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Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period.Pediatric-onset IBD (17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification.1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/10In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

Esophagogastroduodenoscopy (EGD) is the standard method for the diagnosis of esophago-gastric varices. The aim of this prospective multicenter study was to evaluate the PillCam esophageal capsule endoscopy (ECE) for this indication.Patients presenting with cirrhotic or noncirrhotic portal hypertension underwent ECEfollowed by EGD at the time of diagnosis. Capsule recordings were blindly read by two endoscopists.A total of 120 patients (72 males, mean age: 58 years; mean Child-Pugh score: 7.2) were included. Esophageal varices were detected in 74 patients. No adverse event was observed after either EGD or ECE. Seven (6%) patients were unable to swallow the capsule. The mean recording time was 204 s (range 1-876). Sensitivity, specificity, negative predictive value, and positive predictive value of ECE for the detection of esophageal varices were 77%, 86%, 69%, and 90%, respectively. Sensitivity, specificity, negative and positive predictive values of ECE for the indication of primary prophylaxis (esophageal varicesor = grade 2 and/or red signs) were 77, 88, 90, and 75%, respectively, and 85% of the patients were adequately classified for the indication (or not) of prophylaxis. Interobserver concordance for ECE readings was 79.4% for the diagnosis of varices, 66.4% for the grading of varices, and 89.7% for the indication of prophylaxis.This large multicenter study confirms the safety and acceptable accuracy of ECE for the evaluation of esophageal varices. ECE might be proposed as an alternative to EGD for the screening of portal hypertension, especially in patients unable or unwilling to undergo EGD.

The screening for the detection of hepatocellular carcinoma is based on ultrasound sonography which should be realised in patients with post-hepatitis C cirrhosis with a delay between 3 and 6 months according to the most identified risk factors, in particular age and sex male. In the case of discovery of hypoechogen nodule 2 cm and when the ultrasound sonography is not contributive, especially when the nodule is between 1 and 2 cm in size.

BACKGROUND AND STUDY AIMS: Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Societe Francaise d’Endoscopie Digestive (SFED). PATIENTS AND METHODS: A total of 51 patients were selected (mean age 72), the majority (69 %) having pancreatic adenocarcinoma. Palliative treatment was chosen because of irresectability (61.2 %), inoperability (18.4 %), or both (20.4 %). Enteral Wallstent prostheses were used, and the patients were followed up on day 3, after 1 month, and then every month, with weight measurement, and symptomatic and laboratory evaluation. RESULTS: One prosthesis was sufficient in 46 patients. Stent positioning and deployment were correct in 50/51 patients (98 %). Twenty patients also underwent biliary stenting in addition to the duodenal stenting. On day 3, 43 patients (84 %) were able to tolerate soft solids or a full diet. Six complications were attributed to stenting: three intestinal hemorrhages, two cases of peritonitis due to bowel perforation, and one case of septicemia, and these led to five deaths (mortality 9.8 %). Stent dysfunction was observed in 12 cases (23.5 %) after a mean delay of 75 days, comprising 11-malignant obstructions and one migration: a new stent was inserted inside the first one and was effective in eight cases; and no treatment was given in the other four patients because of their clinical state. The median survival was 71.5 days. CONCLUSIONS: Palliative endoscopic treatment of malignant duodenal stenosis using metallic prostheses is highly feasible, even with associated biliary stenting. Symptomatic improvement is fast. However, the mortality and the obstruction rate are high, suggesting that a prospective trial comparing this treatment with surgery is still required.

La videocapsule colique Pillcam® (Given Imaging Ltd., Yoqneam, Israel) est une technique sure et peu invasive, permettant une visualisation complete du colon sans anesthesie. De fait, la videocapsule est devenue en quelques annees l’examen de reference pour l’exploration des pathologies du grele. Les deux premieres etudes sur la videocapsule colique publiees fin 2006 confirment la faisabilite de la methode, la qualite des images obtenues et des performances diagnostiques interessantes pour la detection des lesions polypoides. Ces performances sont liees au developpement technique de la capsule et aux adaptations de la preparation a cet examen si specifique.

