malignant (pancreatic cancer or cholangiocarcinoma, n = 15) or nonmalignant (CP, n = 15) CBD stenosis. Samples were compared using the Mann-Whitney test and nonparametric Spearman correlation analysis. Receiver operating characteristic area under the curve was used to determine diagnostic accuracy. RESULTS: In both cohorts, the median concentration of EVs was significantly higher in bile samples from patients with malignant CBD stenoses than controls or nonmalignant CBD stenoses (2.41 × 1015 vs 1.60 × 1014 nanoparticles/L in the discovery cohort; P < .0001 and 4.00 × 1015 vs 1.26 × 1014 nanoparticles/L in the verification cohort; P < .0001). A threshold of 9.46 × 1014 nanoparticles/L in bile best distinguished patients with malignant CBD from controls in the discovery cohort. In the verification cohort, this threshold discriminated malignant from nonmalignant CBD stenoses with 100% accuracy. Serum concentration of EVs distinguished patients with malignant vs patients with nonmalignant CBD stenoses with 63.3% diagnostic accuracy. CONCLUSIONS: Concentration of EVs in bile samples discriminates between patients with malignant vs nonmalignant CBD stenosis with 100% accuracy. Further studies are needed to confirm these findings. Clinical Trial registration no: ISRCTN66835592.