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International audience; BACKGROUND: The most effective treatment for anal fistula is fistulotomy, but it involves a risk of anal incontinence. To reduce this morbidity, sphincter-sparing treatments have been developed, but their success in real life is often less than 50%. The aim is to determine clinical healing rate 6 months after radiofrequency treatment. PATIENTS AND METHODS: We planned to evaluate 50 patients from 3 French proctology centres. Treatment efficacy was evaluated at 6 and 12 months by means of clinical and magnetic resonance imaging examination. We evaluated morbidity and healing prognostic factors. RESULTS: Fifty patients with a mean age of 51years [22-82] were included. Eleven patients had a low transsphincteric fistula(LTS), 21 high transsphincteric fistula(HTS), 8 complex fistula and 9 Crohn’s disease fistula. After 6 months, 17 patients (34.7%) had a clinically healed fistula, including 5 (45.5%) with LTS fistula, 7 (33.3%) with HTS fistula, 1 (12.5%) with complex fistula, 4 (44.4%) with Crohn’s disease, with no significant difference between these fistula types (p:0.142). At 12 months, the healing rate was identical. MRI in 15 out of 17 clinically healed patients showed a deep remission of 73.3% at 12 months. Energy power was associated with the success of the treatment. There was an 8.2% incidence of post-surgical complications with 4.1% being abscesses (one required surgical management). Postoperative pain was minor. No new cases or deterioration of continence have been shown. CONCLUSION: Radiofrequency is effective in less than 50% of the cases as an anal fistula treatment in this first prospective study, with low morbidity and no effect on continence. Clinical healing was deep (MRI) in ¾ at 1 year. The increase in energy power during the procedure seems to be a key point to be analysed to optimise results.

BACKGROUND AND AIMS The use of telemedicine dramatically increased during the COVID-19 pandemic. We collected patients and physicians experience on telemedicine in the field of inflammatory bowel disease (IBD). METHODS We conducted a nationwide survey between September 2020 and January 2021. A self-administered questionnaire was sent to participants through mailing lists of the national patients' association and IBD expert groups. RESULTS Overall, 300 patients and 110 gastroenterologists filled out the survey. On a 10 points scale of satisfaction with telemedicine, 60% of patients noted a score ≥8 and 52.7% of physicians ≥7. Patients and gastroenterologists felt that the duration of teleconsultations appeared to be shorter than in-person visits in 57.5 and 55.1% of cases, respectively. All participants agreed that telemedicine is appropriate in dedicated situations and not for flare-up consultations. For 55.1% of patients, quality of care was the same via telemedicine, whereas 51.4% of gastroenterologists believed they managed less well their patients. Lack of clinical examination being pointed out as the main limitation of telemedicine. Three-quarters of patients and gastroenterologists would agree to use telemedicine more often in the future. CONCLUSION Patients and gastroenterologists were satisfied with telemedicine and would be willing to use it in the future. However, telemedicine does not replace in-person visits and should be discussed on a case-by-case basis.

Aim Anal dysplasia is caused by chronic infection with the human papillomavirus and exposes to the risk of anal cancer. Usually during a surgery for anal condylomas only one or two biopsies on visible lesions are performed to classify the level of dysplasia. The aim of this study was to evaluate the distribution of dysplasia anal grade among patients operated on for multiple anal condylomas with no macroscopic differences. Method Cross-sectional study of patients operated on for multiple anal condylomas including a mapping of dysplasia by performing systematically for each patient one biopsy on visible lesion from each of the 4 quadrants on anal margin and in anal canal. All biopsies were read independently by 2 different pathologists. Results Among 72 patients, 60 were men, 48 were HIV-infected with a median age of 37.5 years. The proportion of high-grade squamous intraepithelial lesion (HSIL) was higher in the anal canal (41.7%) compared to the margin (20.8%) (p= 0.004). HSIL frequency did not differ according to the quadrant (anterior, posterior, right or left) of the two areas. HSIL on anal canal was not associated with HSIL on anal margin and vice versa (p=0.39). Neither age nor sex was associated to HSIL but HIV positivity increased the risk of HSIL on the anal margin (p=0.01). Conclusion Anal dysplasia is heterogeneously distributed in the anal canal as well as between anal canal and anal margin. The diagnostic of the grade of dysplasia for a person should require multiple biopsies on the canal and anal margin.

In twenty years, significant progress was made in the knowledge of viral hepatitis. Alphabet of hepatotropic viruses has extended, and C, D, E and G viruses have been added to hepatitis A and B viruses; their genomes have been characterized, allowing defining various types, subtypes and isolates with different pathological and therapeutic implications. Our knowledge regarding the epidemiology, virology and treatment of viral hepatitis is in constant evolution, allowing a better diagnostic and therapeutic approach of patients with acute and chronic hepatitis. Markers of infection and early viral kinetics provide important prognostic and therapeutic information to determine the best moment for the treatment of acute and chronic B (HB V) or C (HCV) viral hepatitis. Finally, the improved definition of risk factors for fibrosis progression to cirrhosis in chronic hepatitis may lead to preventive therapies (alcohol withdrawal, treatment of immune deficiencies) and early antiviral treatments. Progresses in liver transplantation and in the treatment of viral recurrence post-transplantation, improved prognosis of cirrhosis and small hepatocellular carcinomas. For HBV and HCV around half of french infected patients are aware of their infection (seroprevalence of 0.65 % and 0.84 % of the adult population respectively) ; access to care is easy and completly covered by the social security. Second generation-nucleos(t)idic analogues allow HBV viral suppression in all the adherent patients but have to be maintai- nedfor the whole life, by contrast with interferon which a 48 weeks course achieve sustained viral virosuppression in one third of patients, including 10 % of HBs Ag loss. HCV infection may be cured by the combination of oral direct acting antivirals in more than 95 %: hepatic and extra-hepatic manifestations are mainly reversible when a sustained virologic response corresponding to a viral cure is achieved.

Background Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam®Eso capsule endoscopy in this setting. Methods Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam®Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures. Results 80 patients (80% males, mean age: 57 ± 12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2–930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication. Conclusion This study demonstrates that accuracy of PillCam®Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam®Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.