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Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Worldwide, gastric adenocarcinoma is a major public health problem, accounting for 6% of all cancers. In France, the incidence of gastric adenocarcinoma has been stabilized at around 4,700 new cases/year, thanks to better control of risk factors, in particular the eradication of Helicobacter pylori. Around 3% of all cases are hereditary forms of the disease, which are part of cancer predisposition syndromes resulting from the presence of constitutional pathogenic variants in some tumor suppressor genes. The best-known predisposition syndromes that increase the risk of developing gastric adenocarcinoma are hereditary diffuse gastric cancer syndrome (CDH1 and CTNNA1 genes; estimated lifetime risk of around 40%), Lynch syndrome (germline alteration of one of the genes in the Mismatch Repair (MMR) system for repairing DNA mismatches (MLH1, PMS2, MSH2, MSH6); estimated lifetime risk of around 10 %) or certain digestive polyposis (Peutz-Jeghers syndrome linked to STK11, juvenile polyposis linked to SMAD4, GAPPS syndrome linked to APC). Identifying these patients is essential in order to implement preventive strategies and screening for gastric adenocarcinoma in unaffected relatives, as well as to be able to guide treatment strategies in patients with gastric adenocarcinoma (prognostic impact, treatment and risk of second cancer). Screening strategies for gastric adenocarcinoma in these patients include upper gastrointestinal endoscopy, and sometimes lead to discussion of prophylactic surgery, warranting management in an expert centre with a multidisciplinary referral committee. Although these syndromes are rare, the role of oncogenetics in the management of patients at high risk of developing gastric adenocarcinoma (or suffering from this cancer) is crucial, and new predisposition genes are regularly described which may also have therapeutic implications. [ABSTRACT FROM AUTHOR]

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

After wide-spreading of carbon dioxid use in endoscopy, underwater procedures are the next big step for the endoscopic technical improvement. In the field of diagnosis, water-assisted colonoscopy is associated with best patient reported outcomes such as pain, but also with higher quality criteria such as cæcal intubation rate, bowel cleanliness and adenoma detection rates. Despite its need for a longer examination duration, water-exchange colonoscopy should be preferred to water-immersion colonoscopy. The better tolerance of water-assisted colonoscopy with excellent outcomes should lead to more examinations without general anesthesia, allowing quicker care for patients. Underwater mucosal resection is a technique of choice, especially for sessile or flat lesions, without prior submucosal injection, providing a distance between the muscular layer and the lesion thanks to flotation effect and the minimal distension of the colonic wall during immersion. Underwater mucosal resection improves the en-bloc resection rate and complete resection rate compared to conventional mucosal resection without increasing the adverse event rate, in particular perforation. This strategy is also feasible and safe in the duodenum. Underwater techniques also reduce the environmental footprint since fewer devices are needed and bacteriological mastered water can be used. [ABSTRACT FROM AUTHOR]

Résumé: Les tumeurs superficielles œsophagiennes sont des lésions fréquentes, de mauvais pronostic oncologique. Compte tenu des progrès de l'endoscopie diagnostique, ces lésions sont diagnostiquées à des stades de plus en plus précoces, autorisant des résections endoscopiques pour les stades superficiels. L'ESGE a édité en 2015 des critères permettant de considérer comme curative une résection de lésion superficielle œsophagienne. Ces critères diffèrent en fonction du type histologique (adénocarcinome ou carcinome épidermoïde), notamment en raison d'un risque d'invasion ganglionnaire plus élevé en cas de carcinome épidermoïde. À ce jour, peu de données existent concernant la résection endoscopique des cancers superficiels de l'œsophage dans un contexte de cirrhose ou d'hypertension portale, alors que des facteurs de risque confondant existent entre maladies hépatiques et risque de cancer œsophagien. Dans cette mini-revue, nous recensons les quelques études de cas ou séries rétrospectives à effectifs limités, décrivant différentes techniques visant à diminuer le risque hémorragique, telles que la ligature de varices œsophagiennes, la pose d'un shunt intrahépatique par voie transjugulaire, ou la technique du « ligate and let go ». Il existe plus de données concernant la résection endoscopique de lésions gastriques en cas de cirrhose ou d'hypertension portale, ainsi qu'une étude traitant de la résection de tumeurs superficielles toutes localisations confondues (tube digestif haut et bas) chez le patient cirrhotique. Superficial esophageal tumors are common lesions with a poor oncological prognosis. With advances in diagnostic endoscopy, these lesions are being diagnosed at increasingly earlier stages, allowing endoscopic resections for superficial stages. The ESGE published criteria in 2015 to classify as curative a resection of a superficial esophageal lesion. These criteria differ according to the histological type of tumor (adenocarcinoma or squamous cell carcinoma), in particular because of a higher risk of lymph node invasion in the case of squamous cell carcinoma. To date, few data exist concerning endoscopic resection of superficial esophageal cancers in the context of cirrhosis or portal hypertension. There are only case reports or small retrospective series describing different techniques to reduce the risk of bleeding from portal hypertension, such as endoscopic band ligation of esophageal varices, Transjugular intrahepatic portosystemic shunt, or the "ligate and let go" technique. There are more data about endoscopic resection of gastric lesions in cirrhosis or portal hypertension, as well as one study about resection of superficial tumors in all locations (upper and lower gastrointestinal tract) in the cirrhotic patient. [ABSTRACT FROM AUTHOR]

Référence: Sperna Weiland CJ, Smeets XJNM, Kievit W, et al. Aggressive fluid hydration plus non-steroidal anti-inflammatory drugs versus non-steroidal anti-inflammatory drugs alone for post-endoscopic retrograde cholangiopancreatography pancreatitis (FLUYT): a multicentre, open-label, randomised, controlled trial. Lancet Gastroenterol Hepatol 2021 ; 6 (5) : 350-58 [ABSTRACT FROM AUTHOR]

Référence: Colán-Hernández J, Sendino O, Loras C, et al. Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology 2020 ; 158 (6) : 1642-1649. [ABSTRACT FROM AUTHOR]