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1.
Surg Endosc ; 30(11): 4895-4903, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-26944730

RESUMO

BACKGROUND AND AIMS: Anastomotic leakages are severe and often lethal adverse events of surgery for esophageal cancer. The endoscopic treatment is growing up in such indications. The aim was to evaluate the efficacy and describe the strategy of the endoscopic management of anastomotic leakages/fistulas after esophageal oncologic surgery. METHODS: Single-center retrospective study on 126 patients operated for esophageal carcinomas between 2010 and 2014. Thirty-five patients with postoperative fistulas/leakages (27 %) were endoscopically managed and included. The primary endpoint was the efficacy of the endoscopic treatment. The secondary endpoints were: delays between surgery, diagnosis, endoscopy and recovery; number of procedures; material used; and adverse events rate. Uni- and multivariate analyses were carried out to determine predictive factors of success. RESULTS: There were mostly men, with a median age of 61.7 years ± 8.9 [43-85]. 48.6 % underwent Lewis-Santy surgery and 45.7 % Akiyama's. 71.4 % patients received neo-adjuvant chemo-radiation therapy. The primary and secondary efficacy was 48.6 and 68.6 %, respectively. The delay between surgery and endoscopy was 8.5 days [6.00-18.25]. Eighty-eight percentages of the patients were treated using double-type metallic stents, with removability and migration rates of 100 and 18 %, respectively. In the other cases, we used over-the-scope clips, naso-cystic drain or combined approach. The mean number of endoscopy was 2.6 ± 1.57 [1-10]. The mortality rate was 17 %, none being related to procedures. No predictive factor of efficacy could be identified. CONCLUSIONS: The endoscopic management of leakages or fistulas after esophageal surgery reached an efficacy rate of 68.8 %, mostly using stents, without significant adverse events. The mortality rate could be decreased from 40-100 to 17 %.


Assuntos
Adenocarcinoma/cirurgia , Fístula Anastomótica/cirurgia , Carcinoma de Células Escamosas/cirurgia , Fístula Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia , Esôfago/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Instrumentos Cirúrgicos , Resultado do Tratamento
2.
Colorectal Dis ; 17(10): O202-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26046765

RESUMO

AIM: Anorectal manometry is the most common test used to explore anorectal disorders. The recent three-dimensional high-resolution anorectal manometry (3D-HRAM) technique appears to be able to provide new topographic information. Our objective was to develop an automated analysis of 3D-HRAM images to diagnose anal sphincter defects and compare the results with those of endoanal ultrasonography (EUS), which is considered to be the gold standard. METHOD: All patients being tested in our department for faecal incontinence or dyschezia by 3D-HRAM and EUS were eligible for the study. 3D-HRAM was used to record resting and squeeze pressure, reflecting internal and external anal sphincter function, respectively. A software platform was designed to automatically analyse the 3D-HRAM images and calculate a diagnostic score for any anal sphincter defect compared with EUS. RESULTS: A total of 206 (91% female) patients of mean age of 54 years were included in the study. A sphincter defect was diagnosed by EUS in 130 (63%). The diagnostic scores from the 3D-HRAM automated analysis for an internal anal sphincter defect showed a sensitivity of 65% and a specificity of 65%. For an external anal sphincter defect, the sensitivity was 43% and the specificity 87%. CONCLUSION: Our study developed a method based on 3D-HRAM to automatically diagnose sphincter defects, allowing a systematic and comprehensive analysis of the test recordings. Compared with EUS, the 3D-HRAM image analysis procedure revealed poor sensitivity and specificity.


