Un anneau préalable augmente la morbidité et le taux de fistules gastriques après gastrectomie longitudinale coelioscopique pour obésité

Dans certains cas une gastrectomie longitudinale cœlioscopique (GLC) pour obésité est réalisée après l'échec d'un anneau périgastrique. Le but de cette étude était d'évaluer l'impact d'un antécédent d'anneau périgastrique préalable sur la morbidité après gastrectomie longitudinale secondaire pour obésité. Une étude rétrospective sur 140 patients consécutifs ayant eu une GLC a été réalisée. L'intervention était standardisée. Deux groupes étaient comparés : les patients ayant eu une GLC secondaire après anneau (n=37) et les patients ayant eu une GLC de première intention (n=103). Les critères de jugement étaient la morbidité globale et les complications per et postopératoires, incluant les fistules gastriques par désunion de la ligne d'agrafes et les autres complications septiques ou hémorragiques. Des analyses uni et multivariées étaient réalisées pour rechercher des facteurs de risque indépendants de morbidité. La morbidité globale était significativement plus élevée dans le groupe de patients ayant eu une GLC après anneau que dans le groupe de patients ayant eu une GLC de première intention (35,1% vs 10,7%, p<=0,001). Les fistules gastriques par désunion de la ligne d'agrafes étaient aussi significativement plus fréquentes chez les patients ayant un antécédent d'anneau (21,6% vs 2,9%, p=0,001). L'ablation de l'anneau six mois avant la GLC n'empêchait pas une surmorbidité significative par rapport à la GLC de première intention. L'analyse multivariée a montré que, parmi les facteurs analysés (âge, sexe, comorbidités, index de masse corporelle, anneau gastrique préalable), deux facteurs indépendants de désunion de la ligne d'agrafes ressortaient : la présence d'un anneau posé avant la GLC avec un odd ratio=13 et un intervalle de confiance à 95%=(2,9-57,6) et le sexe masculin avec un odd ratio=4,2, et un intervalle de confiance à 95%=(1-17,3). La présence d'un anneau périgastrique préalable augmente le risque de complications après GLC. Il convient soit d'en prévenir le patient porteur d'anneau qui doit subir une GLC, soit de préférer une GLC de première intention.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Microbial markers in colorectal cancer detection and/or prognosis

International audienceColorectal cancer (CRC) is the second leading cause of cancer worldwide. CRC is still associated with a poor prognosis among patients with advanced disease. On the contrary, due to its slow progression from detectable precancerous lesions, the prognosis for patients with early stages of CRC is encouraging. While most robust methods are invasive and costly, actual patient-friendly screening methods for CRC suffer of lack of sensitivity and specificity. Therefore, the development of sensitive, non-invasive and cost-effective methods for CRC detection and prognosis are necessary for increasing the chances of a cure. Beyond its beneficial functions for the host, increasing evidence suggests that the intestinal microbiota is a key factor associated with carcinogenesis. Many clinical studies have reported a disruption in the gut microbiota balance and an alteration in the faecal metabolome of CRC patients, suggesting the potential use of a microbial-based test as a non-invasive diagnostic and/or prognostic tool for CRC screening. This review aims to discuss the microbial signatures associated with CRC known to date, including dysbiosis and faecal metabolome alterations, and the potential use of microbial variation markers for non-invasive early diagnosis and/or prognostic assessment of CRC and advanced adenomas. We will finally discuss the possible use of these markers as predicators for treatment response and their limitations

Acute Thrombotic Mesenteric Ischemia: Primary Endovascular Treatment in Eight Patients

International audienc

Effet des souches d’E. coli pathogènes sur les défense antioxydantes des entérocytes et impact sur la carcinogenèse colique: approche microscopique

National audienc

Microbiota & Cancer: Between detection and prognosis

International audienc

Interactions between microsatellite instability and human gut colonization by Escherichia coli in colorectal cancer

Recent studies suggest that colonization of colonic mucosa by pathogenic Escherichia coli could be involved in the development of colorectal cancer (CRC), especially through the production of genotoxins such as colibactin and/or by interfering with the DNA mismatch repair (MMR) pathway that leads to microsatellite instability (MSI). The present study, performed on 88 CRC patients, revealed a significant increase in E. coli colonization in the MSI CRC phenotype. In the same way, E. coli persistence and internalization were increased in vitro in MMR-deficient cells. Moreover, we demonstrated that colibactin-producing E. coli induce inhibition of the mutL homologue 1 (MLH1) MMR proteins, which could lead to genomic instability. However, colibactin-producing E. coli were more frequently identified in microsatellite stable (MSS) CRC. The present study suggests differences in the involvement of colibactin-producing E. coli in colorectal carcinogenesis according to the CRC phenotype. Further host-pathogen interactions studies should take into account CRC phenotypes

Determination of biomarkers associated with neoadjuvant treatment response focusing on colibactin-producing Escherichia coli in patients with mid or low rectal cancer: a prospective clinical study protocol (MICARE)

Introduction The management of mid and low rectal cancer is based on neoadjuvant chemoradiotherapy (CRT) followed by standardised surgery. There is no biomarker in rectal cancer to aid clinicians in foreseeing treatment response. The determination of factors associated with treatment response might allow the identification of patients who require tailored strategies (eg, therapeutic de-escalation or intensification). Colibactin-producing Escherichia coli (CoPEC) has been associated with aggressive colorectal cancer and could be a poor prognostic factor. Currently, no study has evaluated the potential association between intestinal microbiota composition and tumour response to CRT in mid and low rectal cancer. The aim of this study is to assess the association between response to neoadjuvant CRT and faecal intestinal microbiota composition and/or CoPEC prevalence in patients with mid or low rectal cancer.Methods and analysis This is a non-randomised bicentric prospective clinical study with a recruitment capacity of 200 patients. Three stool samples will be collected from participants with histological-proven adenocarcinome of mid or low rectum who meet eligibility criteria of the study protocol: one before neoadjuvant treatment start, one in the period between CRT end and surgery and one the day before surgery. In each sample, CoPEC will be detected by culture in special media and molecular (PCR) approaches. The global microbiota composition will be also assessed by the bacterial 16S rRNA gene sequencing. Neoadjuvant CRT response and tumour regression grade will be described using the Dworak system at pathological examination. Clinical data and survival outcomes will also be collected and investigated.Ethics and dissemination MICARE was approved by the local ethics committee (Comité de Protection des Personnes Sud-Est II, 18 December 2019. Reference number 2019-A02493-54 and the institutional review board. Patients will be required to provide written informed consent. Results will be published in a peer reviewed journal.Trial registration number NCT04103567

Etude de la valeur pronostique de facteurs innovants (microbiote intestinal, sarcopénie, obésité, syndrome métabolique) sur les résultats chirurgicaux du cancer colorectal

International audienc

Endoscopy-based management within the first year after surgery decreases the risk of clinical and surgical postoperative recurrences in Crohn's disease

Endoscopy-based management within the first year after surgery decreases the risk of clinical and surgical postoperative recurrences in Crohn's disease. 11. Congress of European Crohn's and Colitis Organisatio