Diagnosis of liver fibrosis by transient elastography (FibroScan) and non-invasive methods in Crohn's disease patients treated with methotrexate.

BACKGROUND: Methotrexate is an effective treatment in Crohn's disease, which may induce liver fibrosis with high cumulative doses. Transient elastography (FibroScan, Echosens, Paris, France) is a new non-invasive rapid, allowing assessment of liver fibrosis by measurement of liver stiffness. AIM: A prospective study to evaluate liver fibrosis with FibroScan and non-invasive biochemical methods in Crohn's disease patients treated with methotrexate. METHODS: Consecutive Crohn's disease patients had evaluation of liver fibrosis with non-invasive methods. Two subgroups of patients were compared: cumulative dose of methotrexate of more than 1500 mg (group 1) and naive for methotrexate (group 2). Liver biopsy was performed in patients with persistent liver enzyme abnormalities or FibroScan value >8.7 kPa. RESULTS: Fifty-four consecutive Crohn's disease patients were fully investigated (45 females, mean age 41 +/- 14 years). Median FibroScan values were similar in group 1 (n = 21) and in group 2 (n = 33), 5.5 and 4.5 kPa, respectively. FibroScan values were not correlated with the cumulative dose of methotrexate. CONCLUSION: In Crohn's disease patients treated with a high dose of methotrexate, significant liver fibrosis is rare and not accurately detected with liver enzymes abnormalities. FibroScan could be recommended and liver biopsy could be performed only with patients with high values and/or with chronic liver enzymes abnormalities.

Pharmacokinetics and protein binding of cefpiramide in patients with alcoholic cirrhosis.

The pharmacokinetics of cefpiramide, a new cephalosporin, were investigated after a single 1 gm intravenous injection in 11 patients with alcoholic cirrhosis and compared with those of 11 healthy subjects. In patients with cirrhosis the plasma elimination half-life was three times longer than that in normal subjects. The total plasma clearance was decreased significantly (p less than 0.001): 12.3 +/- 6.5 ml/min in patients and 25.6 +/- 4.6 ml/min in healthy volunteers, respectively. The urinary excretion of unchanged drug (percent of intravenous dose) for patients (69.8% +/- 29.9%) was statistically higher (p less than 0.01) than that for subjects (16.2% +/- 3.9%). The renal elimination became increasingly important with hepatic impairment. Protein binding of cefpiramide was reduced significantly in the group with cirrhosis. The average unbound fraction was 10.4% +/- 9.5% in patients with cirrhosis and 1.9% +/- 0.3% in normal subjects (p less than 0.01). Because the rate of elimination from plasma in patients is slower, the dosage regimen of cefpiramide would probably be modified in cirrhosis.

Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas.

OBJECTIVE: To compare incidence rates and epidemiological characteristics of acute upper gastrointestinal haemorrhage (AUGIH) in France with those of other European studies. DESIGN: Population-based multi-centre prospective survey. SETTING: 29 public hospitals and 96 private specialists in gastroenterology in four administrative areas in France during 1996. SUBJECTS: A total of 2133 AUGIH patients 18 years and over were included in the six-month study. OUTCOME MEASURES: Incidence and mortality. RESULTS: The overall incidence in France was 143 cases per 100000 persons per year, classified as out-patients (16%), emergency admissions (59%) and in-patients (25%). The incidence rates increased with age except for in-patients, and were higher in males. Peptic ulcer (36.6%), varices (13.7%) and erosive disease (12.3%) were the most frequent diagnoses. In 677 patients (31.7%), aspirin, antiinflammatory drugs or corticosteroids were taken on the 7 days before bleeding. The overall mortality (out-patients excluded) was 14.3% (10.7% for emergency patients and 23% for in-patients). Mortality was associated with comorbidities (especially malignancies, cirrhosis, asthma or respiratory deficiency), was lower in emergency patients using non-steroid anti-inflammatory drugs, and higher in in-patients using corticosteroids. CONCLUSIONS: In France, patients with AUGIH are frequently managed as out-patients. Gastrotoxic drug use is frequently associated with AUGIH and constitutes a strategic opportunity for preventive treatment. Discrepancies between countries are not clearly explained either by demographic factors or by drug use, but this may be related to the emphasis on AUGIH in in-patients.

Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital.