Assuntos
Canal Anal/diagnóstico por imagem , Automação/instrumentação , Incontinência Fecal/diagnóstico , Imageamento Tridimensional , Manometria/métodos , Adulto , Idoso , Canal Anal/fisiopatologia , Estudos de Coortes , Constipação Intestinal/diagnóstico , Endossonografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Software
3.
Surg Endosc ; 29(7): 2013-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25303919

RESUMO

INTRODUCTION: The management of post-operative anastomotic leakage and fistulas of the upper GI tract remains challenging. Fully covered stents are used despite a high risk of migration because of a better removability. The goal of our study was to evaluate the effectiveness of this new type of endoscopic stent in this indication. The secondary objective was to determine the ability of withdrawing this stent. METHODS: Thirty-six patients treated for upper GI fistula using a double-type metallic stent (DTMS) (Taewoong, Korea) for a benign indication were included in this retrospective study. This stent associates an outer uncovered metallic stent, decreasing the risk of migration, to an inner fully covered stent that ensured its tightness. The DTMS was removed after 4 weeks of treatment. RESULTS: Twenty-four patients had a post-operative fistula (15 sleeve gastrectomies), eight had an anastomotic leakage, and four had an esophageal perforation. Seventeen patients underwent a previous failed stenting, and fourteen had an associated treatment with OTSC clips. A final complete healing was achieved in twenty-six patients (72%). For patients with fistulas, the overall success rate was 66.6% (16/24) mostly in case of post sleeve fistula (80%), and it was 75% (6/8) for patients with anastomotic leakages (3/4). We reached a primary success (one session) in twenty-one cases (58.3%), and a second session was required in five cases. All the stents were removed without complications after a median stenting time of 32 [20-71] days. The spontaneous migration rate was 16.6%. CONCLUSION: This new double-type stent is a new and efficient way to treat post-operative fistulas and leakages in the upper GI tract. The stents were always removable despite the external uncovered part with a low migration rate.


Assuntos
Fístula Anastomótica/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Fístula Esofágica/cirurgia , Perfuração Esofágica/cirurgia , Fístula Gástrica/cirurgia , Complicações Pós-Operatórias/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Perfuração Esofágica/etiologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Instrumentos Cirúrgicos
4.
Colorectal Dis ; 16(5): O170-5, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24373215

RESUMO

AIM: Three-dimensional high-resolution anorectal manometry (3DHRAM) is a new technique that can simultaneously provide physiological and topographical data on the terminal part of the digestive tract. Our object was to assess whether 3DHRAM is able to reliably diagnose excessive perineal descent already diagnosed with conventional defaecography, which is considered to be the gold standard. METHOD: All patients referred to our centre for anorectal manometry and conventional defaecography were evaluated with a maximum of 6 months between the two examinations. Anorectal manometry was performed using the 3D High-Resolution Given Imaging® probe. Excessive perineal descent was defined as the downward movement of the anal high-pressure zone during straining. At the end of the straining effort, the high-pressure zone regained its initial position, thereby indicating that the probe had not moved. RESULTS: Nineteen female patients of median age 53 (21-70) years were included in the study. All cases with excessive perineal descent diagnosed using defaecography were visualized with 3DHRAM. The degree of perineal descent determined by 3D and conventional defaecography was compared (Spearman correlation 0.726, P = 0.01). In contrast, the averages measured were significantly different; the average was 11.68 ± 3.3 mm for 3DHRAM but 34.21 ± 13.3 mm for conventional defaecography (P = 0.002). CONCLUSION: The results of the study demonstrate that 3DHRAM can diagnose excessive perineal descent with the same degree of reliability as defaecography. Quantitative measures were not correlated, however, possibly because of methodological differences. The study confirms the value of the morphological data provided by 3DHRAM.


Assuntos
Canal Anal/fisiopatologia , Defecação/fisiologia , Manometria/métodos , Reto/fisiopatologia , Adulto , Idoso , Canal Anal/diagnóstico por imagem , Constipação Intestinal/fisiopatologia , Defecografia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Projetos Piloto , Pressão , Reto/diagnóstico por imagem , Estudos Retrospectivos , Transdutores de Pressão , Adulto Jovem
5.
Int J Clin Pract ; 68(2): 245-54, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24147869

