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20 results on '"Chirurgie Générale et Digestive [Rangueil]"'

1. End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7): A Prospective, Randomized, Double Blinded, Multicentre Trial

Author: Guillaume Meurette, Zaher Lakkis, Bernard Meunier, Pascale Fabbro-Peray, Anne Dubois, Mehrdad Jafari, Christophe Demattei, Yves Panis, Philippe Rouanet, Mehdi Karoui, Eric Rullier, Eddy Cotte, Guillaume Piessen, Igor Sielezneff, Michel Prudhomme, Jean-Jacques Tuech, Bernard Lelong, Jean-Luc Faucheron, M. Bertrand, Guillaume Portier, Yann Parc, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), The French Research Group of Rectal Cancer Surgery = Groupe de Recherche en Chirurgie du Rectum (GRECCAR), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Hôpital JeanMinjoz, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Service de Gastroentérologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Pontchaillou, CRLCC Val d'Aurelle - Paul Lamarque, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Chirurgie Générale et Digestive [Rangueil], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Clermont-Ferrand, Centre Hospitalier Vichy, Service d'oncologie digestive et hépato-gastro-entérologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Cancérologie-Radiothérapie Hôpital Albert MICHALLON (CHU de Grenoble), Université Joseph Fourier - Grenoble 1 (UJF), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Hôpital Claude Huriez [Lille], CHU Lille, CHU Pitié-Salpêtrière [AP-HP], Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Population, MESH: Colostomy, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Surgical Mesh, Parastomal hernia, Group B, law.invention, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, Colostomy, medicine, Clinical endpoint, Humans, MESH: Double-Blind Method, Prospective Studies, MESH: Hernia, Abdominal, education, Aged, MESH: Aged, education.field_of_study, MESH: Humans, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Odds ratio, Surgical Mesh, Confidence interval, MESH: Male, MESH: Prospective Studies, Hernia, Abdominal, Surgery, MESH: France, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, France, business, MESH: Female
Abstract: International audience; To evaluate whether systematic mesh implantation upon primary colostomy creation was effective to prevent PSH.Summary of background data: Previous randomized trials on prevention of PSH by mesh placement have shown contradictory results.Methods: This was a prospective, randomized controlled trial in 18 hospitals in France on patients aged ≥18 receiving a first colostomy for an indication other than infection. Participants were randomized by blocks of random size, stratified by center in a 1:1 ratio to colostomy with or without a synthetic, lightweight monofilament mesh. Patients and outcome assessors were blinded to patient group. The primary endpoint was clinically diagnosed PSH rate at 24 months of the intention-to-treat population. This trial was registered at ClinicalTrials.gov, number NCT01380860.Results: From November 2012 to October 2016, 200 patients were enrolled. Finally, 65 patients remained in the no mesh group (Group A) and 70 in the mesh group (Group B) at 24 months with the most common reason for drop-out being death (n = 41). At 24 months, PSH was clinically detected in 28 patients (28%) in Group A and 30 (31%) in Group B [P = 0.77, odds ratio = 1.15 95% confidence interval = (0.62;2.13)]. Stoma-related complications were reported in 32 Group A patients and 37 Group B patients, but no mesh infections. There were no deaths related to mesh insertion.Conclusion: We failed to show efficiency of a prophylactic mesh on PSH rate. Placement of a mesh in a retro-muscular position with a central incision to allow colon passage cannot be recommended to prevent PSH. Optimization of mesh location and reinforcement material should be performed.
Published: 2021

2. Outcome of community- versus hospital-acquired intra-abdominal infections in intensive care unit: a retrospective study

Author: Jean-Marie Conil, Marion Grare, Bertrand Suc, Bernard Georges, Olivier Fourcade, Fanny Vardon-Bounes, Timothée Abaziou, Stéphanie Ruiz, Marc Leone, Vincent Minville, Antoine Rouget, Service d'Anesthésie - Réanimation, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Laboratoire de Bactériologie-Hygiène [Toulouse], Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Bactériologie et hygiène [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Male, Apache II score, Severity of Illness Index, law.invention, 0302 clinical medicine, Postoperative Complications, fluids and secretions, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, ComputingMilieux_MISCELLANEOUS, Outcome, 0303 health sciences, Cross Infection, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Mortality rate, Middle Aged, Intensive care unit, female genital diseases and pregnancy complications, 3. Good health, Community-Acquired Infections, Hospitalization, Intensive Care Units, embryonic structures, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Female, Research Article, medicine.medical_specialty, Critical Care, Peritonitis, Microbiology, lcsh:RD78.3-87.3, 03 medical and health sciences, Intra-abdominal infection, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Anesthesiology, medicine, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Aged, Retrospective Studies, 030306 microbiology, business.industry, Abdominal Infection, 030208 emergency & critical care medicine, Retrospective cohort study, Length of Stay, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, business, Hospital stay
Abstract: Background To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications. Methods Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis. Results Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI. Conclusion CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.
Published: 2020

3. Characterization of Human Colon Organoids From Inflammatory Bowel Disease Patients

Author: Emilie d’Aldebert, Muriel Quaranta, Morgane Sébert, Delphine Bonnet, Sylvain Kirzin, Guillaume Portier, Jean-Pierre Duffas, Sophie Chabot, Philippe Lluel, Sophie Allart, Audrey Ferrand, Laurent Alric, Claire Racaud-Sultan, Emmanuel Mas, Céline Deraison, Nathalie Vergnolle, Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), MARine Biodiversity Exploitation and Conservation (UMR MARBEC), Institut de Recherche pour le Développement (IRD)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Chirurgie Générale et Digestive [Purpan], CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, Institut de pharmacologie et de biologie structurale (IPBS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), UROsphere S.A.S., Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Faculte des Sciences Pharmaceutiques, Centre de Physiopathologie Toulouse Purpan ex IFR 30 et IFR 150 (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Centre Hospitalier Universitaire de Toulouse, Department of Physiology and Pharmacology, University of Calgary, University of Calgary, Region Provence-Alpes-Cote d'Azur, Region Occitanie, European Research Council (ERC) : ERC-2012-StG20111109, FUI (Fond Unique Interministeriel) Program ORGANOCAN, 'Banque Publique d'Investissement' of France, Toulouse-Metropole, Conseil Departemental du Tarn, 'Delegation Regionale a la Recherche Clinique des Hopitaux de Toulouse,' the MICILIP project, ANR: ANR,ANR (R12177BB to NV), Centre de Physiopathologie Toulouse Purpan (CPTP), and ANR (R12177BB to NV) ANR
Subjects: Crohn’s disease, organoid, IBD, Cell Biology, inflammatory bowel diseases, digestive system diseases, intestine Abbreviations: CD, Cell and Developmental Biology, Crohn's disease, UC, lcsh:Biology (General), inflammation, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], intestine, lcsh:QH301-705.5, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Original Research, Developmental Biology, ulcerative colitis
Abstract: International audience; Inflammatory Bowel Diseases (IBD) are chronic inflammatory disorders, where epithelial defects drive, at least in part, some of the pathology. We reconstituted human intestinal epithelial organ, by using three-dimension culture of human colon organoids. Our aim was to characterize morphological and functional phenotypes of control (non-IBD) organoids, compared to inflamed organoids from IBD patients. The results generated describe the epithelial defects associated with IBD in primary organoid cultures, and evaluate the use of this model for pharmacological testing of anti-inflammatory approaches. Human colonic tissues were obtained from either surgical resections or biopsies, all harvested in non-inflammatory zones. Crypts were isolated from controls (non-IBD) and IBD patients and were cultured up to 12-days. Morphological (size, budding formation, polarization, luminal content), cell composition (proliferation, differentiation, immaturity markers expression), and functional (chemokine and tight junction protein expression) parameters were measured by immunohistochemistry, RT-qPCR or western-blot. The effects of inflammatory cocktail or anti-inflammatory treatments were studied in controls and IBD organoid cultures respectively. Organoid cultures from controls or IBD patients had the same cell composition after 10 to 12-days of culture, but IBD organoid cultures showed an inflammatory phenotype with decreased size and budding capacity, increased cell death, luminal debris, and inverted polarization. Tight junction proteins were also significantly decreased in IBD organoid cultures. Inflammatory cytokine cocktail reproduced this inflammatory phenotype in non-IBD organoids. Clinically used treatments (5-ASA, glucocorticoids, anti-TNF) reduced some, but not all parameters. Inflammatory phenotype is associated with IBD epithelium, and can be studied in organoid cultures. This model constitutes a reliable human pre-clinical model to investigate new strategies targeting epithelial repair.
Published: 2020

4. Th22 cells are efficiently recruited in the gut by CCL28 as an alternative to CCL20 but do not compensate for the loss of Th17 cells in treated HIV-1-infected individuals

