Search

Background The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. Methods All patients who underwent traction-assisted ESD for an ICV lesion at three centers were identified from a prospective ESD database. En bloc and R0 rates were evaluated. Factors associated with non-R0 resection were explored. Results 106 patients with an ICV lesion were included. The median lesion size was 50 mm (interquartile range 38–60) and 58.5% (62/106) invaded the terminal ileum. The en bloc and R0 resection rates were 94.3% and 76.4%, respectively. Factors associated with non-R0 resection were lesions covering ≥75% of the ICV (odds ratio [OR] 0.21. 95%CI 0.06–0.76; P=0.02), and involving the anal lip (OR 0.36, 95%CI 0.13–0.99; P=0.04) or more than two sites on the ICV (OR 0.27, 95%CI 0.07–0.99; P=0.03). Conclusion Traction-assisted ESD for treatment of ICV lesions was a safe and feasible option. Large lesions and anal lip involvement appeared to be factors predictive of difficulty. [ABSTRACT FROM AUTHOR]

Introduction The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure. Methods Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts. Results The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43–119 g) accounted for 9 %–97 % of total weight, and included deactivation magnets (5 g [4 %–6 %]) and paper instructions (11–50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2 , with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible. Conclusion The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions. [ABSTRACT FROM AUTHOR]

Introduction: It is still unclear whether Crohn's disease (CD) might be associated with diminished ovarian reserve (OvR) and factors influencing anti‐Mullerian hormone (AMH) levels in CD are poorly known. Material and Methods: We conducted a comprehensive literature search of multiple electronic databases from inception to June 2022 to identify all studies reporting AMH levels or factors associated with diminished OvR in patients with CD. Results: Of the 48 studies identified in our search, eight (including 418 patients with CD) were finally included. The mean difference (95% confidence interval [CI]) in the AMH level between pooled CD patients and controls was −0.56 (−1.14 to 0.03) (p = 0.06). A history of CD‐related surgery was not associated with a lower OvR (odds ratio, OR [95% CI] 1.34, [0.66–2.7]; p = 0.4). While disease activity and perianal disease seems associated with a low OvR, disease location (L2 vs. L1, OR [95% CI] = 95% CI [0.47–7.4]; p = 0.4) and L3 vs. L1 (OR [95% CI] = 1.44 [0.67–3.12]; p = 0.3), CD medication, and disease behavior were not. Conclusions: Our systematic review and meta‐analysis did not identify a significantly low OvR in patients with CD. Contrary to CD‐related surgery risk factor, active disease was associated lower AMH levels. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the use of an adaptive traction device called ATRACT in endoscopic submucosal dissection (ESD) procedures. The study found that the ATRACT device was effective in achieving successful resections with minimal complications. It provided strong traction and improved access to challenging lesions in the gastrointestinal tract. However, the study suggests that more extensive research is necessary to fully assess the safety and efficacy of the ATRACT device. [Extracted from the article]

For lesions of 20-30 mm, the difference was already large, with rates of 83.9 % and 57.1 % for R0 resections in the ESD and FTRD groups, respectively ( I P i = 0.06), and this difference dramatically increased when the lesion size was > 30 mm (93.6 % vs. 33.3 %; I P i = 0.002). The lesions treated by ESD were however statistically larger than those treated by FTRD ( I P i < 0.001), and small lesion size was the only factor associated with en bloc and R0 resection on univariate analysis (Table 2; B Table 1 s, b see online-only Supplementary material). Graph Introduction Endoscopic submucosal dissection (ESD) is a safe and effective technique to achieve R0 resection of superficial colorectal neoplasia, regardless of its size, and is associated with few recurrences [1][2][3][4]. [Extracted from the article]

Adenomas or adenocarcinomas of the ampulla are rare and mostly diagnosed fortuitously during an endoscopy performed for another indication. For a long time, surgical resection by pancreatic duodenectomy was the standard, at the cost of a significant morbidity and mortality. Transduodenal papillectomy is a less morbid surgical alternative. Nowadays, advances in interventional endoscopy allow a minimally invasive approach. Ampullary adenomas can be completely removed by endoscopic resection which should be the first treatment to propose. The risks of endoscopic papillectomy are dominated by acute pancreatitis and hemorrhage. This endoscopic technique could be proposed under certain conditions for localized adenocarcinomas without lymph node risk. The purpose of this review is to focus on the management of localized ampullary lesions that can benefit from endoscopic or surgical management. [ABSTRACT FROM AUTHOR]

