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Background and study aims Over-the-scope clip (OTSC) has been recently used in management of gastrointestinal perforations, but data on it are still limited. The aim of this study was to compare management of iatrogenic perforations before and after the OTSC was available in our endoscopy unit. Patients and methods We conducted a monocentric retrospective study from June 2007 to June 2015. All iatrogenic gastrointestinal perforations detected during endoscopy were included. Two time periods were compared in terms of surgery and mortality rates: before use of OTSC (June 2007 to June 2011) and after OTSC became available (June 2011 to June 2015). Results During the first period, 24 perforations were recorded. Fifteen (62.5 %) were managed with surgery. The mortality rate was 8 %. During the second period, 16 perforations occurred. In 11 patients (68.7 %), an OTSC was used to close the perforation, with complete sealing of the perforation in 100 % of cases. However, 2 patients with sigmoid perforation had to undergo surgery due to right ureteral obstruction by the clip in 1 case and to presence of a localized peritonitis in the other. The surgery rate during this period was 12.5 % (2 /16), with a statistically significant difference compared to the first period (P = 0.002). There was no mortality in the second period versus 8 % in the first one (P = 0.23). Conclusions OTSC is effective for endoluminal closure of iatrogenic perforations and results in a significant decrease in surgery rate.

Les tumeurs sous-muqueuses (TSM) de l’estomac sont des lesions frequentes de decouverte souvent fortuite. La plupart des TSM sont asymptomatiques et d’evolution benigne, telles que les lipomes, les leiomyomes, les schwannomes, les pancreas aberrants. Certaines TSM gastriques ont un potentiel de malignite, notamment celles developpees a partir de la musculeuse comme les gastrointestinal stromal tumor et les tumeurs neuroendocrines. Le diagnostic de certitude de ces lesions peut etre difficile, meme apres la realisation d’une echoendoscopique et/ou de biopsies. La resection chirurgicale des tumeurs de plus de 2 cm est justifiee car elle permet une analyse histologique et un traitement carcinologique. Concernant les TSM gastriques de petite taille (

La maladie coeliaque est une affection auto-immune de l’intestin grele en reponse a la gliadine, fraction du gluten, survenant chez des individus predisposes genetiquement. Son diagnostic requiert classiquement la mise en evidence d’auto-anticorps anti-transglutaminase tissulaire dans le serum des patients et l’existence de criteres histologiques sur les biopsies de l’intestin grele, tels que l’atrophie villositaire. L’enjeu de l’evaluation endoscopique est de cibler les prelevements histologiques dans une maladie dont les lesions peuvent etre discontinues dans l’intestin, et de diagnostiquer d’eventuelles complications evolutives, telles que la jejunite ulcereuse, la sprue refractaire, ou le lymphome T intestinal. Nous avons passe en revue l’interet relatif et les performances diagnostiques des differents outils endoscopiques a la disposition du gastroenterologue dans la prise en charge du patient atteint de maladie coeliaque.

Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia.

Inflammatory liver pseudotumor is a rare entity. Associations with several inflammatory conditions were reported but association with inflammatory bowel disease is unusual. We report the case of liver inflammatory pseudotumor occurring in the course of Crohn's disease in a 23-year-old woman and treated conservatively.