Mucosectomie colorectale fragmentaire étendue pour des tumeurs dépassant 4 cm

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude prostpective et descriptive de la prescription des inhibiteurs de la pompe à protons dnas un service de médecine

INTRODUCTION: Les inhibiteurs de la pompes à protons (IPP) constituent une classe médicamenteuse largement prescrite. En 2010, les prescriptions d'IPP ont généré une dépense évalué à 643 483 637 EUR selon les données de la CPAM. L'objectif de ce travail était d'effectuer un état des lieux de la prescription des IPP, afin d'évaluer la part des prescriptions injustifiées. PATIENTS ET METHODES: Il s'agit d'une étude prospective, incluant tous les patients hospitalisés dans le service sur 15 semaines consécutive. Concernant les patients traités par IPP, les données ont été recensées à partir d'un questionnaire standardisé comportant: la nature, la posologie, la durée, l'horaire de la prise, le médecin prescripteur et l'indication du traitement. RESULTATS: 244 patients, d'âge moyen 62 ans, ont été hospitalisés dans le service pendant la période considérée; 82 (soit 34%) ont reçu un traitement par IPP. Dans 51% (42/82) des cas l'indication n'entrait pas dans le cadre de l'autorisation de mise sur le marché (AMM). La prévention des lésions gastro-intestinales sous antiagrégant plaquettaire ou corticoïdes était la principale cause (50%). Seulement 12% (10/82) des patients prenaient leur IPP le matin et à jeun conformément aux recommandations. La posologie (dose quotidienne et/ou durée du traitement) était inadéquate dans 20% des cas. CONCLUSION: Notre étude confirme la large prescription des IPP, avec un non-respect de l'AMM dans la moitié des cas. La posologie et le moment de la prise contribuent au mésusage des IPP. Il est primordial à l'heure actuelle de sensibiliser les différents acteurs de santé (médecins et patients) à l'utilisation rationnelle des IPP.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

De la Danse du Lion au Wu Shu: la médiation interculturelle à La Réunion et à Taiwan

International audienc

Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication.

INTRODUCTION: Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % - 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. METHODS: A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow - Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. RESULTS: HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. CONCLUSION: POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

AIM: To evaluate the feasibility and the outcome of endoscopic mucosal resection (EMR) for large colorectal tumors exceeding 4 cm (LCRT) undergoing piecemeal resection

[Ectopic pancreas: an exceptional cause of lower intestinal bleeding with hemorrhagic shock]

International audienc

A Prospective Comparative Study of Blended and Pure Coagulation Current in Endoscopic Mucosal Resection of Large Sessile Colorectal Polyps

Background:The aim of this study was to compare pure coagulation and blended current in the resection of large colorectal sessile polyps (SPs). Patients and Methods:Between January 2009 and June 2012, 84 patients (45 men, 39 women; median age 66 y; range, 42 to 88 y) with large colorectal SPs (diameter 2 cm) were randomized in 1:1 ratio to undergo treatment by the lift and cut piecemeal resection technique. A total of 43 blended current subjects (group A) were well matched to 41 pure coagulation current subjects (group B), with a median lesion size of 3.9 cm (group A, 3.7 vs. group B, 4.2 cm; P=0.316), respectively. The rate of complications, the factors that predict complications, and the recurrence of adenoma were analyzed. Results:Complete macroscopic resection was achieved in 39 patients (90.7%) of group A and in 36 patients (87.6%) of group B (P=0.735). Argon plasma coagulation at resection's margins was performed in 10 patients (23.2%) of group A and in 14 patients (34.1%) of group B (P=0.269). Eight patients (9.5%) [group A, n=3 patients (7.1%) vs. group B, n=5 patients (12%); P=0.756] developed immediate (4) or delayed (4) bleeding. Four patients with bleeding were under treatment with selective serotonin reuptake inhibitors. All bleedings were successfully treated conservatively or with endoclipping and heater probe application. Perforation occurred in 1 patient of each group and was managed by clips closure and antibiotics and right hemicolectomy, respectively. Postpolypectomy syndrome was observed in 2 patients (4.6%) of group A and 3 patients (7.3%) of group B (P=0.834). In 3 patients, the histopathologic analysis of resected SPs revealed invasive carcinoma, and surgical resection was performed in 1 patient. Two patients refused operation. Among the patients who underwent follow-up surveillance colonoscopy, a total recurrence rate of 25.67% of adenomas with no difference was observed between the 2 groups [group A, n=8 patients (21.6%) vs. group B, n=11 patients (31.4%); P=0.345]. Recurrence of adenoma was observed in 12 patients (16.22%) without and in 7 patients (9.46%) with argon plasma coagulation treatment. Conclusions:No difference was found in the rate of complications between the 2 types of current used in the resection of large colorectal SPs. However, an influence of selective serotonin reuptake inhibitors on postpolypectomy bleeding was observed, which deserves further investigation