Author: Guillaume Martin-Blondel, Jacques Izopet, Mary Requena, Bertrand Suc, Laurent Alric, Manon Nayrac, Nicolas Carrere, Pierre Delobel, Karl Barange, Claire Loiseau, Michelle Cazabat, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Virologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), James Cook University (JCU), Chirurgie Générale et Digestive [Rangueil], Université de Toulouse (UT), Pôle Maladies de l'appareil digestif [CHU Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Virologie [Toulouse], CHU Toulouse [Toulouse], CHU Toulouse [Toulouse]-Hôpital de Rangueil, Université Fédérale Toulouse Midi-Pyrénées, Service de Gastro-entérologie - Hépatologie [Purpan], CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Service des maladies infectieuses et tropicales [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées
Subjects: 0301 basic medicine, Chemokine, [SDV]Life Sciences [q-bio], HIV Infections, C-C chemokine receptor type 6, MESH: Antiretroviral Therapy, Highly Active, 0302 clinical medicine, T-Lymphocyte Subsets, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antiretroviral Therapy, Highly Active, MESH: HIV Infections / metabolism, Immunology and Allergy, CCR10, Intestinal Mucosa, MESH: T-Lymphocyte Subsets / metabolism, biology, MESH: Host-Pathogen Interactions / immunology, hemic and immune systems, MESH: Inflammation Mediators / metabolism, 3. Good health, Cell biology, Chemotaxis, Leukocyte, Chemokines, CC, Host-Pathogen Interactions, MESH: T-Lymphocyte Subsets / immunology, Cytokines, MESH: Chemotaxis, Leukocyte / genetics, [SDV.IMM]Life Sciences [q-bio]/Immunology, MESH: Intestinal Mucosa / metabolism, Antibody, Inflammation Mediators, MESH: Host-Pathogen Interactions / genetics, MESH: Chemokines, CC / metabolism, Immunology, MESH: HIV Infections / drug therapy, MESH: Chemokine CCL20 / metabolism, chemical and pharmacologic phenomena, 03 medical and health sciences, Humans, MESH: HIV Infections / virology, MESH: Intestinal Mucosa / immunology, MESH: Chemotaxis, Leukocyte / immunology, Chemokine CCL20, MESH: Humans, MESH: Cytokines / metabolism, Chemotaxis, CCL20, 030104 developmental biology, MESH: HIV-1 / immunology, biology.protein, HIV-1, MESH: Biomarkers, CCL28, Ex vivo, Biomarkers, 030215 immunology, MESH: HIV Infections / immunology
Abstract: International audience; Gut CD4+ T cells are incompletely restored in most HIV-1-infected individuals on antiretroviral therapy, notably Th17 cells, a key subset in mucosal homeostasis. By contrast, gut Th22 cells are usually restored at normal frequencies. Th22 cells display a CCR6+CCR10+ phenotype and could thus respond to CCL20- and CCL28-mediated chemotaxis, while Th17 cells, which express CCR6 but not CCR10, depend on CCL20. Herein, we found that CCL28 is normally expressed by duodenal enterocytes of treated HIV-1-infected individuals, while CCL20 expression is blunted. Ex vivo, we showed that Th22 cells contribute to the reduction of CCL20 production by enterocytes through an IL-22- and IL-18-dependent mechanism. Th22 cells preferentially migrate via CCL20- rather than CCL28-mediated chemotaxis when both chemokines are available in the microenvironment. However, when the CCL20/CCL28 ratio drops, as in treated HIV-1-infected individuals, Th22 cells can migrate via the CCR10-CCL28 axis, as an alternative to CCR6-CCL20. This could explain the better reconstitution of gut Th22 compared with Th17 cells on antiretroviral therapy. Lastly, we assessed the relationships between the frequencies of gut Th17 and Th22 cells and inflammatory markers related to microbial translocation, and showed that Th22 cells do not compensate for the loss of Th17 cells in treated HIV-1-infected individuals.
Published: 2020

5. Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database

Author: Carine Jasseron, Claire Francoz, Corinne Antoine, Camille Legeai, François Durand, Sébastien Dharancy, null Collaborators, Christan Jacquelinet, Daniel Azoulay, Christophe Duvoux, Olivier Scatton, Yvon Calmus, Daniel Cherqui, Didier Samuel, Olivier Soubrane, Jean‐Yves Mabrut, Jérôme Dumortier, Christian Letoublon, Vincent Leroy, Denis Pezet, Armand Abergel, Antonio Iannelli, Rodolphe Anty, Francis Navarro, Georges Pageaux, François‐René Pruvot, Philippe Bachellier, Camille Besh, Georges Mantion, Vincent Di Martino, Nassim Kamar, Fabrice Muscari, Laurence Chiche, Martine Neau Cransac, Karim Boudjema, Pauline Houssel Debry, Ephrem Salame, Agence de la biomédecine [Saint-Denis la Plaine], Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris 8 Vincennes-Saint-Denis (UP8), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Claude Huriez [Lille], CHU Lille, Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Henri Mondor, Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, Hôpital Michallon, Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Strasbourg, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Chirurgie Générale et Digestive [Rangueil], Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Biothérapies des maladies génétiques et cancers, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), CHU Henri Mondor [Créteil], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut National de la Recherche Agronomique (INRA)-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Intubation, allocation system, Dialysis, Transplantation, business.industry, MELD score, discriminative capacity, Post transplant, 3. Good health, body regions, Waiting list, 030211 gastroenterology & hepatology, business, survival, Cohort study
Abstract: International audience; Concerns related to equity and efficacy of our previous center-based allocation system have led us to introduce a patient-based allocation system called the "Liver Score" that incorporates the MELD score. The main objective of this study was to compare waitlist and post-transplant survivals before and after implementation of the "Liver Score" using the French transplant registry (period before: 2004-2006 and period after: 2007-2012). Patients transplanted during the second period were sicker and had a higher MELD. One-year waitlist survival (74% versus 76%; p=0.8) and one-year post-transplant survival (86.3% vs 85.7%; p=0.5) were similar between the 2 periods. Cirrhotic recipients with MELD>35 had lower one-year post-transplant survival compared to those with MELD35, patients presenting 2 or 3 risk factors (dialysis, intubation or infection) had a lower 1-year survival compared to those with none of these risk factors (61.2% vs 92%; p35 should be completed to allow safe transplantation. This article is protected by copyright. All rights reserved.
Published: 2019

6. Penetrating Crohn Disease Is Not Associated With a Higher Risk of Recurrence After Surgery

Author: Maggiori, Léon, Brouquet, Antoine, Zerbib, Philippe, Lefêvre, Jérémie, Denost, Quentin, Germain, Adeline, Cotte, Eddy, BEYER-BERJOT, Laura, Munoz-Bongrand, Nicolas, Desfourneaux, Véronique, Rahili, Amine, Duffas, Jean-Pierre, Pautrat, Karine, Denet, Christine, Bridoux, Valérie, Meurette, Guillaume, Faucheron, Jean-Luc, Loriau, Jérôme, Souche, Regis, Vicaut, Eric, PANIS, Yves, Benoist, Stéphane, Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bicêtre, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Charles Gerhardt Montpellier - Institut de Chimie Moléculaire et des Matériaux de Montpellier (ICGM ICMMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Université Montpellier 2 - Sciences et Techniques (UM2)-Institut de Chimie du CNRS (INC), CEREST-TC [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Bioingénierie tissulaire (BIOTIS), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), CHU Marseille, Hopital Saint-Louis [AP-HP] (AP-HP), CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Nice (CHU Nice), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Lariboisière-Fernand-Widal [APHP], Hôpital Lariboisière, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mutualiste de Montsouris (IMM), Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre hospitalier Saint-Joseph [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
Subjects: MESH: Colon/surgery, Crohn Disease/surgery, Crohn Disease/diagnosis, Digestive System Surgical Procedures/methods, Ileum/surgery, Intestinal Perforation/surgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVE:The aim of this study was to assess recurrence risk factors following ileocolonic resection (ICR) for Crohn disease (CD) in a nationwide cohort study SUMMARY BACKGROUND DATA:: Recurrence rate after ICR for CD can be up to 60%, but its predictive factors have never been evaluated in large prospective cohort studies.METHODS:From 2013 to 2015, 346 consecutive patients undergoing ICR for CD and a postoperative ileocoloscopy within 6 to 12 months after surgery at 19 academic French centers were included prospectively.RESULTS:Twelve-month postoperative endoscopic (Rutgeerts score ≥i2) and clinical recurrence rates were 57.6% [95% confidence interval (CI), 54.2-61.0] and 11.3% (95% CI, 9-13.6), respectively. A total of 185 patients (54%) had a postoperative CD prophylaxis, comprising thiopurine in 69 (20%), or anti-tumor necrosis factor (TNF) therapy in 93 (27%). In multivariate Cox regression analysis, absence of postoperative smoking {odds ratio [OR] = 0.60 (95% CI, 0.40-0.91); P = 0.016}, postoperative prophylaxis [OR = 0.60 (95% CI, 0.41-0.88); P = 0.009], and penetrating disease behavior [OR = 0.58 (95% CI, 0.39-0.86); P = 0.007] were the only independent predictors of reduced endoscopic recurrence risk. Postoperative prophylaxis [OR 0.31 (95% CI, 0.15-0.66); P = 0.002), and penetrating behavior [OR = 00.36 (95% CI, 0.16-0.81); P = 0.013), were the only independent predictors of reduced clinical recurrence risk. Postoperative anti-TNF therapy was associated with a significant reduction of both 12-month risks of endoscopic (P < 0.001) and clinical (P = 0.019) recurrences.CONCLUSION:Absence of postoperative smoking, CD prophylaxis, and penetrating disease behavior could be independent predictors of reduced postoperative recurrence after ICR for CD. Prophylactic anti-TNF therapy reduces both endoscopic and clinical recurrence rates. It suggests that upfront surgery followed by postoperative anti-TNF therapy is probably the best therapeutic approach for complex CD (penetrating disease behavior).
Published: 2019

7. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease

Author: Brouquet, Antoine, Maggiori, Léon, Zerbib, Philippe, Lefèvre, Jérémie, Denost, Quentin, Germain, Adeline, Cotte, Eddy, BEYER-BERJOT, Laura, Munoz-Bongrand, Nicolas, Desfourneaux, Véronique, Rahili, Amine, Duffas, Jean-Pierre, Pautrat, Karine, Denet, Christine, Bridoux, Valérie, Meurette, Guillaume, Faucheron, Jean-Luc, Loriau, Jérôme, Guillon, Françoise, Vicaut, Eric, Benoist, Stéphane, PANIS, Yves, Service de Chirurgie générale et digestive [CHU Le Kremlin-Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Gastroentérologie [Hôpital Beaujon], Hôpital Beaujon, Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bioingénierie tissulaire (BIOTIS), Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie digestive [Bordeaux], CHU Bordeaux [Bordeaux], Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Lyon Sud, Service de Chirurgie Digestive, Hospices Civils de Lyon (HCL), Laboratoire de Biomécanique Appliquée (LBA UMR T24), Aix Marseille Université (AMU)-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Department of Gastroenterological Surgery, Hop St Louis, CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Nice (CHU Nice), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Service de chirurgie digestive [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Centre hospitalier universitaire de Nantes (CHU Nantes), Unité de Chirurgie Colorectale, CHU Grenoble-Hôpital Michallon, Groupe Hospitalier Paris Saint-Joseph, Hépato-gastro-entérologie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Université Gustave Eiffel, Hôpital Lariboisière-Fernand-Widal [APHP], Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Service de chirurgie digestive [CHU Rouen], Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Beaujon [AP-HP]-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hémostase et pathologie cardiovasculaire, EA2693-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Service de Chirurgie Générale (A), CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Service de chirurgie oncologique, Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut Mutualiste de Montsouris (IMM), Department of Digestive Surgery, Rouen University Hospital, Clinique de Chirurgie Digestive et Endocrinienne [CHU Nantes], Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-GMCAO ), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service de Chirurgie digestive [GH Paris Saint-Joseph], Groupe hospitalier Paris Saint-Joseph - Hôpital, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Histoire Archéologie Littérature des Mondes Anciens - UMR 8164 (HALMA), Ministère de la Culture (MC)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Department Colorectal Surgery, Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Groupe Hospitalier Paris Saint-Joseph (hpsj), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Histoire Archéologie Littérature des Mondes Anciens (HALMA) - UMR 8164 (HALMA), and Ministère de la Culture et de la Communication (MCC)-Université de Lille-Centre National de la Recherche Scientifique (CNRS)
Subjects: [SDV]Life Sciences [q-bio], [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; Objective: To determine the risk factors of morbidity after surgery for ileocolonic Crohn disease (CD).Summary Background Data: The risk factors of morbidity after surgery for CD, particularly the role of anti-TNF therapy, remain controversial and have not been evaluated in a large prospective cohort study. Methods: From 2013 to 2015, data on 592 consecutive patients who underwent surgery for CD in 19 French specialty centers were collected prospectively. Possible relationships between anti-TNF and postoperative overall morbidity were tested by univariate and multivariate analyses. Because treatment by anti-TNF is possibly dependent on the characteristics of the patients and disease, a propensity score was calculated and introduced in the analyses using adjustment of the inverse probability of treatment-weighted method.Results: Postoperative mortality, overall and intra-abdominal septic morbidity rates in the entire cohort were 0%, 29.7%, and 8.4%, respectively; 143 (24.1%) patients had received anti-TNF 180 min (OR = 2.71; CI 95% = 1.54–4.78, P < 0.001) and recurrent CD (OR = 1.99; CI 95% = 1.13–3.36, P = 0.017). After calculating the propensity score and adjustment according to the inverse probability of treatment-weighted method, anti-TNF Conclusions: Preoperative anti-TNF therapy is associated with a higher risk of morbidity after surgery for ileocolonic CD. This information should be considered in the surgical management of these patients, particularly with regard to the preoperative preparation and indication of temporary defunctioning stoma.
Published: 2018

8. Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant-based prognostic models

Author: Charlotte E, Costentin, Giuliana, Amaddeo, Thomas, Decaens, Karim, Boudjema, Philippe, Bachellier, Fabrice, Muscari, Ephrem, Salamé, Pierre-Henri, Bernard, Claire, Francoz, Sébastien, Dharancy, Claire, Vanlemmens, Sylvie, Radenne, Jérôme, Dumortier, Marie-Noelle, Hilleret, Olivier, Chazouillères, Georges P, Pageaux, Julien, Calderaro, Alexis, Laurent, Françoise, Roudot-Thoraval, Christophe, Duvoux, Alain, Luciani, Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Pôle des Pathologies Digestives Hépatiques et Transplantation [Hôpital Hautepierre-Strasbourg], Hôpital de Hautepierre [Strasbourg], Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Service d'hépatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), service d'Hépato-gastro-entérologie, Hospices Civiles de Lyon-Hôpital Edouard Heriault, Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service d'hépatologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance Publique-Hôpitaux de Paris, Department of Pathology, Centre hospitalier universitaire Henri Mondor, F-94000 Créteil, France, Service de chirurgie digestive, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service de santé publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Pôle Recherche Clinique-Santé Publique [Mondor], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), CHU Toulouse [Toulouse]-Hôpital de Rangueil, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Hôpital Beaujon-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz-Université de Franche-Comté (UFC), Service d'hépatologie [Saint-Antoine], CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Pierre et Marie Curie - Paris 6 (UPMC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri-Mondor, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Oncology, Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, recurrence, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, Kaplan-Meier Estimate, 030230 surgery, Liver transplantation, Milan criteria, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Prognostic models, ComputingMilieux_MISCELLANEOUS, Neoplasm Staging, Retrospective Studies, Hepatology, liver transplantation, business.industry, Liver Neoplasms, explant pathology, Retrospective cohort study, hepatocellular carcinoma, Middle Aged, Models, Theoretical, medicine.disease, Prognosis, Tumor Burden, Hepatocellular carcinoma, Area Under Curve, Cohort, 030211 gastroenterology & hepatology, Neoplasm staging, Female, France, Neoplasm Recurrence, Local, business, Explant culture
Abstract: Aim Discordance between pre-LT imaging and explanted liver findings have been reported after liver transplantation (LT) for hepatocellular carcinoma (HCC), suggesting the need of reassessing the risk of HCC recurrence post-LT. Our aims were to compare pre-LT imaging and explants features and to test the performances of four explant-based predictive models of recurrence in an external cohort. Methods Staging according to pre-LT imaging and explant features were compared. Four explants-based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared. Results Pre-LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUCs for prediction of 5-years recurrence were observed in the "Up to seven" (0.7915 [95% CI: 0.7339-0.849]) and Decaens models (0.747 [95% CI: 0.6877-0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUCs (0.68 and 0.70) respectively. Accuracy of the "Up to seven" model was superior to the Decaens model (P=.034), which was superior to the Chan model (P=.0041) but not to the Iwatsuki model (P=.17). Conclusion Pre-LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT. The explant-based "Up to seven" and Decaens models provided the best accuracy for prediction of 5-year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT.
Published: 2017