OBJECTIVE: To describe the effect of local adaptation of national guidelines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics. DESIGN: Assessment of preoperative tests ordered over one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. SETTING: Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. SUBJECTS: 42 anaesthetists, 60 surgeons, and their teams. MAIN OUTCOME MEASURES: Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings. RESULTS: Of 536 patients at low risk from anaesthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied in 1994 after the intervention only 48% had one or more preoperative tests ordered (p < 0.05). Estimated mean (SD) saving for one year if changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. CONCLUSIONS: A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change.

[Congenital hepatic fibrosis disclosed late by hepatic encephalopathy]. / Fibrose hépatique congénitale tardivement révélée par une encéphalopathie hépatique.

A case of hepatic encephalopathy revealing congenital hepatic fibrosis in a 47-year-old woman is reported. The characteristic features of this observation were: a) the long clinical latency of a congenital disease usually discovered in childhood or in adolescence; b) the existence of hepatocellular insufficiency which appeared without any other reason than an ordinary infection; c) the absence of digestive bleeding or portacaval shunt, factors always found in the rare, previously described cases of encephalopathy in congenital hepatic fibrosis.

[Necrotizing amebic colitis]. / Colite amibienne nécrosante.

We report a case of necrotizing amebic colitis in a 43 year-old patient, 10 years after a stay in Senegal, successfully treated by right hemicolectomy. Entamoeba histolytica were found in colon necrosis and amoebiasis serology was positive, leading to the diagnosis. The epidemiologic, physiopathologic, clinical and therapeutic features of this exceptional affection are described. A few cases have been previously reported in non endemic areas where pre-operative diagnosis is rarely made. In endemic areas, a conservative treatment by ileostomy and colonic lavage seems to reduce the death rate.

[Acid-sensitive esophagus: natural history and effect on the quality of life. Comparison with gastroesophageal reflux]. / OEsophage acido-sensible: histoire naturelle et retentissement sur la qualité de vie. Comparaison avec le reflux gastro-oesophagien.

UNLABELLED: The acid hypersensitive esophagus (AHE) is characterized by a normal esophageal acid exposure but a significant association between symptoms and reflux episodes. The natural history of AHE remains poorly known. We therefore conducted a follow-up study to compare the initial presentation and natural history of AHE and classical GERD. Quality of life (QOL) was also assessed. PATIENTS AND METHODS: Two groups of patients referred to our laboratory for 24-hour pH-monitoring (between 1991 and 1996) were compared. Group 1 consisted of 127 consecutive patients with AHE. Group 2 consisted of 101 patients with GERD. All patients were invited by mail to fill-in two questionnaires, the first concerning clinical course and therapeutic needs and the second QOL (questionnaire Reflux-Qual). Finally 62% and 59% of group 1 and 2 respectively did respond to both questionnaires. The corresponding follow-up periods were 4.1 and 4.3 years, respectively. RESULTS: The two groups did not differ at initial presentation with regard to age, sex, symptoms prevalence and severity of esophagitis (80% of group 1 and 75% of group 2 were endoscopy-negative patients). At an average follow-up of 4 years symptoms persisted in 80% and 71% of patients respectively. Seventy five per cent of patients in both groups continued to take antireflux drugs. QOL scores were similarly reduced in both groups (71 +/- 26 vs 70 +/- 27). CONCLUSIONS: The initial presentation and clinical outcome of AHE and GERD are similar. QOL is notably impaired and the majority of patients continue to receive antireflux medications.

[Changes in circulating lymphocyte subsets in alcoholic hepatopathies. Respective role of alcohol, hepatocellular insufficiency and malnutrition]. / Etude des modifications des sous-populations lymphocytaires circulantes au cours des hépatopathies alcooliques. Rôle respectif de l'alcool, de l'insuffisance hépato-cellulaire et de la dénutrition.