Position du probleme Le but de cette etude prospective etait d’evaluer l’incidence et les facteurs de risque de l’infection par le virus de l’hepatite C (VHC) dans un groupe de toxicomanes du Nord et de l’Est de la France. Methodes Un suivi trimestriel pendant 12 mois ou jusqu’a seroconversion VHC a ete propose a 231 sujets toxicomanes ayant des Ac anti-VHC, anti-VIH et l’AgHBs negatifs et ayant utilise la voie intra-veineuse au moins une fois dans la vie. Une recherche des Ac anti-VHC, de l’AgHBs et des Ac anti-VIH seriques etait effectuee a l’inclusion et en fin de suivi. Un controle des Ac anti-VHC ELISA seriques etait effectue en cas de positivite des Ac anti-VHC dans la salive. A l’inclusion et a chaque suivi, un questionnaire comportant des donnees demographiques et detaillant les pratiques de consommation et d’injection des drogues etait administre et une recherche d’Ac anti-VHC sur prelevement salivaire effectuee. Resultats Parmi les 231 sujets inclus, 165 (71,4%) ont beneficie d’un suivi et d’une serologie VHC finale. L’incidence de la seroconversion VIH etait nulle et celle du VHC etait de 9% (IC 95% ; 4,6-13,4) personnes-annees. L’incidence etait de 11% (IC 95%; 4,7-17,1) personnes-annees dans la sous-population des usagers actuels (ayant injecte au moins une fois dans les 6 mois precedant l’inclusion). L’analyse multivariee a partir des donnees d’inclusion montre que seul le sexe feminin etait un facteur predictif independant de seroconversion VHC. A partir des donnees de suivi, l’analyse multivariee montre que seuls les partages de seringue et de coton etaient des facteurs predictifs independants de seroconversion VHC. Le risque relatif ajuste de seroconversion etait estime a 16,4 (IC 95% ; 1,4-190,6 : p Conclusion L’incidence de l’hepatite C reste elevee malgre les mesures de prevention. Cette etude rappelle le role du partage de seringue et confirme celui du partage du coton.

Deux nouveaux instruments ont ete developpes dans le cadre des applications de la video-capsule : 1) la «patency capsule» destinee au test de calibrage avant endoscopie diagnostique par video capsule de facon a eviter une eventuelle retention en cas de suspicion de stenose du grele. Les avantages et inconvenients de cette nouvelle methode sont discutes ; 2) un instrument destine a l’examen de l’œsophage appele “PILLCAMTM ESO” de maniere non invasive et dans de bonnes conditions de confort et permettant d’observer les lesions œsophagiennes en delivrant des images de haute qualite.

Nous rapportons le cas d’une patiente de 52 ans presentant une lesion grelique pseudotumorale responsable de douleurs abdominales chroniques sans deperdition sanguine dont l’origine vasculaire a ete determinee par une videocapsule endoscopique (VCE) de l’intestin grele. Le diagnostic final d’hemangiome caverneux a ete retenu grâce a l’etude anatomopathologique couplee a l’analyse clinicobiologique.

Background: Topical treatments with steroids or mesalazine are the most effective treatments for idiopathic proctitis. Aim: to compare the efficacy and tolerance of mesalazine suppositories vs. hydrocortisone acetate foam in the treatment of acute proctitis. Patients and methods: 242 patients with active idiopathic proctitis were randomized to receive once daily either one Pentasa suppository (mesalazine 1 g) or 100 mg hydrocortisone (Colofoam) for 14–21 days (until remission). Disease activity and tolerance of the treatments were assessed using a daily questionnaire, by physician assessment, and endoscopy score. Results: Both treatments induced a significant reduction in disease activity. Mesalazine suppositories were significantly more effective than hydrocortisone on rectal blood loss (P=0.002) and mucus (P=0.02) parameters, and on the degree of the decrease in endoscopy score (P=0.02). No significant difference was observed between treatments concerning histology or tolerance. Conclusion: Mesalazine suppositories were as well-tolerated as hydrocortisone foam, but were more effective for some parameters of disease activity.