RESUMO

BACKGROUND: In routine practice, irritable bowel syndrome (IBS) symptoms are often difficult to be relieved and impair significantly patients' quality of life (QoL). A randomised, double-blind, placebo-controlled study has shown the efficacy of alverine citrate/simeticone (ACS) combination for IBS symptom relief. AIM: As IBS symptoms are often intermittent, this pragmatic study was designed to compare the efficacy of an on-demand ACS treatment vs. that of usual treatments. METHODS: Rome III IBS patients were enrolled by 87 general practitioners who were randomly allocated to one of two therapeutic strategies: on-demand ACS or usual treatment chosen by the physician. The primary outcome measure was the improvement of the IBSQoL score between inclusion and month 6. RESULTS: A total of 436 patients (mean age: 54.4 years; women: 73.4%) were included, 222 in the ACS arm and 214 patients in the usual treatment arm, which was mainly antispasmodics. At 6 months, improvement of IBSQoL was greater with ACS than with the usual treatment group (13.8 vs. 8.4; p < 0.0008). The IBS-severity symptom score (IBS-SSS) was lower with ACS than in the usual treatment arm with a mean (SE) decrease of 170.0 (6.6) vs. 110.7 (6.7), respectively (p = 0.0001). An IBS-SSS < 75 was more frequent in the ACS group (37.7% vs. 16.0%; p < 0.0001). Improvement of both abdominal pain and bloating severity was also greater with the on-demand ACS treatment, which was associated with both lower direct and indirect costs. CONCLUSIONS: After 6 months, on-demand ACS treatment led to a greater improvement of QoL, reduced the burden of the disease and was more effective for IBS symptom relief than usual treatments.


Assuntos
Antiespumantes/uso terapêutico , Síndrome do Intestino Irritável/tratamento farmacológico , Propilaminas/uso terapêutico , Agonistas do Receptor de Serotonina/uso terapêutico , Simeticone/uso terapêutico , Dor Abdominal/prevenção & controle , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
6.
Colorectal Dis ; 15(12): e726-31, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24034300

RESUMO

AIM: Our aim was to compare for the first time measurements obtained with water-perfused catheter anorectal manometry and three-dimensional (3D) high-resolution manometry in patients with anorectal disorders. METHOD: Consecutive patients referred to our centre for anorectal manometry (ARM) were recruited to undergo the two procedures successively. Conventional manometry was carried out using a water-perfused catheter (WPAM) and high-resolution manometry was achieved with a 3D probe (3DHRAM). For each procedure, parameters recorded included the following: anal canal length, resting pressure, squeeze pressure and rectal sensitivity. RESULTS: Two hundred and one patients were included in this study. The mean values for resting and squeeze pressures were correlated and found to be significantly higher when measured with 3DHRAM than with WPAM. However, the length of the anal canal was not significantly different when measured by the two techniques without correlation between the two mean values obtained. The presence of the rectoanal inhibitory reflex was systematically assessed by both WPAM and 3DHRAM and anismus was also systematically diagnosed by both WPAM and 3DHRAM. CONCLUSION: The pressure values obtained with 3DHRAM are correlated with those measured with conventional manometry but are systematically higher. 3DHRAM has the advantage of providing a pressure recording over the entire length and circumference of the anal canal, allowing a more useful physiological assessment of anorectal function.


Assuntos
Doenças do Ânus/diagnóstico , Manometria/métodos , Adulto , Idoso , Canal Anal/fisiopatologia , Doenças do Ânus/complicações , Doenças do Ânus/fisiopatologia , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Pressão , Doenças Retais/complicações , Doenças Retais/diagnóstico , Doenças Retais/fisiopatologia , Reto/fisiopatologia
7.
Colorectal Dis ; 15(10): e607-11, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23773540