Peripheral lymphocyte subpopulations have been quantified by a direct and indirect, immunofluorescence technique, using monoclonal antibodies, in 22 patients with continued heavy drinking, hepatocellular dysfunction (spider angiomata, ascites, and factor V decrease) (group I), in 16 patients with a history of heavy drinking and abstinence maintained for at least 6 months and hepatocellular dysfunction (group II) and in 28 patients admitted for continued heavy drinking, without hepatocellular dysfunction (group III). Sixteen normal subjects were studied as controls. The total number of lymphocytes and T lymphocytes (OKT3+) were significantly reduced (p less than 0.001) in groups I and II. A significant decrease of B lymphocytes was observed in group II (p less than 0.02). The OKT8+ lymphocytes were significantly reduced in group I (p less than 0.01) and in group II (p less than 0.001); the decrease of the OKT4+ lymphocytes was significant in group II (p less than 0.01) only. The OKT4/OKT8 ratio was higher in group I (p less than 0.05) and group II (p less than 0.01) than in the control group. Normal values of total lymphocytes, B lymphocytes, T lymphocytes subsets and OKT4/OKT8 ratio were observed in group III. In group III, the lymphocyte subpopulations and OKT4/OKT8 ratio were similar in patients with or without abnormalities of liver function tests. In group I and II, no correlation was found between the lymphocyte subpopulations or the OKT4/OKT8 ratio and factor V or nutritional status assessed by anthropometrical and biological tests. T-cell imbalance in alcoholic liver disease does not seem to be related to alcohol consumption, factor V decrease or malnutrition.

[Pharmacokinetics of alcohol after 3-hour intravenous infusion with and without cimetidine in 10 healthy non-alcoholic subjects]. / Pharmacocinétique de l'alcool après perfusion intraveineuse de trois heures avec et sans cimétidine chez dix sujets sains non alcooliques.

Ethanol metabolism was studied in ten male non-alcoholic subjects following the constant intravenous infusion of ethanol (1.2 g/kg) administered during three hours with and without cimetidine. Pharmacokinetic analysis was performed on the pseudolinear portion of the elimination curve. The mean peak ethanol concentrations were not significantly different with and without cimetidine. There was no acceleration of ethanol metabolism at high concentrations: the ethanol elimination rate was similar above and under 17 mM, with and without cimetidine. Cimetidine administration had no effect on pharmacokinetic parameters of ethanol (area under the curve, Km and Vm). The fact that the ethanol elimination rate is similar whatever be its concentration and the absence of modifications of the pharmacokinetic parameters by cimetidine are not in favor of an important role of the microsomal ethanol oxidizing system (MEOS) in the ethanol metabolism of nonalcoholic subjects. The data do not allow to examine the role of MEOS in ethanol metabolism after chronic alcohol consumption.

[Tissue effects of extracorporeal lithotripsy on a model of experimental biliary calculi in dogs]. / Effets tissulaires de la lithotritie extracorporelle sur un modèle de lithiase biliaire expérimentale du chien.

Extracorporeal shock waves represent a new method to treat gallstones. This study was designed to evaluate: 1) the effectiveness of a recently available lithotripter (EDAP LT 01) for gallstone fragmentation; 2) adverse tissue reactions after treatment; 3) the optimum conditions for use of this apparatus in man. A human cholesterol stone was surgically implanted into the gallbladder of ten 20-25 kg mongrel dogs. One dog was used as a control. The other nine animals were divided into three groups (A, B and C). Two 60 min sessions of lithotripsy were carried out twice a week. Sonographic and CT examinations were performed 9 and 16 days after operation. The animals were killed 21 days after operation. Satisfactory fragmentation was obtained in 4 of the 9 animals, and in 2 dogs no stone fragments were detected. Fragments were found in the common bile duct in 5 dogs. In 2 animals a pathologic aspect of the papilla of Vater was observed. Marked hematoma was observed in the animals treated at 5 and 10 pulses/sec. In 5 cases, hematoma was observed in the gallbladder and in one case the gallbladder was ruptured. Hematoma was also noted in the hepatic vascular bed in 3 animals. Except for microscopic hemorrhagic lesions observed at the base of the right lung, no lesions were detected in any other organ. Shock waves produced by the EDAP LT 01 are effective for fragmentation of gallstones. However, in view of the tissue reactions observed at the higher pulse rates, the pulse rate should not exceed 2.5 pulses/s for use in man.

[Management of upper digestive hemorrhage occurring in the community: patterns of patient care in 4 French administrative areas]. / Prise en charge des hémorragies digestives hautes communautaires. Trajectoires des malades dans 4 départements français.