Orateur: M Pioche Introduction Environ 5% des coloscopies en France sont incompletes pour des raisons techniques ou contreindiquees sur le plan anesthesique. Nous rapportons le suivi sur un an de patients examines par videocapsule colique (Given Imaging°) dans cette situation. Patients et Methodes Nous avions presente en 2010 les resultats de la capsule colique pour explorer le colon en cas d'echec ou de contre indication de la coloscopie. Cette etude prospective avait ete menee dans 17 centres d'endoscopie publics ou (majoritairement) prives en France et avait permis l'inclusion de 100 patients. La capsule avait permis de diagnostiquer 36% de lesions significatives (expliquant les symptomes ou necessitant un traitement endoscopique). En l'absence de Gold standard pour explorer le colon en cas d'impossibilite de la coloscopie, un suivi clinique d'un an a ete realise afin d'evaluer la survenue de cancers colorectaux, ou d'autres lesions coliques symptomatiques, manques par la capsule colique. Nous rapportons le devenir des patients ayant beneficie de la capsule colique pendant l'annee suivant l'inclusion. Resultats Le suivi clinique a 1 an a ete complete chez 95/100 patients ayant eu un examen par videocapsule colique. Sur 36 videocapsules positives (2 patients perdus de vue: 1 polype de 8mm rectal et 1 polype d'1cm sigmoidien), 22 patients ont beneficie d'un traitement adapte: 14 traitements endoscopiques (13 polypectomies ou mucosectomies et 1 coagulation APC pour des telangiectasies), 1 colectomie droite pour cancer, et 7 traitements medicaux (par fer oral (2 pts), par antibiotiques (2pts) et par 5 ASA (1 pt)), 1 bilan vasculaire pour une colite ischemique et une ligature d'hemorroides. Quatorze patients ont donc beneficie secondairement d'un geste endoscopique qui a confirme le diagnostic fait par la capsule. Parmi ces 14 patients, 7 avaient eu un echec de coloscopie, et le geste a pu etre realise secondairement avec un coloscope standard (5) ou un enteroscope double-ballon (2). Les 7 autres avaient une contreindication initiale a la coloscopie, et 5 ont pu secondairement avoir le geste sous anesthesie generale et 2 sans anesthesie. Parmi les 64 capsules negatives (2 perdus de vue), 9 patients ont eu tout de meme une coloscopie (6) ou une coloscopie virtuelle (3) dans l'annee. Une seule coloscopies a retrouve une lesion significative avec 8 adenomes de moins de 5mm. Aucune coloscopie virtuelle n'etait positive. Le suivi a un an n'a montre aucun cas de cancer colo-rectal ni d'autre diagnostic symptomatique manque par la capsule. Conclusion Cette etude prospective en conditions de pratique courante montre la faisabilite d'un examen utilisant la capsule colique dans une situation d'echec de coloscopie, avec un taux de diagnostic pertinent eleve, sans qu'aucun cancer (symptomatique) n'ait ete manque a un an. Une etude prospective comparant la capsule endoscopique aux techniques de coloscanner semble necessaire. Structure: Endoscopie – imagerie

Colon capsule endoscopy (CCE) is a new, non-invasive technology.To conduct a prospective, multicentre trial to compare CCE and colonoscopy in asymptomatic subjects enrolled in screening or surveillance programmes for the detection of colorectal neoplasia.Patients underwent CCE on day one and colonoscopy (gold standard) on day two. CCE and colonoscopy were performed by independent endoscopists.A total of 545 patients were recruited. CCE was safe and well-tolerated. Colon cleanliness was excellent or good in 52% of cases at CCE. Five patients with cancer were detected by colonoscopy, of whom two were missed by CCE. CCE accuracy for the detection of polyps ≥ 6 mm was 39% (95% CI 30-48) for sensitivity, 88% (95% CI 85-91) for specificity, 47% (95% CI 37-57) for positive predictive value and 85% (95% CI 82-88) for negative predictive value. CCE accuracy was better for the detection of advanced adenoma, in patients with good or excellent cleanliness and after re-interpretation of the CCE videos by an independent expert panel.Although well-tolerated, CCE cannot replace colonoscopy as a first line investigation for screening and surveillance of patients at risk of cancer. Further studies should pay attention to colonic preparation (Clinicaltrial.gov number NCT00436514).

