130 research outputs found

    Definition and diagnostic methods for Barrett’s esophagus

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    L’oesophage de Barrett ou endobrachyoesophage (EBO) est le remplacement de la muqueuse malpighienne de l’oesophage par une métaplasie glandulaire. Son diagnostic repose sur la combinaison d’une suspicion endoscopique et d’une confirmation histologique. L’EBO est un facteur de risque reconnu de l’adénocarcinome oesophagien, et il est considéré comme une condition pré-cancéreuse pouvant évoluer chez certains patients selon une séquence métaplasie – dysplasie – cancer. Du fait de son potentiel dégénératif, une surveillance endoscopique est souvent préconisée en l’absence de contre-indication à un traitement éventuel du fait du terrain. Cette surveillance vise à dépister des lésions pré-cancéreuses ou cancéreuses précoces à un stade curable. Dans cette revue générale, nous rappelons la définition de Montréal, la classification endoscopique de Prague, ainsi que les nouvelles modalités endoscopiques de dépistage et de surveillance de l’EBO.Barrett’s esophagus (BE) is a metaplastic change of the lining of the esophagus characterized by the replacement of normal squamous epithelium by a glandular epithelium. The diagnosis of BE requires both an endoscopic suspicion of esophageal metaplasia (ESEM) and a histological proof of gastric or intestinal metaplasia. BE is an established risk factor for esophageal adenocarcinoma, according to a metaplasia – low dysplasia – adenocarcinoma sequence. Therefore, an endoscopic surveillance is frequently recommended in patients without any contra-indication for potential treatment (e.g. associated life-threatening disorders). This surveillance aims at diagnosing early cancerous lesions at a curable stage. In this review, we focus on the Montreal definition, the Prague endoscopic classification and new endoscopic modalities for screening and surveillance of BE

    Endoscopic management of patients with high-risk colorectal colitis–associated neoplasia:a Delphi study

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    Background and Aims: Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis–associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high-risk CAN (HR-CAN) are often not amenable to conventional resection techniques, and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus among experts on the endoscopic management of these lesions. Methods: A 3-round modified Delphi process was conducted to reach consensus among worldwide IBD and/or endoscopy experts (n = 18) from 3 continents. Consensus was considered if ≥75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group. Results: Consensus was reached on all statements (n = 14). Experts agreed on a definition for CAN and HR-CAN. Consensus was reached on the examination of the colon with enhanced endoscopic imaging before resection, the endoscopic resectability of an HR-CAN lesion, and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment, and follow-up in HR-CAN. Conclusions: This is the first step in developing international consensus–based recommendations for endoscopic management of CAN and HR-CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of CAN and HR-CAN. The present work and proposed standardization might benefit future studies

    Second-generation colon capsule endoscopy compared with colonoscopy

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    Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the first-generation system. OBJECTIVE: To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. DESIGN AND SETTING: Prospective, multicenter trial including 8 European sites. PATIENTS: This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. INTERVENTION: CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are >/=6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. MAIN OUTCOME MEASUREMENTS: CCE-2 sensitivity and specificity for detecting patients with polyps >/=6 mm and >/=10 mm were assessed. Capsule-positive but colonoscopy-negative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. RESULTS: Per-patient CCE-2 sensitivity for polyps >/=6 mm and >/=10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. LIMITATIONS: Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. CONCLUSION: In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoid lesions, and it might be considered an adequate tool for colorectal imaging

    A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program

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    International audienceIntroduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 – 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones.Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (P < 0.001).Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp

    Colonic Biopsies to Assess the Neuropathology of Parkinson's Disease and Its Relationship with Symptoms

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    The presence of Lewy bodies and Lewy neurites (LN) has been demonstrated in the enteric nervous system (ENS) of Parkinson's disease (PD) patients. The aims of the present research were to use routine colonoscopy biopsies (1) to analyze, in depth, enteric pathology throughout the colonic submucosal plexus (SMP), and (2) to correlate the pathological burden with neurological and gastrointestinal (GI) symptoms.A total of 10 control and 29 PD patients divided into 3 groups according to disease duration were included. PD and GI symptoms were assessed using the Unified Parkinson's Disease Rating Scale part III and the Rome III questionnaire, respectively. Four biopsies were taken from the ascending and descending colon during the course of a total colonoscopy. Immunohistochemical analysis was performed using antibodies against phosphorylated alpha-synuclein, neurofilaments NF 220 kDa (NF) and tyrosine hydroxylase (TH). The density of LN, labeled by anti-phosphorylated alpha-synuclein antibodies, was evaluated using a quantitative rating score. Lewy pathology was apparent in the colonic biopsies from 21 patients and in none of the controls. A decreased number of NF-immunoreactive neurons per ganglion was observed in the SMP of PD patients compared to controls. The amount of LN in the ENS was inversely correlated with neuronal count and positively correlated with levodopa-unresponsive features and constipation.Analysis of the ENS by routine colonoscopy biopsies is a useful tool for pre-mortem neuropathological diagnosis of PD, and also provides insight into the progression of motor and non-motor symptoms