AIMS: To describe patterns of health care management in patients with upper gastrointestinal hemorrhage and to identify factors linked to the different patterns. PATIENTS AND METHODS: We conducted a prospective study of patients over 18 with upper gastrointestinal hemorrhage (inpatients excluded) among all public hospitals and private practice gastroenterologists in 4 French administrative areas (3 in Northern France and one in the South West). RESULTS: One thousand six hundred and two patients were included over a six-month period (1996). An endoscopic procedure was performed in 1532 patients in public (70%) or private (20.5%) hospitals, or at private office (9.5%). Hospitalization was necessary in 78.8% of the patients in university, non university public or private hospitals (38.9, 45.5 and 15.6%, respectively) with a median duration of 6.5 days. Admission was associated to old age, short delay between hemorrhage and endoscopic procedure, previous gastrointestinal bleeding, cirrhosis or cancer, bleeding from peptic ulcer or esogastric varices. Endoscopic hemostasis was performed in 21.4% of the patients, more often in university and no university public hospitals. Surgery was necessary in 4% of the patients. Death rate was 10.7%. Important geographical variations were observed concerning referral patterns. Patients' characteristics did not differ between the 4 areas. On the other hand, health care supply provided in the management of upper gastrointestinal hemorrhage was different in the four French geographical areas. CONCLUSION: a) An initial endoscopic procedure is nearly always performed in patients with an upper gastrointestinal hemorrhage in France; in 1 patient out of 10, endoscopy was performed in a private gastroenterologist office; b) hospital admission was strongly related to epidemiological and clinical criteria of severity; c) the geographical variations observed in referral patterns depend in part on health care supply; d) upper gastrointestinal haemorrhage status could be used as an indicator of the quality of health care organizations.

[Upper gastrointestinal bleeding in patients treated by low-dose aspirin]. / Hémorragies digestives hautes et aspirine à faible dose.

AIM OF THE STUDY: To estimate the number of people treated by low-dose aspirin (<330 mg daily) in France and to evaluate the risk of upper gastrointestinal bleeding associated with low-dose aspirin treatment. SUBJECTS AND METHODS: One thousand six hundred and two patients with upper gastrointestinal bleeding were included between January and June 1996 in 4 French areas. Data about patients characteristics, drugs recently used, and bleeding lesions were prospectively collected. Five hundred seventy five cases were matched for sex, age and area with control people without previous upper gastrointestinal bleeding. Low-dose aspirin intake in the population was estimated from the control group. Aspirin intake in the previous 7 days in cases and in controls was compared by logistic regression, adjusted for other gastrotoxic drugs intake. RESULTS: Low-dose aspirin is taken by about 1.2 millions adults in France. In 1 602 patients, gastrointestinal bleeding was related to a peptic ulcer in 34%. Aspirin was associated with higher risk of upper gastrointestinal bleeding: OR=1.68 (1.03-2.74) with low-dose, and OR 1.42 (0.91-2.21) with higher doses. CONCLUSION: About 2.8% of the population is exposed to low-dose aspirin in France. This treatment seems to be associated with a high risk of upper gastrointestinal bleeding.

[Quality assessment of colonscopies in current practice in the Aquitaine area]. / Qualité des coloscopies réalisées en pratique courante dans la région Aquitaine.

UNLABELLED: Sensitivity of colonoscopy depends on the technical quality of the procedure. The aims of this study were to evaluate the usual of colonoscopy in the French area of Aquitaine and to determinate the factors associated with a procedure of good quality. Thirty four gastroenterologists prospectively recorded indications, conditions of practice and results of the colonoscopies that were performed during 4 consecutive weeks. Six hundred and eighty six colonoscopies were analysed, performed in 387 women and 299 men, mean age: 59.9 years. INDICATIONS: irritable bowel syndrome: 34%, patients belonging to high risk groups: 30%, recent transit disturbance: 27%, rectal bleeding: 23%, positive fecal occult blood test: 4.3%. Preparations: polyethylene glycol (PEG) 78%, in 2 doses: 20%; PEG alone: 43%, associated with enemas and laxatives: 19%, with enemas: 14%, with laxatives: 2%; minimum-residue diet before colonoscopy: 58%. The caecum was reached in 86% of colonoscopies. Ninety-nine colonoscopies were incomplete. Fifty one per cent of colonoscopies reached the caecum with visualization of total colic mucosa, 35% reached the caecum with one at least imperfectly seen colic area.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy of ranitidine and cimetidine in the treatment of gastric or duodenal ulcer resistant to an initial treatment with cimetidine. Multicenter controlled therapeutic trial]. / Efficacité de la ranitidine et de la cimétidine dans le traitement de l'ulcère duodénal ou gastrique résistant à un traitement initial par la cimétidine. Essai thérapeutique contrôlé multicentrique.