RESUMO

AIM: Three-dimensional high-resolution anorectal manometry (3D HRAM) is a new technique that can simultaneously provide physiological and topographical data. Our aim was to assess whether it can identify anal sphincter defects by comparing it with endoanal ultrasonography (EUS) considered as the gold standard. METHOD: An anal defect on 3D HRAM was defined as a continuous circumferential area over which the pressure was < 10 mmHg during the measurement of anal resting and voluntary contraction pressure. Inter-observer agreement was also assessed. RESULTS: A total of 100 patients (93 females) with a mean age of 53.5 ± 15.3 years were included. The positive diagnosis of an anal sphincter defect using 3D HRAM and EUS was in agreement (59.3%) (κ = 0.419) of the time for the internal anal sphincter (IAS) and (55.9%) (κ = 0.461) for the external anal sphincter (EAS). The inter-observer agreement for a diagnosis of an anal sphincter defect was (100%) (κ = 0.937) for the IAS and (95%) (κ = 0.751) for the EAS. The intra-class correlation coefficient for the extent of the defect was 0.853 for the IAS and 0.651 for the EAS. CONCLUSION: The preliminary results demonstrate some level of agreement in the diagnosis of anal sphincter defects between 3D HRAM and EUS but insufficient for 3D HRAM to be adequately reliable using the criteria chosen. The excellent inter-observer agreement, however, demonstrates that 3D HRAM is reproducible and provides a new dimension for the evaluation of sphincter function.


Assuntos
Doenças do Ânus/diagnóstico por imagem , Doenças do Ânus/fisiopatologia , Endossonografia , Imageamento Tridimensional , Manometria/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão
8.
Endoscopy ; 44(5): 539-42, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22389233

RESUMO

Recent developments in therapeutic endoscopic ultrasound (EUS) have enabled new approaches to the management of refractory gastrointestinal bleeding, including EUS-guided sclerotherapy and vessel embolization. Few cases have been reported in the literature. Eight patients were admitted for severe, refractory gastrointestinal bleeding, seven of whom were actively bleeding. Causes of bleeding were gastric varices secondary to portal hypertension (n = 3); gastroduodenal artery aneurysm or fundal aneurysmal arterial malformation (n = 3); and Dieulafoy's ulcer (n = 2); the latter five patients having arterial bleeding. During the procedures, the bleeding vessel was punctured with a 19-gauge needle then injected with a sclerosing agent (cyanoacrylate glue [n = 6] or polidocanol 2 % [n = 2]) under Doppler control. The median follow-up time was 9 months (3 - 18 months). In all 10 endoscopic procedures were performed. The procedure was successful at the first attempt in seven out of eight patients (87.5 %). No clinical complications were observed, although in one case there was diffusion of cyanoacrylate in the hepatic artery. The seven successful cases all showed immediate and complete disappearance of the Doppler flow signal at the end of the procedure. This retrospective study highlights the utility of EUS-guided vascular therapy. However, more large randomized studies should be conducted to confirm these results.


Assuntos
Endossonografia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica , Soluções Esclerosantes/administração & dosagem , Ultrassonografia de Intervenção , Idoso de 80 Anos ou mais , Cianoacrilatos/administração & dosagem , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Injeções Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Polidocanol , Polietilenoglicóis/administração & dosagem , Adesivos Teciduais/administração & dosagem
9.
J Crohns Colitis ; 15(3): 432-440, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32969469

RESUMO

BACKGROUND: Better patient knowledge on inflammatory bowel disease [IBD] could improve outcome and quality of life. The aim of this study was to assess if an education programme improves IBD patients' skills as regards their disease. METHODS: The GETAID group conducted a prospective multicentre randomised controlled study. IBD patients were included at diagnosis, or after a significant event in the disease course. Patients were randomised between 'educated' or control groups for 6 months. Education was performed by trained health care professionals. A psycho-pedagogic score [ECIPE] was evaluated by a 'blinded' physician at baseline and after 6 and 12 months [M6 and M12]. The primary endpoint was the increase of ECIPE score at M6 of more than 20%. RESULTS: A total of 263 patients were included in 19 centres (male:40%; median age:30.8; Crohn's disease [CD]:73%). Of these, 133 patients were randomised into the educated group and 130 into the control group. The median relative increase in ECIPE score at M6 was higher in the educated group as compared with the control group (16.7% [0-42.1%] vs 7% [0-18.8%], respectively, p = 0.0008). The primary endpoint was met in 46% vs 24% of the patients in the educated and control groups, respectively [p = 0.0003]. A total of 92 patients met the primary endpoint. In multivariate analysis, predictors of an increase of at least 20% of the ECIPE score were randomisation in the educated group (odds ratio [OR] = 2.59) and no previous surgery [OR = 1.92]. CONCLUSIONS: These findings support the set-up of education programmes in centres involved in the management of IBD patients.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Doenças Inflamatórias Intestinais/epidemiologia , Educação de Pacientes como Assunto , Autogestão , Adulto , Avaliação Educacional , Feminino , França/epidemiologia , Humanos , Masculino , Estudos Prospectivos
10.
Gastroenterol Clin Biol ; 34(4-5): 329-31, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20510559

