Fistules post sleeve gastrectomie (Évaluation multicentrique de l'efficacité du traitement endoscopique)

Buts: 1) évaluer l'efficacité de l'endoscopie interventionnelle dans le traitement des fistules post-Sleeve gastrectomie (SG), 2) décrire les techniques endoscopiques et leurs complications, 3) préciser les facteurs prédictifs de cicatrisation endoscopique. Matériels et Méthodes: Des malades ayant une fistule post-SG ont été inclus dans une série rétrospective multicentrique. Les procédures thérapeutiques et leurs complications ont été colligées, les délais et les modes de cicatrisation ont été précisés. Les facteurs prédictifs de cicatrisation endoscopique ont été recherchés en analyse univariée puis multivariée. Résultats: 104 malades issus de 6 centres et ayant une fistule post-SG ont été inclus rétrospectivement. 6% des patients ont cicatrisé spontanément, 74% après traitement endoscopique et 19% après traitement chirurgical; un malade est décédé avant cicatrisation. L'efficacité du traitement endoscopique était maximale dans les 3 mois de traitement Entre le 6ème et le 12ème mois, 50 % des cicatrisations étaient obtenues après chirurgie et 50 % après endoscopie; après le 12ème mois, 60 % des cicatrisations étaient obtenues après chirurgie, 40 % après endoscopie. Trois facteurs prédictifs de cicatrisation après traitement endoscopique ont été identifiés en analyse multivariée: 1) un délai court entre le diagnostic de fistule et la 1 ère endoscopie < 21 jours) (p=0,007), 2) la petite taille de la fistule, (p=O,O1) et 3) l'encollage per-opératoire de la ligne d'agrafage (p=O,047). Conclusion: Le traitement endoscopique est efficace'datts le traitement des fistules post-SG, surtout s'il est réalisé précocement. Dans les 6 premiers mois, l'endoscopie interventionnelle doit être privilégiée; au-delà, le recours au traitement chirurgical est préfërable. Des études prospectives randomisées sont nécessaires pour confirmer ces observations rétrospectivesMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Intérêt de laVidéocapsule endoscopique dans le diagnostic précoce de la réaction du greffon contre l'hôte en transplantation de cellules souches hématopoïetiques

La réaction du greffon contre l'hôte (GVH) en transplantation de cellules souches hématopoïétiques est source d'une importante morbi-mortalité. Le praticien en hématologie est confronté à la difficulté diagnostique devant une symptomatologie clinique aspécifique. Dans cette étude, nous proposions un dépistage précoce systématique de la GVH digestive aiguë par Vidéocapsule endoscopique, quelque soit la symptomatologie du patient. En cas de lésion, les patients étaient explorés par endoscopie haute et/ou basse, avec réalisations de biopsies multiples. Il n'y avait pas de corrélation entre la symptomatologie clinique et les constatations en Vidéocapsule. Il n'y avait pas de corrélation entre Vidéocapsule et endoscopie/biopsies. Enfin aucun patient n'avait développé de GVH digestive dans les 60 premiers jours. Sous réserve d'un effectif réduit, cette étude ne permettait pas de recommander la Vidéocapsule comme examen de dépistage précoce de la GVH digestive aiguë.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Anémie pernicieuse et hépatite chronique virale C (étude de cas cliniques et revue de la littérature)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Reply to Rebibo et al.