    L'endomicroscopie confocale (une nouvelle méthode d'analyse quantitative des cryptes coliques de patients sains ou atteints de maladie de Crohn)

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    Contexte : L'endomicroscopie confocale utilise des critères subjectifs, qualitatifs pour décrire les anomalies inflammatoires de la muqueuse digestive. Objectifs : Evaluer la faisabilité d'une étude quantitative architecturale des cryptes coliques et fonctionnelle de perméabilité de la muqueuse colique par endomicroscopie et comparer les résultats obtenus entre témoins sains et patients atteints de maladie de Crohn (MC). Patients et méthodes : 10 patients atteints de MC et 6 témoins sains ont été inclus. 15 images par patients ont été sélectionnées pour la réalisation de mesures architecturales (Rapport de diamètre maximal et minimal des cryptes, nommé DMc/dmc, et de la lumière des cryptes, nommé DMl/dml, distance intercrypte, diamètre vasculaire) et fonctionnelle (rapport d'intensité de fluorescence, RIF). Les mesures architecturales des cryptes étaient comparées à des mesures réalisées sur biopsies marquées au bleu de méthylène (BMBM). Résultats : Il existait une corrélation significative entre les DMl/dml et les DMc/dmc mesurés endomicroscopiquement et ceux mesurés sur BMBM (r=0,67;p=0,006 / r=0,65; p=0,009 respectivement). Les patients atteint de MC présentaient un DMl/dml significativement plus grand (p=0,016). Individuellement, 50% des patients en rémission endoscopique avaient un DMl/dml anormal par rapport à la médiane des témoins. Les mesures de distance intercrypte ne différaient pas entre les groupes. Les diamètres vasculaires étaient plus petits chez les patients avec inflammation endoscopique (p=0,02). Les RIF étaient plus importants chez les patients avec inflammation endoscopique mais de façon non significative. Conclusion : Un rapport DMl/dml supérieur à 1,7 semblerait être un bon marqueur d'inflammation colique mais doit être validé sur de plus grandes cohortes. Le développement de mesures automatisées et de l'étude fonctionnelle sont probablement à développer en endomicroscopie.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

    Neuropathies entériques (méthodes d'exploration et caractérisation dans un modèle expérimental humain de shigellose)

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    Le système nerveux entérique (SNE), constitué de neurones et de cellules gliales entériques, est un régulateur clef des fonctions digestives. Néanmoins, la nature des lésions du SNE au cours des principales pathologies digestives ainsi que le rôle de l'inflammation restent mal connus. Ce travail de thèse visait : 1) à développer une méthode permettant d'étudier les neuropathies du SNE chez l homme, et 2) à caractériser ex vivo les atteintes du SNE dans le colon humain dans un modèle d'inflammation aiguë induite par Shigella flexneri (S. flexneri) afin d'identifier les mécanismes physiopathologiques mis en cause. Dans un premier temps, nous avons montré la possibilité d'étudier le SNE sur des biopsies coliques humaines en combinant des approches immunohistochimiques et de Western blot du plexus sous-muqueux interne. Parallèlement, nous avons développé un modèle de culture organotypique afin de caractériser les interactions précoces entre le SNE et S. flexneri. Nous avons ainsi montré que S. flexneri induisait une plasticité neuronale bloquée par un inhibiteur de la NOS (L-Name), ainsi qu'une dégénérescence neuronale et gliale inhibée par un antagoniste des récepteurs NMDA au glutamate. Outre les lésions du SNE, nous avons montré que S. flexneri induisait des altérations majeures de la BEI et identifié le rôle clef de la sérine protéase SepA dans l'induction de ces lésions.The enteric nervous system (ENS) is composed of neurons and enteric glial cells. It plays a major role in the regulation of digestive functions. However, the nature of ENS lesions during the majority of digestive disease, as well as the role of inflammation, is poorly understood. The aims of this study were : 1) to develop a routine method allowing characterisation of enteric neuropathies in humans, and 2) to characterise the ENS alterations ex vivo in a human colonic model of shigella infection and identify the mechanisms involved. Firstly, we demonstrated the accuracy of human colonic biopsies to study the ENS, by combining immunohistochemical and Western blot methods. Secondly, we developed an organotypic culture model to study early interactions between the ENS and Shigella flexneri (S. flexneri), and showed that S. flexneri induced a neuronal plasticity that was bloked by NOS inhibitor (L-Name), as well as neuronal and glial damages that were prevented by NMDA receptors to glutamate. Beyond ENS alterations, we also noted a major disruption of the intestinal epithelial barrier and identified the key role of the SepA serine protease in these alterations.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF
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