RESUMO

Intramural esophageal dissection is a rare disorder characterized by extensive laceration between the mucosal and submucosal layers of the esophageal wall, but without perforation. The etiology of intramural dissection of the esophagus remains uncertain. Conservative management is usually considered adequate. Only one case of circumferential intramural esophageal dissection has been reported previously. We report here on a case due to an infectious cause (paryngeal abscess) that is also an unusual example of circumferential intramural esophageal dissection, which was then treated by endoscopic transection of the true internal esophageal wall and bougienage dilation.


Assuntos
Abscesso/complicações , Doenças do Esôfago/etiologia , Doenças do Esôfago/terapia , Esofagoscopia , Doenças Faríngeas/complicações , Adulto , Cateterismo , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Humanos , Masculino
11.
Ann Dermatol Venereol ; 137(1): 12-20, 2010 Jan.
Artigo em Francês | MEDLINE | ID: mdl-20110063

RESUMO

BACKGROUND: The cutaneous adverse effects of TNFalpha inhibitors and their potential implication in the onset of associated dermatoses remain poorly understood. PURPOSE: To describe the different clinical dermatological situations seen in patients treated with TNFalpha inhibitors. PATIENTS AND METHODS: We conducted a prospective, observational study of patients followed at the Dermatology Department of the CHU Nord university teaching hospital of Marseilles. All patients, referred by various departments, were treated with TNFalpha inhibitors and presented cutaneous events. RESULTS: Forty-one patients were included in the study. Various cutaneous manifestations were observed, including: 15 psoriatic rashes, six skin infections, three eczema rashes, three cases of lupic syndrome, two anaphylactic reactions to infusion and two cutaneous drug reactions. An original case of parapsoriasis was observed. Cutaneous tumors are rarely described. DISCUSSION: This study confirms the multiple clinical dermatological situations observed in patients treated with TNFalpha inhibitors and illustrates the need for good coordination between dermatologists and other specialists in order to ensure optimal management of this population.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Toxidermias/etiologia , Imunoglobulina G/efeitos adversos , Imunossupressores/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anafilaxia/induzido quimicamente , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Toxidermias/epidemiologia , Eczema/induzido quimicamente , Etanercepte , Feminino , Humanos , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Infliximab , Lúpus Eritematoso Cutâneo/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores do Fator de Necrose Tumoral/uso terapêutico , Dermatopatias Infecciosas/etiologia , Dermatopatias Papuloescamosas/induzido quimicamente , Adulto Jovem
12.
Gastroenterol Clin Biol ; 33(10-11 Suppl): F7-11, 2009 Oct.
Artigo em Francês | MEDLINE | ID: mdl-19762184

RESUMO

The risk of colorectal cancer in case of IBD-related pancolitis reaches 2% after 10 years follow-up, 8% after 20 years up to 18% at 30 years, and was probably over-estimated in the first series. Chromoendoscopy appears to be helpful in the surveillance of IBD, and moreover recommended, using carmine indigo or methylene blue with a well-standardized procedure. Its place regarding other techniques like virtual coloration has to be clarified with randomized studies. The chromoendoscopy allows the operator to perform targeted biopsies, which appear to be more efficient for the detection of dysplasia than systematic biopsies performed every 10 cm. Nevertheless, it is too soon to remove systematic biopsies from scientific recommendations.