BACKGROUND AND STUDY AIM: A video capsule similar to that used in small-bowel capsule endoscopy is now available for esophageal exploration. The aim of our study was to compare the accuracy of upper endoscopy (esophageal gastroduodenoscopy [EGE]) with esophageal capsule endoscopy (ECE) in patients at risk of esophageal squamous cell cancer (SCC). PATIENTS AND METHODS: 68 patients at risk of SCC secondary to a history of head and neck neoplasia were included in this comparison of techniques for detecting SCC and dysplasia. ECE was done using the first generation Pillcam ESO and EGE was performed in accordance with the usual practice of each center, followed by examination with 2 % Lugol staining and biopsy of unstained areas (39 neoplasia comprising 5 low grade dysplasia, 8 high grade dysplasia and 26 SCC). RESULTS: Compared with EGE with and without Lugol staining, the sensitivities of ECE for neoplasia diagnosis were 46 % and 54 %, respectively. On a per-patient basis, the sensitivity, specificity, and positive and negative predictive value of ECE were 63 %, 86 %, 77 % and 76 %, respectively, compared with EGE without staining, and 61 %, 86 %, 77 % and 73 % compared with EGE with iodine staining. Neither the ECE transit time nor the distance between the esopharyngeal line and the neoplastic lesion differed between the 21 false-negative and 18 true-positive cases diagnosed by ECE; the only difference was a smaller median diameter among false negatives ( P < 0.001). CONCLUSION: In a cohort at high risk for esophageal SCC, ECE is not sensitive enough to diagnose neoplastic lesions.

International audience; The screening for the detection of hepatocellular carcinoma is based on ultrasound sonography which should be realised in patients with post-hepatitis C cirrhosis with a delay between 3 and 6 months according to the most identified risk factors, in particular age and sex male. In the case of discovery of hypoechogen nodule < or = 1cm, a follow-up is mandatory because it is usually untypical by ultrasound sonography and to propose a liver biopsy in the case of an increasing in size is shown. The ultrasound guided cutting biopsy can precise the histological characteristics of the nodule, the grade, and indicate prognostic factors. The liver biopsy is also mandatory in the case of a nodule > 2 cm and when the ultrasound sonography is not contributive, especially when the nodule is between 1 and 2 cm in size.

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among intravenous drug users we conducted a prospective cohort study of HCV and HIV negative IVDU in the North and East of France.Two hundred and thirty-one IVDU who had injected drug at least once in their lifetime and were negative for anti-HCV and anti-HIV were followed-up every three months over a 12-month period. Serum anti-HCV and anti-HIV antibodies were tested at inclusion in the study and at the end of the follow-up. Data on injection practices and behaviours were collected at inclusion and at each visit, and a test for anti-HCV antibodies was performed on a saliva sample. When this proved positive, an ELISA test for serum anti-HCV antibodies was carried out.Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9% (95% CI: 4.6-13.4) person-years for HCV infection. Among IVDU who injected at least once during the last 6 months HCV infection incidence was 11% (95% CI: 4.7-17.1) person-years. The multivariate analysis carried out on the inclusion data found female sex alone to be an independent predictive factor of HCV seroconversion. In a Cox proportional hazard multivariate analysis that took into account time-dependent exposures and covariates, we found that syringe and cotton sharing were, after adjusting for other covariates, the only independent predictive factors of HCV seroconversion: hazard ratio: 6.3 [corrected] (95% CI: 1.1-35.4; [corrected] p0.05) and 16.4 (95% CI: 1.4-190.6; [corrected] p0.05), respectively.The transmission of the HCV virus persists among French IVDU despite an ongoing national harm reduction program. Injecting material and cotton sharing are the two major determinants of transmission in this cohort.

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71·4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4·6–13·4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.

The authors report a preliminary series assessing the feasibility of duodenal stenting using a surgical approach. The study included 16 patients with a malignant duodenal outlet obstruction for whom a biliaryobstruction necessitated a laparotomyor following an endoscopic stenting failure. The stent was efficient in 15 patients with a complete relieve of obstruction. These patients could have oral intake at the end of the first postoperative week. No stent obstruction occurred. The duodenal stenting by laparotomy could be a good alternative to palliative gastroenteral anasotomosis.