Background Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. Methods In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Results 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4). Conclusion ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) fistula is a life-threatening condition and a therapeutic challenge. Endoscopic approaches include mucosal abrasion, clip closure, or stent diversion, with moderate success rates in the long term. We assessed whether fistula endoscopic submucosal dissection with clip closure (FESDC) could lead to complete resolution of fistulas even after failure of previous endoscopic therapy.Methods: Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. The primary outcome was long-term (> 3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with FESDC success.Results: 23 patients (13 refractory 57 %) were included. Tight immediate sealing was achieved in 19 patients (83 %; 95 % confidence interval [CI] 61 %-95 %). Long-term closure was achieved in 14 patients (61 %; 95 %CI 39 %-80 %), with median follow-up of 20 months. Complications occurred in two patients (9 %). Previous local malignancy (P = 0.08) and radiotherapy (P = 0.047) were associated with a higher risk of failure.Conclusion: This novel FESDC strategy was demonstrated to be safe and feasible for permanent endoscopic closure of GI fistulas. Further studies are warranted to determine the place of this technique in the management of chronic GI fistula. [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.)

The management of colorectal stricture complicating inflammatory bowel disease [IBD] remains a challenging condition. Stricture raises concern about neoplastic complications, which cannot be fully ruled out by negative endoscopic biopsies. Also, impassable strictures restrict the endoscopic monitoring of upstream disease activity and dysplasia. Surgery remains the 'gold standard' treatment for colonic strictures but is associated with high morbidity. Over the past few decades, our therapeutic arsenal for IBD has been reinforced by biologics and therapeutic endoscopy. Few studies have focused on colonic strictures, and so current therapeutic strategies are based on a low level of evidence and applied by analogy with the treatment of ileal strictures. With a view to facilitating the decision making process in clinical practice, we reviewed the literature on the epidemiology, natural history, and management of colonic strictures in IBD. [ABSTRACT FROM AUTHOR]

Introduction: An increased risk of dental caries and periodontal diseases has been reported for inflammatory bowel disease (IBD) patients and are challenging conditions to manage. Areas covered: The authors searched international databases to find all studies assessing dental/periodontal outcomes in patients with IBD and other immune-mediated inflammatory disease (IMID), as well as the association between IMID medications and dental/periodontal status. Expert opinion: IBD are associated with a higher risk of both periodontitis and caries. Some evidence from rheumatoid arthritis suggests that periodontitis may be associated with a lower response to anti-TNF. There is no reliable evidence that IBD patients may be at greater risk of complications during routine dental care. On the basis of current data, guidelines can be proposed for the dental management focusing on the detection and eradication of infectious foci prior to the implementation of immunosuppressants/biologics and modified dental treatment protocol for invasive dental procedures that includes antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Résumé: L'endoscopie est l'examen de référence pour le diagnostic et la surveillance des maladies inflammatoires chroniques intestinales (MICI). À l'heure des stratégies de « tight-control » et de « treat-to-target », le développement de biomarqueurs ou d'examen non invasif, bien toléré, répétable et peu coûteux est indispensable. Comparativement, à l'endoscopie ou à l'imagerie en coupe, l'échographie intestinale s'est avérée performante dans l'évaluation et la surveillance de l'activité de la maladie de Crohn et de la rectocolite hémorragique. Elle peut être réalisée « au chevet du malade » et permettre ainsi une prise de décision clinique en temps réel. L'objectif de cette revue est d'effectuer une mise au point sur la place actuelle et future de l'échographie dans les MICI. The gold standard for the diagnosis and monitoring of inflammatory bowel disease (IBD) is the colonoscopy. In the era of "tight control" and "treat to target" strategies, the development of non-invasive, well-tolerated, repeatable and inexpensive biomarkers are needed. Compared to colonoscopy and Magnetic resonance imaging, bowel ultrasound (US) has shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both Crohn's disease and ulcerative colitis. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. The aim of this review is to discuss the interest of intestinal ultrasound in the management of patients with IBD. The objective of this review is to provide an update on the current and future place of ultrasound in IBD. [ABSTRACT FROM AUTHOR]

Epstein‐Barr virus‐related mucocutaneous ulcer lymphoma is a rare entity promoted by immunosuppression. It is less described in inflammatory bowel diseases, and mostly these are refractory diseases. CD30 acts to Epstein‐Barr virus (EBV) local proliferation and thus could be an interesting target. Brentuximab vedotin could become a new helpful tool. [ABSTRACT FROM AUTHOR]