9. European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group

Author: Daniel Sommacale, Emilie Bollon, Bernard Pol, François-René Pruvot, Marie Castagnet, Yves Patrice Le Treut, Alexandre Filippello, Jacques Belghiti, Frédéric Borie, Lorenzo Capussotti, Pierre Allemann, Guido Torzilli, Alexis Laurent, Daniel Cherqui, Philippe Bachellier, Gilles Mentha, Olivier Scatton, Mustapha Adham, Bertrand Suc, Olivier Turrini, Reza Kiamanesh, Jean Hardwigsen, Marco Montorsi, Romain Riboud, Fabrice Muscari, Benjamin Darnis, Patrice Pessaux, Olivier Farges, Olivier Soubrane, Mathieu Gonot-Gachard, Jean Yves Mabrut, Safi Dokmak, Jean-Charles Nault, Manuela Cesaretti, Pietro Addeo, Laura Ornella Perotto, Jean Marc Régimbaud, Nicolas Demartines, Alexandra Dili, Irinel Popescu, Jean Robert Delpero, Ahmet Ayav, Mikael Chetboun, Emmanuel Boleslawski, Jean luc Porcheron, Jean Michel Fabre, Christian Letoublon, Ricardo Gauzolino, Service de chirurgie digestive, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Service de chirurgie hepato-pancreato-biliaire, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Jean Verdier [AP-HP], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'hépato-gastroentérologie, CHU Grenoble-Université Grenoble Alpes (UGA), CHU Strasbourg, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Hôpital Jean Verdier [Bondy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, and UCL - (MGD) Service de chirurgie
Subjects: Adult, Male, Oncology, medicine.medical_specialty, Time Factors, Adenoma, Cross-sectional study, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Liver resections, Gastroenterology, Adenoma, Liver Cell, Malignant transformation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Hepatectomy, Humans, Medicine, Retrospective Studies, Hepatology, business.industry, Incidence, Incidence (epidemiology), Liver Neoplasms, Large series, Retrospective cohort study, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Middle Aged, Hepatocellular adenoma, medicine.disease, digestive system diseases, Tumor Burden, 3. Good health, Europe, Cell Transformation, Neoplastic, Cross-Sectional Studies, Treatment Outcome, 030220 oncology & carcinogenesis, Original Article, Female, Laparoscopy, 030211 gastroenterology & hepatology, business
Abstract: International audience; BACKGROUND:Hepatocellular adenoma (HCA) is a benign hepatic lesion that may be complicated by bleeding and malignant transformation. The aim of the present study is to report on large series of liver resections for HCA and assess the incidence of hemorrhage and malignant transformation.METHODS:A retrospective cross-sectional study, from 27 European high-volume HPB units.RESULTS:573 patients were analyzed. The female: male gender ratio was 8:2, mean age: 37 ± 10 years. Of the 84 (14%) patients whose initial presentation was hemorrhagic shock (Hemorrhagic HCAs), hemostatic intervention was urgently required in 25 (30%) patients. No patients died after intervention. Tumor size was >5 cm in 74% in hemorrhagic HCAs and 64% in non-hemorrhagic HCAs (p < 0.001). In non-hemorrhagic HCAs (n = 489), 5% presented with malignant transformation. Male status and tumor size >10 cm were the two predictive factors. Liver resections included major hepatectomy in 25% and a laparoscopic approach in 37% of the patients. In non-hemorrhagic HCAs, there was no mortality and major complications occurred in 9% of patients.DISCUSSION:Liver resection for HCA is safe. Presentation with hemorrhage was associated with larger tumor size. In males with a HCA >10 cm, a HCC should be suspected. In such situation, a preoperative biopsy is preferable and an oncological liver resection should be considered.
Published: 2016

10. Liver transplantation for adenomatosis: European experience

Author: Christophe Laurent, Yves Patrice Le-Treut, Jorge Ortiz-de-Urbina, François-René Pruvot, Martin Oliverius, Jean Gugenheim, Phillipe Bachelier, Ephrem Salamé, Anaelle David, Vincenzo Scuderi, Jürgen Klempnauer, René Adam, Stefano Di-Sandro, Paulette Bioulac-Sage, Jan Lerut, Jean Yves Mabrut, Francis Navarro, Jeroˆme Dumortier, Eric Vibert, Marco Spada, Roberto Troisi, Michele Colledan, Ignacio Gonzalez-Pinto, Laurence Chiche, V. Vincenzo Mazzafero, Bertrand Suc, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], CHU Strasbourg, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Physiopathologie du cancer du foie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pathologie [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Chiche, L, David, A, Adam, R, Oliverius, M, Klempnauer, J, Vibert, E, Colledan, M, Lerut, J, Mazzafero, V, Di-Sandro, S, Laurent, C, Scuderi, V, Suc, B, Troisi, R, Bachelier, P, Dumortier, J, Gugenheim, J, Mabrut, J, Gonzalez-Pinto, I, Pruvot, F, Le-Treut, Y, Navarro, F, Ortiz-De-Urbina, J, Salame, E, Spada, M, and Bioulac-Sage, P
Subjects: Registrie, Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Clinical Decision-Making, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Glycogen Storage Disease Type I, Liver transplantation, Gastroenterology, Adenoma, Liver Cell, Cohort Studies, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Rare Disease, Retrospective Studie, Internal medicine, Carcinoma, Humans, Medicine, Registries, Retrospective Studies, Transplantation, Glycogen storage disease type I, Hepatology, business.industry, Liver Neoplasms, Focal nodular hyperplasia, Retrospective cohort study, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Hepatocellular adenoma, medicine.disease, Liver Transplantation, 3. Good health, Europe, Treatment Outcome, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Female, 030211 gastroenterology & hepatology, Surgery, Cohort Studie, business, Human
Abstract: International audience; The aim of this study was to collect data from patients who underwent liver transplantation (LT) for adenomatosis; to analyze the symptoms, the characteristics of the disease, and the recipient outcomes; and to better define the role of LT in this rare indication. This retrospective multicenter study, based on data from the European Liver Transplant Registry, encompassed patients who underwent LT for adenomatosis between January 1, 1986, and July 15, 2013, in Europe. Patients with glycogen storage disease (GSD) type IA were not excluded. This study included 49 patients. Sixteen patients had GSD, and 7 had liver vascular abnormalities. The main indications for transplantation were either a suspicion of hepatocellular carcinoma (HCC; 15 patients) or a histologically proven HCC (16 patients), but only 17 had actual malignant transformation (MT) of adenomas. GSD status was similar for the 2 groups, except for age and the presence of HCC on explants (P = 0.030). Three patients with HCC on explant developed recurrence after transplantation. We obtained and studied the pathomolecular characteristics for 23 patients. In conclusion, LT should remain an extremely rare treatment for adenomatosis. Indications for transplantation primarily concern the MT of adenomas. The decision should rely on morphological data and histological evidence of MT. Additional indications should be discussed on a case-by-case basis. In this report, we propose a simplified approach to this decision-making process.
Published: 2016

11. Targeting KRAS for diagnosis, prognosis, and treatment of pancreatic cancer: Hopes and realities

Author: Pierre Cordelier, Camille Buscail, Fabrice Muscari, Louis Buscail, Barbara Bournet, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gastro-entérologie et Nutrition[Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Département d'Information Médicale, Centre Hospitalier Universitaire [Rennes]-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Chirurgie Générale et Digestive [Rangueil], Centre de Recherches en Cancérologie de Toulouse (CRCT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre Hospitalier Universitaire [Rennes], Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de l'information médicale [CHU Rennes], CHU Pontchaillou [Rennes], and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, [SDV]Life Sciences [q-bio], DNA Mutational Analysis, Biology, medicine.disease_cause, P21 RAS Protein, Diagnosis, Differential, Proto-Oncogene Proteins p21(ras), Pancreatic ductal adenocarcinoma, 03 medical and health sciences, Quantitative PCR, 0302 clinical medicine, Growth factor receptor, Predictive Value of Tests, Pancreatic cancer, Internal medicine, medicine, Biomarkers, Tumor, Animals, Humans, Genetic Predisposition to Disease, Molecular Targeted Therapy, Endoscopic Ultrasound-Guided Fine Needle Aspiration, MEK inhibitors, Oncogene, KRAS mutation, medicine.disease, Prognosis, Pancreatic Neoplasms, 030104 developmental biology, Real-time polymerase chain reaction, Phenotype, Cytopathology, 030220 oncology & carcinogenesis, Mutation, Cancer research, Adenocarcinoma, KRAS, Solid pancreatic masses, Carcinoma, Pancreatic Ductal, Signal Transduction
Abstract: International audience; Mutation of the KRAS oncogene in pancreatic cancer is responsible for permanent activation of the P21 RAS protein and the cascade of signalling pathways. Consequently, multiple cellular processes, such as transformation, proliferation, invasion, and survival are activated. The aim of this review was to present all potential clinical applications of targeting KRAS in terms of diagnosis and management of pancreatic adenocarcinoma. Quantitative polymerase chain reaction technology provides reliable assessment of KRAS mutations, both in tissues and from fine-needle aspiration biopsies. Numerous studies report that the combination of endoscopic ultrasound-guided cytopathology and a KRAS mutation assay can improve the positive and differential diagnosis of pancreatic cancer, differentiating between benign versus malignant solid pancreatic cancer, and reducing false-negative results compared to cytopathology alone. In addition, the presence of a KRAS mutation is frequently associated with a worse prognosis, both in cases of advanced and resected tumours. However, the KRAS mutation assay is not as efficient at predicting a response to both anti-epidermal growth factor receptor treatments and/or chemotherapy. Targeting of KRAS to treat pancreatic adenocarcinoma has been applied at different stages of RAS molecular intracellular processes: at the transcription level with antisense or interference RNA, at the posttranslational level with inhibitors of farnesyl transferase or anti-RAS vaccination peptides, and to target multiple signalling pathways using inhibitors of mitogen-activated protein kinase, phosphoinositide 3-kinase, AKT, mammalian target of rapamycin, RAF. Despite some encouraging results at pre-clinical and phase I stages, no significant clinical benefits have been observed. Combinatory approaches with standard chemotherapy will be welcome
Published: 2016

