Impact of an optimized colonoscopic screening program for patients with Lynch syndrome: 6-year results of a specialized French network.

BACKGROUND: Despite colonoscopic screening, colorectal cancer (CRC) remains frequent in patients with Lynch syndrome (LS). The objective of this study was to evaluate the impact of an optimized colorectal screening program within a French dedicated network. METHODS: All LS patients followed at our institution were consecutively included in the Prédisposition au Cancer Colorectal-Ile de France (PRED-IdF) network. Patients were offered an optimized screening program allowing an adjustment of the interval between colonoscopies, depending on bowel preparation, chromoendoscopy achievement and adenoma detection. Colonoscopies were defined as optimal when all the screening criteria were respected. We compared colonoscopy quality and colonoscopy detection rate before and after PRED-IdF inclusion, including polyp detection rate (PDR), adenoma detection rate (ADR) and cancer detection rate (CDR). RESULTS: Between January 2010 and January 2016, 144 LS patients were consecutively included (male/female = 50/94, mean age = 51 ± 13 years and mutations: MLH1 = 39%, MSH2 = 44%, MSH6 = 15%, PMS2 = 1%). A total of 564 colonoscopies were analyzed, 353 after inclusion and 211 before. After PRED-IdF inclusion, 98/144 (68%) patients had optimal screening colonoscopies versus 33/132 (25%) before (p < 0.0005). The optimal colonoscopy rate was 304/353 (86%) after inclusion versus 87/211 (41%) before, (p < 0.0001). PRED-IdF inclusion was associated with a reduction of CRC occurrence with a CDR of 1/353 (0.3%) after inclusion versus 6/211 (2.8%) before (p = 0.012). ADR and PDR were 99/353 (28%) versus 60/211 (28.8%) (p > 0.05) and 167/353 (48.1%) versus 90/211 (42.2%) (p > 0.05), respectively after and before inclusion. CONCLUSIONS: An optimized colonoscopic surveillance program in LS patients seems to improve colonoscopic screening quality and might possibly decrease colorectal interval cancer occurrence. Long-term cohort studies are needed to confirm these results.

Over-the-scope clip (OTSC) reduces surgery rate in the management of iatrogenic gastrointestinal perforations.

Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit. Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015). Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23). Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.

[Diagnosis management of gastroesophageal reflux disease in adults]. / Stratégie diagnostique du reflux gastro-oesophagien chez l'adulte. Avant 50 ans, pas d'endoscopie en cas de symptômes typiques.

Diagnosis management of gastroesophageal reflux disease in adults. Gastroesophageal reflux (GERD) is a common disease that can however impair quality of life. A diagnostic algorithm was established by the French societies of gastroenterology based on clinical manifestations. In the absence of warning signs, the diagnosis of GERD is based on patient's history of a typical symptomatology. In other cases, an upper digestive endoscopy has to be performed, associated or not with a 24-hours pH monitoring. Concerning proton pump inhibitors resistant reflux, impedance pH monitoring is the exam of choice to highlight non acid reflux. A baseline esophageal manometry is recommended in the preoperative assessment for GERD surgery.

Stratégie diagnostique du reflux gastro-oesophagien chez l'adulte. Le reflux gastro-oesophagien est une affection très répandue qui peut être très invalidante au quotidien et altérer la qualité de vie. En fonction de la symptomatologie clinique, une stratégie diagnostique a été mise en place par les sociétés savantes françaises de gastro- entérologie. Le diagnostic du reflux gastro-oesophagien est fondé sur l'interrogatoire du patient quand il s'agit d'une symptomatologie typique et en l'absence de signes d'alarme. Dans le cas contraire, une endoscopie digestive haute est réalisée en première intention, associée ou non à une pH-métrie de 24 heures. Concernant les reflux résistants aux inhibiteurs de la pompe à protons, l'impédancemétrie est l'examen de choix pour objectiver un reflux non acide. Dans le cadre d'un bilan préopératoire d'une chirurgie de reflux, une manométrie oesophagienne de référence est préconisée.

[Follow-up and dietary advice after sigmoid diverticulitis]. / Suivi et conseils diét6téques dans la diverticulose colique et ses complications.

Currently published data do not demonstrate the benefit of any medical treatment in the prevention of the onset or the recurrence of colonic diverticular disease. No specific diet can be recommended to patients with colonic diverticula for the prevention of diverticular disease. Non steroidal anti-inflammatory drugs as well as corticosteroids should be used cautiously in patients with diverticular disease since they induce a higher rate of complications, especially diverticular haemorrhage and severe sigmoid diverticulitis. In patients over 50 years old, or if a sigmoidectomy is needed, physicians should perform a colonoscopy in order to rule out colonic polyps or neoplasm.

[Achalasia: role of endoscopic therapy and surgery]. / Achalasie: place du traitement endoscopique et du traitement chirurgical.

Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia.

Inflammatory pseudotumor of the liver associated with Crohn's disease.

Inflammatory liver pseudotumor is a rare entity. Associations with several inflammatory conditions were reported but association with inflammatory bowel disease is unusual. We report the case of liver inflammatory pseudotumor occurring in the course of Crohn's disease in a 23-year-old woman and treated conservatively.