Analysis of the polyp confirmed the presence of gastric heterotopia in two patients and a Brunner's gland hyperplasia without dysplasia in one patient. The exploration of the duodenum was performed immediately for two patients, who benefited from a one-step procedure using a transnasal scope to pass through the LAMS and perform the resection using a small-caliber snare by underwater technique. [Extracted from the article]

EndoGel (Fujifilm, Tokyo, Japan) is a new non-animal training model for endoscopic submucosal dissection (ESD) that seems a good option for initial training. We hypothesize that such a dedicated model, which is ecologically acceptable with no animal components, could facilitate ESD training with adaptive traction strategies. [Extracted from the article]

Résumé: Les biothérapies utilisées pour le traitement des maladies inflammatoires chroniques de l'intestin sont associées à un risque de réactions immédiates (< 24 h). L'infliximab (IFX) a rapidement été associé à un risque de réaction à l'injection potentiellement grave. Les biothérapies sous-cutanées (adalimumab, golimumab et ustékinumab) peuvent être responsables de réactions locales, qui justifient exceptionnellement l'arrêt du traitement. Les incertitudes sur les mécanismes physiologlogiques engagés et le peu d'études d'intervention ont abouti à des protocoles d'administration et de prise en charge des réactions multiples et empiriques. Biologics used for the treatment of Inflammatory Bowel Diseases are associated with a risk of immediate reaction (< 24h). Infliximab (IFX) was associated with a potentially serious infusion reaction risk. Subcutaneous biologics (adalimumab, golimumab and ustekinumab) may be responsible for local reaction, which exceptionally justifies stopping treatment. Uncertainties about the physiopathological mechanisms involved and the lack of interventional studies have led to different empirical protocols for their administration and their management. [ABSTRACT FROM AUTHOR]

Summary: Background: The significance of endoscopic activity in asymptomatic ulcerative colitis (UC) patients with an ileal pouch is unknown. Aim: To investigate the association of endoscopic pouch activity in asymptomatic patients with the subsequent development of pouchitis. Methods: We analyzed a retrospective cohort of patients with UC or IBD‐unspecified who underwent a total proctocolectomy with ileal pouch anal anastomosis (IPAA). Asymptomatic patients with a Pouchitis Disease Activity Index (PDAI) symptom sub‐score of zero who underwent an index surveillance pouchoscopy were included. Endoscopic pouch body activity was graded as 0: normal, 1: mucosal inflammation, or 2: mucosal breaks (ulcers and/or erosions). The primary outcome was primary acute idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting less than four weeks and responsive to standard antibiotics, not otherwise meeting criteria for secondary pouchitis. The secondary outcome was chronic idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting greater than four weeks despite standard antibiotics. Predictors of pouchitis were analyzed using Kaplan‐Meier and Cox regression methods with hazard ratios (HR) and 95% confidence intervals (CI) reported. Results: 143 asymptomatic pouch patients were included. Index endoscopic pouch body activity was 0 in 86 (60.1%) patients, 1 in 26 (18.2%) and 2 in 31 (21.7%). The median length of follow‐up after index surveillance pouchoscopy was 3.03 [IQR 1.24‐4.60] years. Primary acute idiopathic pouchitis occurred in 44 (31%) patients and chronic idiopathic pouchitis in 12 (8.4%). Grade 2 endoscopic pouch activity was associated with the development of acute pouchitis (HR 2.39, 95% CI 1.23‐4.67), although not chronic pouchitis (HR 1.76, 95% CI 0.53‐5.87). Histologic inflammation in endoscopically normal pouch mucosa was not associated with acute or chronic pouchitis. Conclusions: Mucosal breaks are present in nearly a quarter of asymptomatic patients with IPAA and are associated with an increased risk of acute pouchitis. [ABSTRACT FROM AUTHOR]

Abdominal computed tomography (CT) and magnetic resonance enterography (MRE) showed a thickening of the small bowel at the junction between the jejunum and ileum, at 30 cm, suggesting Crohn's disease. Small-bowel capsule endoscopy and enteroscopy are relevant tests to explore suspected refractory celiac disease [2][3]. [Extracted from the article]

Bougies and balloons are two instruments commonly used for endoscopic dilation of benign strictures in the upper gastrointestinal tract, with similar efficacy [1]. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. [Extracted from the article]