International audienc

Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding

ABSTRACT: Aim. To perform an updated meta-analysis comparing β-blockers (BB) with endoscopic variceal banding ligation (EVBL) in the primary prophylaxis of esophageal variceal bleeding.Material and methods. Randomized controlled trials were identified through electronic databases, article reference lists and conference proceedings. Analysis was performed using both fixed-effect and random-effect models. Heterogeneity and publication bias were systematically taken into account. Main outcomes were variceal bleeding rates and all-cause mortality, calculated overall and at 6, 12, 18 and 24 months.Results. 19 randomized controlled trials were analyzed including a total of 1,483 patients. Overall bleeding rates were significantly lower for the EVBL group: odds ratio (OR) 2.06, 95% confidence interval (CI) [1.55-2.73], p < 0.0001, without evidence of publication bias. Bleeding rates were also significantly lower at 18 months (OR 2.20, 95% CI [1.04-4.60], P = 0.04), but publication bias was detected. When only high quality trials were taken into account, results for bleeding rates were no longer significant. No significant difference was found for either bleeding-related mortality or for all-cause mortality overall or at 6, 12, 18 or 24 months. BB were associated with more frequent severe adverse events (OR 2.61, 95% CI 1.60-4.40, P < 0.0001) whereas fatal adverse events were more frequent with EVBL (OR 0.14, 95% CI 0.02-0.99, P = 0.05).Conclusion. EVBL appears to be superior to BB in preventing the first variceal bleed, although this finding may be biased as it was not confirmed by high quality trials. No difference was found for mortality. Current evidence is insufficient to recommend EVBL over BB as first-line therapy

Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis

AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding

Detection of soluble biomarkers of pancreatic cancer in endoscopic ultrasoundguided fine-needle aspiration samples

International audienceBackground: Biomarkers are urgently needed for pancreatic ductal adenocarcinoma (PDAC). Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the cornerstone for diagnosing PDAC. We developed a method for discovery of PDAC biomarkers using the discarded EUS-FNA liquid.Methods: This retrospective study included 58 patients with suspected pancreatic lesions who underwent EUS-FNA. Protein extracts from EUS-FNA liquid were analyzed by mass spectrometry. Proteomic and clinical data were modeled by supervised statistical learning to identify protein markers and clinical variables that distinguish PDAC.Results: Statistical modeling revealed a protein signature for PDAC screening that achieved high sensitivity and specificity (0.92, 95 % confidence interval [CI] 0.79-0.98, and 0.85, 95 %CI 0.67-0.93, respectively). We also developed a protein signature score (PSS) to guide PDAC diagnosis. In combination with patient age, the PSS achieved 100 % certainty in correctly identifying PDAC patients > 54 years. In addition, 3 /4 inconclusive EUS-FNA biopsies were correctly identified using PSS.Conclusions: EUS-FNA-derived fluid is a rich source of PDAC proteins with biomarker potential. The PSS requires further validation and verification of the feasibility of measuring these proteins in patient sera

Refractory ulcerative proctitis: How to treat it?

International audienceUlcerative proctitis is defined as a mucosal inflammation limited to the rectum. Ulcerative proctitis is responsible for distressing symptoms and alteration of patient quality of life. Effective treatment is important to prevent or delay proximal extension of the disease and to improve quality of life. Refractory ulcerative proctitis is defined as the failure of topical and oral 5-aminosalicylic acid and corticosteroids. Medical management of refractory ulcerative proctitis may be challenging as there is little evidence regarding drug efficacy in this clinical situation. Data are currently available for azathioprine, topical tacrolimus and anti-TNF monoclonal antibodies as rescue treatment for refractory ulcerative proctitis. Other biologics may be of benefit despite a lack of dedicated clinical trials. Ultimately, experimental therapies such as epidermal growth factor enemas, appendectomy or fecal transplantation may be tried before restorative proctocolectomy with J pouch anastomosis, which has demonstrated good results with regards to clinical remission and quality of life

Oral vancomycin induces sustained deep remission in adult patients with ulcerative colitis and primary sclerosing cholangitis

International audienceUlcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. The treatment of UC is challenging, especially when it is associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the bile ducts that affects around 5% of patients with UC, and leads to an increased risk of cholangiocarcinoma and colorectal cancer. Microbiota is considered to play an important role in the pathogenesis of UC, although the efficacy of antibiotics in this context is only limited and transient. Several studies have investigated the use of antibiotics for the treatment of PSC in adult and pediatric populations, with conflicting results. In this brief report, we describe the effect of oral vancomycin treatment in three patients with UC and PSC refractory to conventional and biologic therapies. All three patients achieved clinical remission and mucosal healing with vancomycin 500 mg twice a day administered orally. Maintenance treatment with oral vancomycin was well tolerated and led to sustained clinical and endoscopic remission in all three patients. Oral vancomycin also improved liver function tests in two patients who did not have pre-existing cirrhosis