In a controlled clinical trial conducted in 28 centers, 354 ambulatory patients with a cimetidine-resistant duodenal or gastric ulcer (at least six weeks of treatment at a dose of 1 g/day) confirmed by endoscopy were allocated at random to either ranitidine or cimetidine treatment: 166 patients received cimetidine (1.6 g/day in 4 oral doses), and 188, ranitidine (0.3 g/day in 2 oral doses). The two groups differed significantly with regard to sex and history of gastrointestinal hemorrhage but not with regard to age, weight, history of peptic disease, history of perforated ulcer, duodenal/gastric ulcer ratio, number of smokers and alcohol consumers. The criterion of effectiveness was endoscopic healing of the ulcer after six weeks of treatment; in case of doubt, vital staining with methyl blue was performed. A significant difference was observed between the results of the two treatments in the duodenal group (p less than 0.05) but not in the gastric group, the healing rates being respectively 71 p. 100 and 65 p. 100 with ranitidine, and 59 p. 100 and 44 p. 100 with cimetidine. Twelve patients developed side-effects with a highly significant difference between the two groups: 11 patients under cimetidine and one patient under ranitidine (p less than 0.001). These results show the effectiveness of ranitidine as a complementary treatment in cimetidine-resistant peptic ulcers of duodenal location.

[Evaluation of decontamination procedures used at digestive endoscopy units in Gironde]. / Evaluation des procédures de décontamination utilisées dans les centres d'endoscopie digestive de Gironde.

Decontamination procedures used for endoscopes were noted in 23 digestive endoscopy units, public and private, in the department of Gironde and compared to recommended procedures. Serial, bacteriological samples were obtained from one esogastroscope and one colonoscope in each unit, after upper endoscopy and colonoscopy diagnostic procedures at the end of the endoscopy session. Six units of 23 used complete decontamination procedures. In the 17 other units, principal errors of decontamination procedures were: inadequate cleaning of internal channel of scopes (12 units) and lack of utilization of glutaraldehyde between each endoscopy (8 units). Bacteriological samples were negative in 11/12 endoscopes after a complete decontamination procedure and in 8/39 after an inadequate procedure (p less than 0.01). Complete procedures are efficacious but not used often enough. Information and changes in endoscopic practices are necessary in digestive endoscopy units.

[Evolution of serum gammaglutamyl transpeptidase activity in treated hyperthyroid and hypothyroid patients]. / Evolution de l'activité sérique gammaglutamyl transpeptidase (GGT) au cours des hyperthyroïdies et des hypothyroïdies traitées.

The pattern of gammaglutamyl transpeptidase levels was studied in the sera of 25 subjects with hyperthyroidism and 11 subjects with hypothyroidism, before and after treatment, and in 14 age- and sex-matched control subjects. Gammaglutamyl transpeptidase levels were significantly increased in hyperthyroidism (65 +/- 59 U/l) (p less than 0.01) and significantly decreased under treatment (40 +/- 27 U/l) (p less than 0.001). Before treatment, gammaglutamyl transpeptidase levels correlated with alkaline phosphatase levels and 5'-nucleotidase levels, the correlation persisting after treatment with 5'-nucleotidase. Alkaline phosphatase levels significantly increased under treatment (p less than 0.01). The percentages of gammaglutamyl transpeptidase variation correlated with thyroxine (r = 0.44, p less than 0.03), triiodothyronine (r = 0.47, p less than 0.02) and latent fixation capacity (r = 0.44, p less than 0.03) variations. Subjects with hypothyroidism had significantly decreased gammaglutamyl transpeptidase levels before treatment (18 +/- 9 U/l, p less than 0.01). Alkaline phosphatase levels were significantly decreased before treatment, and significantly increased after treatment. For all subjects with hyperthyroidism of hypothyroidism, the percentages of gammaglutamyl transpeptidase variations correlated with thyroxine (r = 0.48, p less than 0.003) and triiodothyronine (r = 0.39, p less than 0.016) variations. These results suggest that variations in gammaglutamyl transpeptidase levels in hyperthyroidism and hypothyroidism are, at least in part, in relation with variations in thyroid hormone levels.

[Quality of psychomotor recovery after colonoscopy under general anesthesia using propofol. Value of tests of awakening]. / Qualité de la récupération psychomotrice après une coloscopie sous anesthésie générale par propofol. Intérêt des tests de réveil.