12. KRAS G12D Mutation Subtype Is A Prognostic Factor for Advanced Pancreatic Adenocarcinoma

Author: Louis Buscail, Pascal Hammel, Camille Buscail, Janick Selves, Pierre Cordelier, Barbara Bournet, Eric Assenat, Rosine Guimbaud, Fabrice Muscari, Marc Barthet, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gastro-entérologie et Nutrition[Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Chirurgie Générale et Digestive [Rangueil], Département d'Information Médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre Hospitalier Universitaire [Rennes], CHU Pontchaillou [Rennes], Unité d'Oncologie Médicale [St-Eloi], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Centre de Recherches en Cancérologie de Toulouse (CRCT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de l'information médicale [CHU Rennes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Oncology, medicine.medical_specialty, Original Contributions, medicine.medical_treatment, [SDV]Life Sciences [q-bio], medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pancreatic cancer, medicine, 10. No inequality, Prospective cohort study, Chemotherapy, business.industry, Hazard ratio, Gastroenterology, medicine.disease, Primary tumor, Confidence interval, 3. Good health, 030104 developmental biology, 030220 oncology & carcinogenesis, Adenocarcinoma, KRAS, business
Abstract: International audience; OBJECTIVES: There is no molecular biomarker available in the clinical practice to assess the prognosis of advanced pancreatic carcinoma. This multicenter prospective study aimed to investigate the role of KRAS mutation subtypes within the primary tumor to determine the prognosis of advanced pancreatic cancer. METHODS: The exon-2 KRAS mutation status was tested on endoscopic ultrasound-guided fine-needle aspiration biopsy material (primary tumor; restriction fragment-length polymorphism plus sequencing and TaqMan allelic discrimination) of patients with proven locally advanced and/or metastatic pancreatic ductal carcinoma. We used the Kaplan-Meier method, log-rank test, and Cox's model to evaluate the impact of KRAS status on the overall survival (OS), adjusting for age, stage of disease, clinical performance status, CA 19-9 levels, and treatment. RESULTS: A total of 219 patients (men: 116; mean age: 67±9.4 years) were included: 147 harbored a codon-12 KRAS mutation (G12D: 73; G12V: 53; G12R: 21) and 72 had a wild-type KRAS. There was no difference in the OS between patients with a mutant KRAS (8 months; 95% confidence interval (95% CI): 8.7-12.3) and the wild-type (9 months; 95% CI: 8.7-12.8; hazard ratio (HR): 1.03; P=0.82). However, the patients with a G12D mutation had a significantly shorter OS (6 months; 95% CI: 6.4-9.7) compared with the other patients (OS: 9 months; 95% CI: 10-13; HR: 1.47; P=0.003; i.e., wild type: 9 months, G12V: 9 months, G12R: 14 months). Similar results were observed in the subgroup of 162 patients who received chemotherapy (HR: 1.66; P=0.0013; G12D (n=49): 8 months, wild type (n=56): 10 months, G12V (n=38): 10 months, G12R (n=19): 14 months). Multivariate analyses identified KRAS G12D as an independent predictor for worse prognosis within the entire series (HR: 1.44; P=0.01) and in the subgroup of patients that received chemotherapy (HR: 1.84; P=0.02). CONCLUSIONS: The KRAS G12D mutation subtype is an independent prognostic marker for advanced pancreatic ductal carcinoma. Codon and amino-acid-specific mutations of KRAS should be considered when evaluating the prognoses as well as in trials testing drugs that target RAS and downstream RAS pathways
Published: 2016

13. Detection of Dysplasia or Cancer in 3.5% of Patients with Inflammatory Bowel Disease and Colonic Strictures

Author: Jean-Pierre Duffas, Emmanuelle Leteurtre, Carmen Stefanescu, Laurent Peyrin-Biroulet, Mathurin Fumery, Marion Simon, Stéphane Nancey, Romain Altwegg, Aurelien Amiot, Laurent Beaugerie, Vered Abitbol, Xavier Hébuterne, Xavier Roblin, Aude Bressenot, Guillaume Savoye, Jérémie H. Lefevre, Gilles Bommelaer, Guillaume Bouguen, Yoram Bouhnik, Anthony Buisson, Guillaume Pineton de Chambrun, Francesco Brunetti, F. Guillon, Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Amiens-Picardie, Hôpital Claude Huriez [Lille], CHU Lille, CHU Clermont-Ferrand, Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Gastroentérologie et nutrition [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de gastro-entérologie [Henri Mondor AP-HP, Créteil], Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hépato-gastro-entérologie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département de gastroentérologie, Hôpital Cochin [AP-HP], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Pontchaillou, Institut Mutualiste de Montsouris (IMM), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Centre Hospitalier Universitaire de Nice (CHU de Nice), Service d'hépato-gastroentérologie, Hospices Civils de Lyon (HCL), Département de gastro-entérologie et Hépatologie, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, CHU Henri Mondor, The authors thank Patricia Détré, Association Francois Aupetit. This work was presented in part and orally at the European Crohn’s and Colitis Organization (ECCO) meeting in Copenhagen in 2014, at the Digestive Disease Week (DDW) in Chicago in 2014, and at the UEG week in Vienna in 2014., CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, CHU Henri Mondor [Créteil], Jonchère, Laurent, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, Colorectal cancer, [SDV]Life Sciences [q-bio], Constriction, Pathologic, Gastroenterology, Inflammatory bowel disease, UC, Prevalence, Aged, 80 and over, Crohn's disease, Middle Aged, Ulcerative colitis, 3. Good health, CD, [SDV] Life Sciences [q-bio], Colonic Neoplasms, colon cancer risk factors, Female, France, carcinogenesis, Adult, stricture, medicine.medical_specialty, Adolescent, [SDV.CAN]Life Sciences [q-bio]/Cancer, Primary sclerosing cholangitis, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, dysplasia, inflammatory bowel disease, Internal medicine, medicine, Humans, cancer, Aged, Retrospective Studies, GETAID study, Hepatology, colon, business.industry, Cancer, Retrospective cohort study, Inflammatory Bowel Diseases, medicine.disease, digestive system diseases, Surgery, Dysplasia, business, Precancerous Conditions
Abstract: This work was presented in part and orally at the European Crohn’s and Colitis Organization (ECCO) meeting in Copenhagen in 2014, at the Digestive Disease Week (DDW) in Chicago in 2014 and at the UEG week in Vienna in 2014.; International audience; Background: Aims Colonic strictures complicate inflammatory bowel disease (IBD) and often lead to surgical resection to prevent dysplasia or cancer. We assessed the frequency of dysplasia and cancer among IBD patients undergoing resection of a colorectal stricture. Methods We analyzed data from the Groupe d’études et thérapeutiques des affections inflammatoires du tube digestif study. This was a nationwide retrospective study of 12,013 patients with IBD in France who underwent surgery for strictures at 16 centers, from August 1992 through January 2014 (293 patients for a colonic stricture, 248 patients with Crohn’s disease, 51% male, median age at stricture diagnosis was 38 y). Participants had no preoperative evidence of dysplasia or cancer. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes. Results When patients were diagnosed with strictures, they had IBD for a median time of 8 y (3−14 y). The strictures were a median length of 6 cm (4−10 cm) and caused symptoms in 70% of patients. Of patients with Crohn’s disease, 3 were found to have low-grade dysplasia (1%), 1 was found to have high-grade dysplasia (0.4%), and 2 were found to have cancer (0.8%). Of patients with ulcerative colitis, 1 had low-grade dysplasia (2%), 1 had high-grade dysplasia (2%), and 2 had cancer (5%). All patients with dysplasia or cancer received curative surgery, except 1 who died of colorectal cancer during the follow-up period. No active disease at time of surgery was the only factor associated with dysplasia or cancer at the stricture site (odds ratio, 4.86; 95% confidence interval, 1.11–21.27; P=.036). Conclusion In a retrospective study of patients with IBD undergoing surgery for colonic strictures, 3.5% were found to have dysplasia or cancer. These findings can be used to guide management of patients with IBD and colonic strictures.
Published: 2015