To describe the characteristics of in-patients with alcoholic liver disease in Hepatogastroenterology and to evaluate whether geographic location was a risk factor for cirrhosis.A French, national, multicenter, prospective investigation was performed in the last quarter of 1997. To be included in the study, patients had to have drunk at least 50 g of alcohol per day for the past year or to have cirrhosis.Seventeen centers included 802 patients, 20% had histologically proven cirrhosis or probable cirrhosis. Thirty-five percent had undergone liver biopsy. Twenty five percent of these patients had cirrhosis without acute alcoholic hepatitis and 37% had cirrhosis with acute alcoholic hepatitis. After dividing France along a Bordeaux-Strasbourg axis, there was more histologically proven or probable cirrhosis in the North (46%) than in the South (36%) (P0.005) while daily alcohol intake was greater the South (150 +/- 6 g) than in the North (129 +/- 4 g) (P0.0001). When the six variables (age, sex, daily consumption of alcohol over the past 5 years, presence of hepatitis B surface antigen and antibodies to hepatitis C virus, total duration of alcohol abuse) were considered together in stepwise logistic regression analysis, geographic location changed the prediction of cirrhosis. The odds ratio for cirrhosis in patients living to the North of the Bordeaux-Strasbourg axis was 1.9 (95% confidence interval range 1.1-3.2) (P0.02), suggesting the role of nutritional factors.

La VCC est legerement plus longue que son equivalent destine a l’exploration du grele (32 versus 26 mm), mais de meme calibre (11 mm). Elle possede deux cameras, l’une proximale, l’autre distale, permettant l’acquisition de quatre images par seconde. Il existe un systeme automatique d’eclairage de la lumiere colique, et la batterie permet une autonomie d’environ dix heures apres activation de l’acquisition des images dans le colon. La preparation colique est d’une extreme importance puisque, contrairement a la coloscopie standard, il n’est pas possible de la completer in situ par un lavage des zones occultees par des matieres fecales. Cette preparation consiste actuellement en un regime liquide la veille de l’examen suivi de la prise de PEG en quantite identique a celle d’une coloscopie classique (quatre litres). Un prokinetique est ingere, un quart d’heure avant l’ingestion de la VCC pour favoriser sa progression hors de l’estomac. Des laxatifs sont ingeres apres que la VCC ait franchi le pylore afin de favoriser sa progression dans l’intestin grele et lui permettre d’atteindre le colon plus rapidement.

The aim of this retrospective study was to evaluate the feasibility and the morbidity of laparoscopic cholecystectomy for acute cholecystitis in elderly patients.Among 891 consecutive patients who underwent cholecystectomy, 151 had acute cholecystitis. Fifty three patients ofor = 70 years of age (group 1) were compared to 98 younger patients (group 2). Analysis was made in "intention to treat" so directly open cholecystectomies during the same period were also included.Elderly patients had a lower success rate of laparoscopic treatment (52.8% versus 70.4%; p0.05). This difference was due to higher rate of directly open cholecystectomy in the elderly (17% versus 2%). There was no difference between both groups in conversion rate to laparotomy (30.2% versus 26.5%). Surgical morbidity was 7.5% in group 1 and 4% in group 2 (NS). General complications were more frequent in the elderly (p0.05). Five patients in group 1 (9.4%) died of general complications of which 3 were operated on directly by open cholecystectomy. There was no mortality in group 2.Acute cholecystitis in the elderly remains a severe disease in which laparoscopic treatment is only possible in about fifty percent.