Achieving colonoscopy under general anaesthesia entails the problem of ambulatory-care anaesthesia, in particular because perception of patient's recovery determines to some extent the length of monitoring following colonoscopy. The aims of the study was to assess the quality of patient's recovery after a colonoscopy under general anaesthesia while using propofol, by means of psychomotor-tests. METHODS--Colonoscopy was performed in 40 patients according to the following anaesthetic protocol: induction: propofol 2 mg/kg, continuous support: propofol 10 mg/kg/h i.v. with a 50 mg bolus in case of insufficient sedation; series of 3 psychomotor-tests were performed the day before and 1 hour, 3 hours and 6 hours after colonoscopy. The 3 psychomotor-tests studied: coordination (Newman test), time-space orientation and short-term memory. RESULTS--Forty patients, 25 females and 15 males, underwent colonoscopy with general anaesthesia for an average time-period of 22 +/- 11 min. The mean dose of propofol used was 286 +/- 102 mg. Awakening was complete in all patients, according to physical criteria such as consciousness and cardiovascular status, 20 min after receiving colonoscopy. The average psychomotor-tests results over time were (as percentages of original values) (*P < 10(-3); **P < 0.05): [table: see text] At 6 hours, 35 patients (87.5%) had recovered to their original performance and at 3 hours, 30 patients (75%) retained 90% their former state as measured with 3 psychomotor-tests. Neither by age or sex nor by propofol doses used or length or anaesthesia, the study population differed significantly. CONCLUSION--Three hours after colonoscopy under general anaesthesia using propofol, 30 patients (75%) had recovered at least 90% to their initial performances. Newman test was the most disturbed but there was no predictive factor for the quality of recovery. Psychomotor-tests may be useful before authorizing early discharge after colonoscopy under general anaesthesia but other recommendations about conditions of discharge after sedation must be also implemented.

[Conditions of practice of upper digestive endoscopy in ambulatory care. Results of a national survey (I)]. / Conditions de réalisation de l'endoscopie digestive haute en ambulatoire. Résultats d'une enquête nationale (I).

OBJECTIVES: The aim of the study was to describe the usual conditions of practice of esophagogastroscopy in ambulatory care by French gastroenterologists. METHODS: During a week, a questionnaire was filled out for each esophagogastroscopy performed in ambulatory or day care. RESULTS: Seven hundred and thirty nine gastroenterologists participated in the study (25.9% of French gastroenterologists) and enrolled 4585 patients. Intra-venous sedation was performed in 36.6% of endoscopic examinations, with diazepam (17.8%), midazolam (41.7%), propofol (14.9%), diazepam and propofol (2.1%) or midazolam and propofol (23.5%). A morphinomimetic was associated in 58.6% of cases. Monitoring equipment of endoscopy units was: aspiration (58.6%), pulse oxymeter (41.6%), electrocardiographic monitoring (37.7%). Recommendations about follow-up after ambulatory anaesthesia were not implemented in 7.3% of examinations with anaesthesia (patient discharged alone). Seventeen minor adverse events were recorded. CONCLUSION: The study underlines variability of practice, mainly about use of sedation, monitoring and follow-up of patients during esophagogastroscopy performed in ambulatory care in France. An improvement in quality of endoscopy practice is likely.

[Patient's opinion following an upper digestive endoscopy in ambulatory care. Results of a national survey (II)]. / Opinion des patients après la réalisation d'une endoscopie digestive haute en ambulatoire. Résultats d'une enquête nationale (II).

OBJECTIVES: The aim of the study was to evaluate patient satisfaction after esophagogastroscopy performed in ambulatory care and to correlate it with conditions of usual practice. METHODS: Study was proposed to the French gastroenterologists. During a week, 2 questionnaires were filled out for each esophagogastroscopy performed in ambulatory care: one recorded conditions of examination and one was independently filled out by the patient one day after endoscopy. RESULTS: Seven hundred and thirty nine gastroenterologists and 4,585 patients participated in the study. Among the patients, 3,758 (82%) filled out the questionnaire. Sedation was performed in 36.6% of cases. Subsequent endoscopy would be accepted by 79.3% of patients in the same conditions. Acceptance was significantly better with use of sedation and use of propofol. Without sedation, independent factors associated with a better acceptance were: male gender, absence of habitual benzodiazepine medication, endoscopy performed in private practice or private hospitals, smaller size of endoscope. CONCLUSION: This study underlines factors associated with a good acceptance of esophagogastroscopy without sedation and could help to improve decision-making regarding use of sedation.