14. Early Administration of Azathioprine vs Conventional Management of Crohn's Disease: a Randomized Controlled Trial

Author: Jacques, Cosnes, Anne, Bourrier, David, Laharie, Stéphane, Nahon, Yoram, Bouhnik, Franck, Carbonnel, Matthieu, Allez, Jean-Louis, Dupas, Jean-Marie, Reimund, Guillaume, Savoye, Pauline, Jouet, Jacques, Moreau, Jean-Yves, Mary, Jean-Frédéric, Colombel, Franck, Zerbib, Université Pierre et Marie Curie - Paris 6 (UPMC), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hépatogastroentérologie, CHU de Bicêtre, Hepato-Gastroenterologie, CHU Amiens-Picardie, Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-gastroentérologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Adult, Male, medicine.medical_specialty, Azathioprine, Management of Crohn's disease, Inflammatory bowel disease, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Randomized controlled trial, law, Interquartile range, Internal medicine, medicine, Clinical endpoint, Humans, Crohn's disease, Hepatology, business.industry, [CHIM.ORGA]Chemical Sciences/Organic chemistry, Gastroenterology, medicine.disease, Crohn's Disease Activity Index, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, medicine.drug
Abstract: This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of these exercises, successful learners will be able to discuss the advantages and limits of early prescription of azathioprine (and other classical immunosuppressants) compared with conventional management in patients diag- nosed with Crohn's disease. BACKGROUND & AIMS: Immunomodulator therapy is effective for patients with Crohn's disease (CD) but has not been shown to affect disease progression, presumably because it is given too late after diagnosis. We compared the efficacy of early treatment (within 6 months after diagnosis) with azathioprine versus conventional man- agement of patients at high risk for disabling disease. METHODS: We performed an open-label trial of adults with a diagnosis of CD for less than 6 months who were at risk for disabling disease. From July 2005 to November 2010, patients at 24 French centers were randomly assigned to treatment with azathioprine (2.5 mg ∙ kg � 1 ∙ day � 1 ,n ¼ 65) or conventional management (azathioprine only in cases of corticosteroid dependency, chronic active disease with frequent flares, poor response to corticoste- roids, or development of severe perianal disease) (n ¼ 67). The primary end point was the proportion of trimesters spent in corticosteroid-free and anti-tumor necrosis factor (TNF)—free remission during the first 3 years after inclu- sion. RESULTS: During the 3-year follow-up period, 16 patients in the azathioprine group were switched to mercaptopurine or methotrexate therapy because of intol- erance or poor efficacy. Forty-one patients in the conven- tional management group required immunosuppressant therapy(61%;mediantimeto firstprescription,11months). In the azathioprine group, a median 67% of trimesters were spent in remission (interquartile range, 11%-85%) compared with 56% in the conventional management group (interquartile range, 29%-73%) (P ¼ .69). Among secondary outcomes, a higher cumulative proportion of patients in the azathioprine group were free of perianal surgery than in the conventional management group (96% � 3%and82% � 6%atmonth36,respectively;P ¼.036).The cumulative proportion of patients free of intestinal surgery and anti-TNF therapy did not differ between groups. CONCLUSIONS: Based on results from a clinical trial, administration of azathioprine within 6 months of diagnosis of CD was no more effective than conven- tional management in increasing time of clinical remission. Clinical trials.gov, Number NCT00546546.
Published: 2013

15. Portomesenteric Vein Thrombosis in Patients With Inflammatory Bowel Disease

Author: Philippe Marteau, Yoram Bouhnik, Jacques Moreau, Non Renseigné, Cécilia Landman, Michel Veyrac, Vered Abitbol, Stéphane Nahon, David Laharie, Jérôme Filippi, Benoit Coffin, Jean-Frederic Colombel, Jacques Cosnes, Guillaume Savoye, Guillaume Bouguen, Hedia Brixi-Benmansour, Matthieu Allez, Université Pierre et Marie Curie - Paris 6 (UPMC), Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gastro-entérologie, Centre hospitalier Universitaire, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'Hépato-gastroentérologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Université Paris Diderot - Paris 7 (UPD7), Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Nice (CHU Nice), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Fédération Médico-Chirurgicale des Maladies de l'Appareil Digestif, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, gastroenterology, Lariboisière hospital, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: Adult, Male, medicine.medical_specialty, Hyperhomocysteinemia, Disease, Severity of Illness Index, Inflammatory bowel disease, Gastroenterology, 03 medical and health sciences, Mesenteric Veins, 0302 clinical medicine, Crohn Disease, Risk Factors, Internal medicine, Mesenteric Vascular Occlusion, Severity of illness, medicine, Humans, Immunology and Allergy, Vein, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Venous Thrombosis, Incidental Findings, Portal Vein, business.industry, [CHIM.ORGA]Chemical Sciences/Organic chemistry, Anticoagulants, Retrospective cohort study, Middle Aged, medicine.disease, Ulcerative colitis, 3. Good health, Surgery, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Concomitant, Colitis, Ulcerative, Female, 030211 gastroenterology & hepatology, business
Abstract: BACKGROUND:: Inflammatory bowel disease (IBD) is associated with a high risk of deep venous thromboembolism. However, few data are available so far on portomesenteric vein thrombosis (PMVT). The aim of this study was to describe the characteristics of PMVT in patients with IBD. METHODS:: A retrospective study was conducted at 13 GETAID (Groupe d'Etude Therapeutique des Affections Inflammatoires du Tube Digestif) centers from January 1995 to June 2010. The following data were collected, using a standardized questionnaire: characteristics of IBD, disease status at the time of PMVT, PMVT characteristics and mode of discovery, concomitant prothrombotic disorders, anticoagulant therapy, and evolution of PMVT. RESULTS:: Fifty cases (29 men and 21 women; median age, 41 years) were identified, including 14 patients with ulcerative colitis and 36 with Crohn's disease. Thirty-one patients (62%) presented with acute PMVT. Twenty-four patients had previously undergone surgical treatment, and IBD was active in 23 cases (77%) of acute thrombosis. The discovery of PMVT was fortuitous in 40% of our cases. Among the 43 patients screened for a prothrombotic disorder, abnormalities were observed in 17 patients (40%) (mainly hyperhomocysteinemia, n = 12). Forty-four patients (88%) were treated with anticoagulants. Recanalization of the vein was significantly more successful in patients with acute thrombosis (65% versus 37%, P = 0.05). CONCLUSIONS:: PMVT can occur when IBD is inactive, and its diagnosis was fortuitous in 40% of our cases. Screening for prothrombotic disorders is essential because it is positive in more than one third of cases.
Published: 2013

16. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial

Author: Philippe Marteau, Marc Lémann, Jean Yves Mary, Jean-Charles Delchier, Elena Ricart, Xavier Roblin, Jean-Frederic Colombel, Jacques Moreau, Antonio López-Sanromán, Javier P. Gisbert, Martti Färkkilä, Maria Esteve, Frank Zerbib, Julien Branche, Gilles Bommelaer, Jean-Louis Dupas, Matthieu Allez, Yoram Bouhnik, Maria Nachury, Franck Carbonnel, Jacques Cosnes, Guillaume Savoye, Gert Van Assche, Benoit Coffin, Martine De Vos, Stéphane Nahon, David Laharie, Denis Franchimont, Arnaud Bourreille, Jérôme Filippi, Olivier Dewit, Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Neuropathies du système nerveux entérique et pathologies digestives, implication des cellules gliales entériques, Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des Maladies de l'Appareil Digestif, Université de Nantes (UN), Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Nice (CHU Nice), Department of Gastroenterology, Hôpital Saint-André, Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Chirurgie Générale et Digestive [Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'hépato-gastro-entérologie [APHP Henri Mondor], Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Gastro-Entérologie et Nutrition, Gastroenterology, Hospital Clinic, Hepato-Gastroenterologie, CHU Amiens-Picardie, Hépatogastroentérologie, CHU de Bicêtre, Gastroenterology Unit, Hôpital Louis Mourier - AP-HP [Colombes], Université Paris Diderot - Paris 7 (UPD7), gastroenterology, Hospital Mutua de Terrassa, La Princesa University Hospital, Lariboisière hospital, Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-gastroentérologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de gastro-entérologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes (UN), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Charles Nicolle [Rouen], CHU Rouen, and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Drug Resistance, Azathioprine, Inflammatory bowel disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Treatment Failure, Infusions, Intravenous, Colectomy, Intention-to-treat analysis, business.industry, [CHIM.ORGA]Chemical Sciences/Organic chemistry, Anti-Inflammatory Agents, Non-Steroidal, Antibodies, Monoclonal, General Medicine, Middle Aged, medicine.disease, Ciclosporin, Ulcerative colitis, Infliximab, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Acute Disease, Cyclosporine, 030211 gastroenterology & hepatology, Colitis, Ulcerative, Female, Steroids, business, Immunosuppressive Agents, medicine.drug
Abstract: International audience; BACKGROUND: Ciclosporin and infliximab are potential rescue treatments to avoid colectomy in patients with acute severe ulcerative colitis refractory to intravenous corticosteroids. We compared the efficacy and safety of these drugs for this indication. METHODS: In this parallel, open-label, randomised controlled trial, patients were aged at least 18 years, had an acute severe flare of ulcerative colitis defined by a Lichtiger score greater than 10 points, and had been given an unsuccessful course of high-dose intravenous steroids. None of the patients had previously received ciclosporin or infliximab. Between June 1, 2007, and Aug 31, 2010, patients at 27 European centres were randomly assigned (via computer-derived permutation tables; 1:1) to receive either intravenous ciclosporin (2 mg/kg per day for 1 week, followed by oral drug until day 98) or infliximab (5 mg/kg on days 0, 14, and 42). In both groups, azathioprine was started at day 7 in patients with a clinical response. Neither patients nor investigators were masked to study treatment. The primary efficacy outcome was treatment failure defined by absence of a clinical response at day 7, a relapse between day 7 and day 98, absence of steroid-free remission at day 98, a severe adverse event leading to treatment interruption, colectomy, or death. Analysis was by intention to treat. This trial is registered with EudraCT (2006-005299-42) and ClinicalTrials.gov (NCT00542152). FINDINGS: 115 patients were randomly assigned; 58 patients were allocated to receive ciclosporin and 57 to receive infliximab. Treatment failure occurred in 35 (60%) patients given ciclosporin and 31 (54%) given infliximab (absolute risk difference 6%; 95% CI -7 to 19; p=0*52). Nine (16%) patients in the ciclosporin group and 14 (25%) in the infliximab group had severe adverse events. INTERPRETATION: Ciclosporin was not more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. In clinical practice, treatment choice should be guided by physician and centre experience. FUNDING: Association François Aupetit, Société Nationale Française de Gastroentérologie, and the International Organization for the study of Inflammatory Bowel Disease.
Published: 2012

17. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria

Author: Christophe, Duvoux, Françoise, Roudot-Thoraval, Thomas, Decaens, Fabienne, Pessione, Hanaa, Badran, Tullio, Piardi, Claire, Francoz, Philippe, Compagnon, Claire, Vanlemmens, Jérome, Dumortier, Sébastien, Dharancy, Jean, Gugenheim, Pierre-Henri, Bernard, René, Adam, Sylvie, Radenne, Fabrice, Muscari, Filomena, Conti, Jean, Hardwigsen, Georges-Philippe, Pageaux, Olivier, Chazouillères, Ephrem, Salame, Marie-Noelle, Hilleret, Pascal, Lebray, Armand, Abergel, Marilyne, Debette-Gratien, Michael D, Kluger, Ariane, Mallat, Daniel, Azoulay, Daniel, Cherqui, Stephane, Bouvier, Le Corre, Morgane, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Pôle Recherche Clinique-Santé Publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service de santé publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Pôle évaluation - biostatistique, Agence de la biomédecine [Saint-Denis la Plaine], Service de Transplantation, Hôpital de Hautepierre [Strasbourg], Service d'hépatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), service d'Hépato-gastro-entérologie, Hospices Civiles de Lyon-Hôpital Edouard Heriault, Hôpital Claude Hurriez, Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Chirurgie Générale et Digestive [Rangueil], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service d'hépatologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Chirurgie, Assistance Publique - Hôpitaux de Marseille (APHM)-Hospices Civiles de Marseille-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département de Chirurgie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Département de Gastroentérologie et hépatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Etaing, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, CHU Saint-Antoine [AP-HP], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'hépatologie [Saint-Antoine], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, medicine.medical_treatment, 030230 surgery, Liver transplantation, Gastroenterology, MESH: Proportional Hazards Models, 0302 clinical medicine, MESH: Practice Guidelines as Topic, MESH: Liver Neoplasms, Medicine, MESH: Carcinoma, Hepatocellular, MESH: Middle Aged, Liver Neoplasms, Middle Aged, MESH: Predictive Value of Tests, Hepatocellular carcinoma, Predictive value of tests, Area Under Curve, Practice Guidelines as Topic, 030211 gastroenterology & hepatology, Female, alpha-Fetoproteins, MESH: Neoplasm Recurrence, Local, Adult, medicine.medical_specialty, MESH: Liver Transplantation, Carcinoma, Hepatocellular, AFP, Milan criteria, MESH: Multivariate Analysis, Decision Support Techniques, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Carcinoma, Humans, Neoplasm Invasiveness, MESH: Patient Selection, Proportional Hazards Models, MESH: Humans, Hepatology, Receiver operating characteristic, business.industry, Proportional hazards model, Patient Selection, MESH: Decision Support Techniques, MESH: Adult, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Hepatocellular Carcinoma, MESH: Neoplasm Invasiveness, medicine.disease, Confidence interval, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Male, Surgery, Liver Transplantation, Multivariate Analysis, MESH: Area Under Curve, MESH: alpha-Fetoproteins, Neoplasm Recurrence, Local, business, MESH: Female
Abstract: International audience; BACKGROUND & AIMS: The aim of this study was to generate an improved prognostic model for predicting recurrence in liver transplant candidates with hepatocellular carcinoma (HCC). METHODS: Predictors of recurrence were tested by a Cox model analysis in a training cohort of 537 patients transplanted for HCC. A prognostic score was developed and validated in a national cohort of 435 patients followed up prospectively. RESULTS: α-Fetoprotein (AFP) independently predicted tumor recurrence and correlated with vascular invasion and differentiation. At a Cox score threshold of 0.7 (area under the receiver operating characteristic curve, 0.701; 95% confidence interval, 0.63-0.76; accuracy, 75.8%), a model combining log(10) AFP, tumor size, and number was highly predictive of tumor recurrence and death. By using a simplified version of the model, with untransformed AFP values, a cut-off value of 2 was identified. In the validation cohort, a score greater than 2 predicted a marked increase in 5-year risk of recurrence (50.6% ± 10.2% vs 8.8% ± 1.7%; P < .001) and decreased survival (47.5% ± 8.1% vs 67.8% ± 3.4%; P = .002) as compared with others. Among patients exceeding Milan criteria, a score of 2 or lower identified a subgroup of patients with AFP levels less than 100 ng/mL with a low 5-year risk of recurrence (14.4% ± 5.3% vs 47.6% ± 11.1%; P = .006). Among patients within Milan criteria, a score greater than 2 identified a subgroup of patients with AFP levels greater than 1000 ng/mL at high risk of recurrence (37.1% ± 8.9% vs 13.3% ± 2.0%; P < .001). Net reclassification improvement showed that predictability of the AFP model was superior to Milan criteria. CONCLUSIONS: Prediction of tumor recurrence is improved significantly by a model that incorporates AFP. We propose the adoption of new selection criteria for HCC transplant candidates, taking into account AFP.
Published: 2012

18. NAD(P)H quinone-oxydoreductase 1 protects eukaryotic translation initiation factor 4GI from degradation by the proteasome

Author: Rodica Anesia, Stéphane Pyronnet, Philippe Pierre, Corinne Bousquet, Bertrand Fabre, Christiane Susini, Amandine Alard, Catherine Marboeuf, Simon, Marie Francoise, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Immunologie de Marseille - Luminy (CIML), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Chirurgie Générale et Digestive [Rangueil], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], and Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Small interfering RNA, MESH: NAD(P)H Dehydrogenase (Quinone), Mice, Peptide Initiation Factors, Chlorocebus aethiops, NAD(P)H Dehydrogenase (Quinone), Protein biosynthesis, MESH: Animals, MESH: Peptide Initiation Factors, MESH: Peptide Fragments, 0303 health sciences, MESH: Protease Inhibitors, MESH: Oxidative Stress, Protein Stability, MESH: Proteasome Endopeptidase Complex, 030302 biochemistry & molecular biology, Articles, Transfection, MESH: Eukaryotic Initiation Factor-4G, Biochemistry, MESH: Protein Biosynthesis, Proteasome Inhibitors, Protein Binding, Proteasome Endopeptidase Complex, MESH: NADPH Dehydrogenase, Biology, Cell Line, 03 medical and health sciences, Eukaryotic translation, MESH: Protein Stability, Animals, Humans, Initiation factor, MESH: Protein Binding, Protease Inhibitors, Molecular Biology, MESH: Mice, 030304 developmental biology, MESH: Humans, NADPH Dehydrogenase, Cell Biology, MESH: Cercopithecus aethiops, Peptide Fragments, MESH: Cell Line, Oxidative Stress, Proteasome, Protein Biosynthesis, NAD+ kinase, Eukaryotic Initiation Factor-4G
Abstract: International audience; The eukaryotic translation initiation factor 4GI (eIF4GI) serves as a central adapter in cap-binding complex assembly. Although eIF4GI has been shown to be sensitive to proteasomal degradation, how the eIF4GI steady-state level is controlled remains unknown. Here, we show that eIF4GI exists in a complex with NAD(P)H quinone-oxydoreductase 1 (NQO1) in cell extracts. Treatment of cells with dicumarol (dicoumarol), a pharmacological inhibitor of NQO1 known to preclude NQO1 binding to its protein partners, provokes eIF4GI degradation by the proteasome. Consistently, the eIF4GI steady-state level also diminishes upon the silencing of NQO1 (by transfection with small interfering RNA), while eIF4GI accumulates upon the overexpression of NQO1 (by transfection with cDNA). We further reveal that treatment of cells with dicumarol frees eIF4GI from mRNA translation initiation complexes due to strong activation of its natural competitor, the translational repressor 4E-BP1. As a consequence of cap-binding complex dissociation and eIF4GI degradation, protein synthesis is dramatically inhibited. Finally, we show that the regulation of eIF4GI stability by the proteasome may be prominent under oxidative stress. Our findings assign NQO1 an original role in the regulation of mRNA translation via the control of eIF4GI stability by the proteasome.
Published: 2010