Assuntos
Colonoscopia/métodos , Corantes , Doenças Inflamatórias Intestinais/patologia , Azul de Metileno , Biópsia/métodos , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer , Medicina Baseada em Evidências , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e Especificidade
13.
Gastroenterol Clin Biol ; 33(3): 210-6, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18952390

RESUMO

OBJECTIVE: The aim of this study was to investigate the clinical progression of patients who had severe acute pancreatitis (AP) and a stay in hospital of more than a month. METHODS: A total of 24 patients (median age: 57 years) were included in this eight-year retrospective study. Cure was defined as the restoration of the pancreatic parenchyma, and the disappearance of all pseudocysts and pancreatic fistulae. Data including the duration of hospital stay, disease severity and pancreatic sequelae were also collected. RESULTS: The median total duration of the hospital stay was 67 days. The overall mortality rate was 20.8%, whereas the mortality rate due to AP was 12.5%. The average healing period was 7.7 months. On univariate analysis, patients who also had respiratory diseases, chronic alcoholism, necrotizing superinfection, pseudocyst, food intolerance and/or hospital-acquired infection took significantly longer to heal. After cure, we observed pancreatic and/or hepatic duct stenoses in 50% of cases, and the onset or aggravation of diabetes in 25%. CONCLUSION: In patients hospitalized for more than one month because of necrotizing AP, the rate of mortality is around 20%, with a final hospital stay of two months and a healing period of more than seven months. In addition, half of the patients presented with pancreatic or biliary sequelae.


Assuntos
Tempo de Internação/estatística & dados numéricos , Pancreatite/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
14.
Endoscopy ; 40(4): 284-90, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18389446

RESUMO

BACKGROUND AND STUDY AIM: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination. PATIENTS AND METHODS: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas. RESULTS: The miss rates for polyps, adenomas, polyps > or = 5 mm, adenomas > or = 5 mm, and advanced adenomas were, respectively, 28 %, 20 %, 12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 % and 26 % but the corresponding rates were 23 % and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (> or = 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate. CONCLUSIONS: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.


Assuntos
Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Erros de Diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Gravação em Vídeo
15.
Gastroenterol Clin Biol ; 32(10): 806-12, 2008 Oct.
Artigo em Francês | MEDLINE | ID: mdl-18538966

RESUMO

Endoscopic treatment of pancreatic pseudocysts and choledocal lithiasis is a first-line treatment in adults. Nevertheless, due to technical difficulties such a management is not always feasible in children. This series reports our results in the management of pancreatic and biliary diseases in children. Seven children, two months to 12 years old, underwent endoscopic management of pancreatic and biliary diseases. Two of them had choledocal lithiasis with jaundice or acute pancreatitis, two had pancreatic pseudocyst due to abdominal traumatism, two had chronic pancreatitis with a communicating pseudocyst in one case, and one had a biliary leakage after traumatism. All the endoscopic treatments were performed under general anesthesia. In six cases, the duodenoscope was a regular one with a large operating channel (Olympus TJF 160; Japan) employed for children aged 33 months to 12 years. In the case of the two months child, a "rendez-vous" technique was performed with a percutaneous approach of the common bile duct followed by an endoscopic sphincteroclasy using an axial endoscope allowing the extraction of a choledocal stone. In two cases, post-traumatic pancreatic pseudocysts (eight and 12 year-old children) were managed with the transgastric insertion of two double pig-tail stents. In two cases, children with chronic pancreatitis (38 months and 12 years old) were managed with pancreatic sphincterotomy. Biliary leakage in an 11-year-old child was managed with biliary sphincterotomy and stenting. All the children became symptom-free without any procedural complications with an 11 months median follow-up. Endoscopic treatment of pancreatic and biliary diseases is possible in children like in adults with the same procedures and results.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Endoscopia Gastrointestinal , Pancreatopatias/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de Doença
16.
Gastroenterol Clin Biol ; 32(2): 128-33, 2008 Feb.
Artigo em Francês | MEDLINE | ID: mdl-18494154

RESUMO

INTRODUCTION: Treatment of pancreatic postoperative collections are usually managed with a multidisciplinary team. Different managements are possible: abstention, external drainage, endoscopic treatment or surgery. METHODS: We report on a case series of five patients with a postoperative pancreatic collection, endoscopically managed. Patients underwent all a CT scan associated or not with endoscopic ultrasonography. RESULTS: An endoscopic cystenterosotomy was performed in all the cases, with two double pig tail stents sometimes associated with nasocystic drainage for clearing the cyst lumen and with transpapillary drainage in one case. All the procedures were successful and patients healed in all the cases with the disappearance of the radiological image within a 33 days to three months range with one complication due to superinfection of the drained cyst, endoscopically managed with a nasocystic catheter. CONCLUSION: Therapeutic endoscopy, with a multidisciplinary approach, is a promising way to manage postoperative pancreatic collections.


Assuntos
Drenagem/métodos , Endoscopia do Sistema Digestório , Exsudatos e Transudatos , Pancreatectomia , Complicações Pós-Operatórias/cirurgia , Adenocarcinoma/cirurgia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Cistadenoma Mucinoso/cirurgia , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia , Pseudocisto Pancreático/cirurgia , Esplenectomia , Tomografia Computadorizada por Raios X
17.
Endoscopy ; 39(6): 535-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17554650

RESUMO

BACKGROUND AND STUDY AIM: The learning curve for endoscopic ultrasonography (EUS) is known to be difficult, especially in the field of pancreatic and biliary diseases. The aim of this study was to assess the impact of a live pig model developed for EUS credentialing in France. METHODS: A total of 17 trainees obtained hands-on EUS experience using a live pig model. Trainees were asked to visualize anatomical structures, to carry out fine-needle aspiration (FNA) on lymph nodes in the liver hilum, and to perform celiac neurolysis. Assessment of the FNA procedure or celiac neurolysis included measurement of time (seconds), evaluation of the precision of the puncture (mm), and existence of technical errors. RESULTS: A significant improvement between a pre-test and post-test was observed for diagnostic procedures in the following anatomical areas: splenic mesenteric vein, vena cava, splenic mesenteric artery, celiac tree, pancreatic gland, and bile duct. For lymph node FNA, a significant improvement was observed in the duration of the procedure (84 seconds vs. 60 seconds; P = 0.01), and precision (4.2 mm vs. 1.8 mm; P = 0.009), but not for the rate of technical error (29% vs. 6%; not significant [n. s.]). For celiac neurolysis, a significant improvement was observed in procedure time (150 seconds vs. 84 seconds; P = 0.003), but not in the rate of technical error (6% vs. 6%; n. s.) or precision (4.2 mm vs. 2.8 mm; n. s.). CONCLUSION: Teaching EUS with a live pig model significantly increased competence in diagnostic procedures with regard to visualizing anatomical structures, performance of FNA and, to a lesser extent, EUS-guided celiac neurolysis.


Assuntos
Educação Médica Continuada/métodos , Endossonografia , Ensino/métodos , Animais , Ductos Biliares/diagnóstico por imagem , Biópsia por Agulha Fina/métodos , Vasos Sanguíneos/diagnóstico por imagem , Competência Clínica , Credenciamento , França , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Modelos Animais , Procedimentos Neurocirúrgicos/educação , Pâncreas/diagnóstico por imagem , Estudos Prospectivos , Circulação Esplâncnica , Suínos
19.
World J Gastroenterol ; 13(16): 2312-8, 2007 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-17511029