19. Erectile dysfunction in end-stage liver disease men

Author: Eric Huyghe, Nassim Kamar, Lionel Rostaing, Fabien Wagner, Pierre Plante, Fabrice Muscari, Labib El-Kahwaji, Aude-Hélène Capietto, Simon, Marie Francoise, Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Groupe de recherche en fertilité humaine ( GRFH), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, Institut de médecine moléculaire de Rangueil (I2MR), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Chirurgie Générale et Digestive [Rangueil], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, medicine.medical_specialty, Cirrhosis, Time Factors, Urology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Population, Comorbidity, Liver transplantation, 03 medical and health sciences, Liver disease, Young Adult, 0302 clinical medicine, Endocrinology, Erectile Dysfunction, Risk Factors, Internal medicine, medicine, Prevalence, Humans, 030212 general & internal medicine, education, Aged, Hepatitis, education.field_of_study, business.industry, Hepatitis B, Middle Aged, medicine.disease, Health Surveys, 3. Good health, Liver Transplantation, Psychiatry and Mental health, Erectile dysfunction, Reproductive Medicine, 030211 gastroenterology & hepatology, business, Sexual function, Liver Failure
Abstract: Introduction In men, erectile dysfunction (ED) is an important issue. Data concerning ED in men with end-stage liver disease (ESLD) is limited, and the risk factors for ED in this population are still unknown. Aims To determine the prevalence, timescale, and risk factors for ED in ESLD patients candidates to liver transplantation. Methods Patients candidates for a liver transplantation were asked to participate in a mailed survey about sexual function. Among the 123 eligible men, 98 (84%) agreed to complete the questionnaire. Main Outcome Measures The quality of erection was evaluated using the five-item International Index of Erectile Function (IIEF-5) score, and satisfaction for sexuality, using the patient-baseline Treatment-Satisfaction Scale (TSS) score. Other questions also focused on patient perception of changes over time. Results On the overall population, 28 patients (29%) were nonsexually active. Among the 70 patients who were sexually active, 52 patients (74%) had ED. Regarding the development of ED, 50% of the patients perceived that a deterioration of erectile function occurred within the six previous months. The absence of sexual activity was more frequent in hepatitis B or C patients ( P = 0.02). The risk factors for ED were alcohol intake ( P = 0.03), tobacco use ( P = 0.03), and cardiovascular disease ( P = 0.004). The significant risk factors for having a low TSS score were having viral hepatitis ( P = 0.01), and cardiovascular disease ( P = 0.01). Conclusion Population of men with ESLD who are candidates for a liver transplantation is characterized by a high frequency of lack of sexual activity, and by a high prevalence of ED and should be targeted by interventions to improve sexual functioning. These preliminary data need further validation in prospective trial using more comprehensive questionnaires. Huyghe E, Kamar N, Wagner F, Capietto A-H, El-Kahwaji L, Muscari F, Plante P, and Rostaing L. Erectile dysfunction in end-stage liver disease men. J Sex Med 2009;6:1395–1401.
Published: 2009

20. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis

Author: Gilles Fourtanier, Pierre Andrau, Jean Escourrou, Hany Shehab, Louis Buscail, Barbara Bournet, Jacques Moreau, Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Chirurgie Générale et Digestive [Rangueil], and Simon, Marie Francoise
Subjects: Male, Necrosis, medicine.medical_treatment, MESH: Pancreatitis, Acute Necrotizing, MESH: Retroperitoneal Space, Endosonography, Digestive System Surgical Procedures, MESH: Treatment Outcome, MESH: Digestive System Surgical Procedures, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Pancreatitis, Acute Necrotizing, Middle Aged, Treatment Outcome, medicine.anatomical_structure, Female, medicine.symptom, Pancreas, MESH: Tomography, X-Ray Computed, Adult, Reoperation, medicine.medical_specialty, MESH: Reoperation, Disease-Free Survival, MESH: Endoscopy, medicine, Humans, Retroperitoneal space, Retroperitoneal Space, Transduodenal approach, MESH: Debridement, Aged, MESH: Necrosis, Debridement, MESH: Endosonography, MESH: Humans, business.industry, Endoscopy, MESH: Adult, Infected pancreatic necrosis, medicine.disease, MESH: Male, Surgery, MESH: Disease-Free Survival, Pancreatitis, Tomography, X-Ray Computed, business, MESH: Female
Abstract: International audience; OBJECTIVE: To assess the results and complications of an endoscopic transgastric/transduodenal approach as a possible alternative to conventional surgery. SUMMARY BACKGROUND DATA: Infected organized pancreatic necrosis carries a high mortality despite antibiotic therapy and numerous conventional and laparoscopic surgical techniques of debridement. The advent of natural orifice transluminal endoscopic surgery (NOTES) provides a possible alternative approach. METHODS: Between 2004 and 2007, patients with infected organized pancreatic necrosis were referred for endoscopic necrosectomy as their initial treatment of choice. Accessibility was confirmed by CT and endoscopic ultrasound. Access to the cavities was transgastric or transduodenal, after passing the endoscope inside the retroperitoneal cavity all necrotic and purulent material was evacuated under direct endoscopic vision. RESULTS: Thirteen patients (12 men, mean age: 55 years, range: 38-66 years) underwent endoscopic necrosectomy. Two patients had complementary percutaneous drainage for endoscopically inaccessible cavities. Resolution infection was the rule in all cases. Infection recurred in 4 patients and a necrotic cavity persisted in 1 patient; all were managed by further endoscopic necrosectomies (total = 23 necrosectomy sessions; mean, 1.8 per patient; range, 1-3). Mean duration of each session was 3.5 hours (range, 2.5-4 hours). Endoscopic treatment was eventually successful in all patients with gradual diminution of the necrotic cavities on CT images. Average duration of follow-up was 19.5 months (range, 2-56 months) with no recurrence of the infectious process and no surgery was required for any patient. Complications included bleeding (n = 3) and transient aggravation of sepsis (n = 3). No mortality occurred. CONCLUSIONS: This technique is highly effective and safe in the treatment of infected organized pancreatic necrosis. Results are achievable and sustainable with a limited number of sessions.
Published: 2008

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20 results on '"Chirurgie Générale et Digestive [Rangueil]"'

1. End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7): A Prospective, Randomized, Double Blinded, Multicentre Trial

2. Outcome of community- versus hospital-acquired intra-abdominal infections in intensive care unit: a retrospective study

3. Characterization of Human Colon Organoids From Inflammatory Bowel Disease Patients

4. Th22 cells are efficiently recruited in the gut by CCL28 as an alternative to CCL20 but do not compensate for the loss of Th17 cells in treated HIV-1-infected individuals

5. Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database

6. Penetrating Crohn Disease Is Not Associated With a Higher Risk of Recurrence After Surgery

7. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease

8. Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant-based prognostic models

9. European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group

10. Liver transplantation for adenomatosis: European experience

11. Targeting KRAS for diagnosis, prognosis, and treatment of pancreatic cancer: Hopes and realities

12. KRAS G12D Mutation Subtype Is A Prognostic Factor for Advanced Pancreatic Adenocarcinoma

13. Detection of Dysplasia or Cancer in 3.5% of Patients with Inflammatory Bowel Disease and Colonic Strictures

14. Early Administration of Azathioprine vs Conventional Management of Crohn's Disease: a Randomized Controlled Trial

15. Portomesenteric Vein Thrombosis in Patients With Inflammatory Bowel Disease

16. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial

17. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria

18. NAD(P)H quinone-oxydoreductase 1 protects eukaryotic translation initiation factor 4GI from degradation by the proteasome

19. Erectile dysfunction in end-stage liver disease men

20. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis

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