RESUMO

AIM: Anti-Saccharomyces cerevisiae antibodies (ASCA), anti-nuclear associated anti-neutrophil antibodies (NANA) and antibodies to exocrine pancreas (PAB), are serological tools for discriminating Crohn's disease (CrD) and ulcerative colitis (UC). Like CrD, coeliac disease (CoD) is an inflammatory bowel disease (IBD) associated with (auto) antibodies. Performing a multicenter study we primarily aimed to determine the performance of ASCA, NANA and PAB tests for IBD diagnosis in children and adults, and secondarily to evaluate the prevalence of these markers in CoD. METHODS: Sera of 109 patients with CrD, 78 with UC, 45 with CoD and 50 healthy blood donors were retrospectively included. ASCA, NANA and PAB were detected by indirect immunofluorescence (IIF). RESULTS: ASCA+/NANA- profile displayed a positive predictive value of 94.2% for CrD. Detection of ASCA was correlated with a more severe clinical profile of CrD and treatment of the disease did not influence their serum levels. ASCA positivity was found in 37.9% of active CoD. PAB were found in 36.7% CrD and 13.3% CoD patients and were not correlated with clinical features of CrD, except with an early onset of the disease. Fifteen CrD patients were ASCA negative and PAB positive. CONCLUSION: ASCA and PAB detected by IIF are specific markers for CrD although their presence does not rule out a possible active CoD. The combination of ASCA, NANA and PAB tests improves the sensitivity of immunological markers for CrD. Repeating ASCA, NANA, and PAB testing during the course of CrD has no clinical value.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Anticorpos Antinucleares/sangue , Anticorpos Antifúngicos/sangue , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/imunologia , Pâncreas Exócrino/imunologia , Saccharomyces cerevisiae/imunologia , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Doença Celíaca/sangue , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Criança , Doença Crônica , Estudos de Coortes , Colite Ulcerativa/sangue , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/imunologia , Doença de Crohn/sangue , Doença de Crohn/diagnóstico , Doença de Crohn/imunologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Técnica Indireta de Fluorescência para Anticorpo/métodos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Artigo em Inglês | MEDLINE | ID: mdl-27891706

RESUMO

BACKGROUND: Three-dimensional high-resolution anorectal manometry (3DHRAM), used for exploring anorectal disorders, was recently developed, providing interesting topographic data for the diagnosis of pelvic floor disorders such as excessive perineal descent. The aim of our study was to define a diagnostic strategy based on selected 3DHRAM parameters to identify rectal intussusceptions (RI), considering conventional defecography (CD) as the gold standard. METHODS: All patients referred to our center in the previous 6 months for 3DHRAM to explore fecal incontinence or constipation, and who previously achieved CD, were eligible. 3DHRAM results were obtained for all classical parameters and the presence of a narrow band of high pressure in the anal canal during attempted defecation, which was recently found to be associated with RI in some studies. The sensitivity, specificity, and positive and negative predictive values were calculated for various 3DHRAM criterion in order to propose a diagnostic strategy for RI. KEY RESULTS: Twenty-six patients (66%) presented with RI on CD. On 3DHRAM, according to our diagnostic strategy, the most relevant manometric criterion for the diagnosis of RI was the association of an anterior additional high-pressure area and an excessive perineal descent, with a positive predictive value of 100% [81.5-100], a specificity of 100% [75.3-100] and a sensibility of 69.2% [48.2-85.7]. CONCLUSIONS & INFERENCES: In this study, 3DHRAM was used to diagnose RI, and we confirmed its use in the diagnosis of pelvic floor disorders. Further studies will be necessary to define classifications for these new anatomic data from 3DHRAM.


Assuntos
Canal Anal/diagnóstico por imagem , Defecografia/métodos , Imageamento Tridimensional/métodos , Intussuscepção/diagnóstico por imagem , Manometria/métodos , Doenças Retais/diagnóstico por imagem , Adulto , Idoso , Canal Anal/fisiopatologia , Constipação Intestinal/diagnóstico por imagem , Constipação Intestinal/fisiopatologia , Defecação/fisiologia , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Intussuscepção/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Retais/fisiopatologia , Estudos Retrospectivos
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