The aim of this study was to assess predictive factors for the progression to liver cirrhosis in hepatitis C.One hundred thirty six patients (79 men; 57 women; mean age 39 years) with transfusion or intravenous drug use-associated hepatitis C virus (HCV) infection were studied. Sex, cause of infection, duration of contamination, and genotype were studied as predictive factors of progression to liver cirrhosis.One hundred twenty three patients presented with chronic hepatitis without cirrhosis and 13 had cirrhosis. At the time of liver biopsy, rates of cirrhosis were: 0% before 40 years, 10% between 40 and 60 years, and 47% after 60 years. (p0.05). Rates of cirrhosis according to the age at the time of contamination were as follows: 3% before 30 years; 16% between 30 and 50 years; 46% after 50 years even though duration of the disease was comparable in the three groups. In multivariate analysis, two independent factors were associated with liver cirrhosis: age at contamination and duration of infection.Duration of infection and especially age at contamination seem better correlated with the probability of cirrhosis than the route of transmission or the genotype 1b. The results of this study suggest that progression to cirrhosis is slower in cases of contamination before 30 years of age than later on. Age at the time of contamination is an important predictive factor of progression to cirrhosis.

Adenocarcinoma of the appendix is rarely encountered and is usually discovered fortuitously at pathology examination of the surgical specimen. Six years after surgery for degenerative villous tumor of the appendix, local and parietal recurrence led to surgery in our patient. We present here the indications for complementary hemicolectomy and management of parietal scars resulting from the initial appendectomy.

Hepatocellular carcinoma is an uncommon complication of primary biliary cirrhosis. Hepatocellular carcinoma occurs generally in the end stage of the disease. We report a case of asymptomatic primary biliary cirrhosis complicated by a hepatocellular carcinoma in a 66 year-old man.

The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users.Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8).This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

We reported a series of 446 consecutive cholecystectomies performed laparoscopically between June 1990 and January 1993. There were 354 females and 92 men, mean age 53 +/- 17 years. Laparoscopic cholangiography was attempted in 410 cases (92%) and led to the discover of a stone in the main bile duct in 18 cases (4%) and an abnormal insertion of the bladder duct in 30% (6.7%). Conversion to laparotomy was required in 84 patients (18.8%) due to difficult dissection (52), peroperative incidents or accidents (15) and abnormal hepatogram (17). No accident inherent to the operation was encountered in this series. One death occurred after laparotomic conversion for acute angiocholitis. The rate of post-operative complications was 5.6% and reoperations were required in 7 patients (1.5%).

Introduction La lecture d’une capsule endoscopique du grele est de 30 minutes en moyenne. Reduire ce temps de lecture, et eventuellement optimiser la detection de lesions cliniquement importantes de l’intestin grele est un objectif que voudraient atteindre plusieurs systemes de detection informatique d’images anormales, actuellement non valides, dont la fonction Quick View (QV) de la firme Given Imaging. Le but de ce travail etait d’evaluer la sensibilite et la specificite d’une lecture en mode QV, et la fiabilite de l’algorithme. Patients et Methodes 106 films cas de capsule endoscopique etaient choisis de facon aleatoire parmi les 10 derniers cas de 12 centres ayant une experience de plus de 200 cas. Une lecture commune etait organisee mobilisant 12 lecteurs experimentes de la commission capsule de la SFED, notant en mode QV seul chaque image selon un grade de pertinence (P2 : responsabilite certaine, P1 : incertaine) et le temps de la lecture. Le resultat obtenu etait compare a la lecture (LN) du meme film en mode normal, et chaque discordance entre les 2 lectures etait revue et classee par 3 experts, image par image. Resultats Le temps moyen de lecture en mode QV etait de 11,6 min (2-27). Le temps de transit moyen du grele evalue en mode QV et LN etait de 258 et 260 min, significativement correle (p eme lecture, il s’agissait de 21 faux positifs (LN 12, QV 9), de 7 lesions non vues en LN, 7 non vues en mode QV, incluant 5 doublons. La sensibilite et la specificite par patient sont indiquees en table 1. Sur 7 lesions manquees par la lecture QV, 4 seulement (chez 3 patients) etaient absentes du film QV, representant a une sensibilite theorique par patient (fiabilite de l’algorithme) de 93,5 %. Conclusion Dans cette etude, l’algorithme d’analyse d’image Quick View detectait pres de 94 % des lesions significatives, et la lecture en mode QV etait aussi sensible et specifique, en conditions de lecture reelle, qu’une lecture normale, pour un temps de lecture beaucoup plus court. D’autres etudes sont necessaires pour confirmer ce resultat, ce qui pourrait permettre a terme de proposer en premiere intention une lecture des films de capsule du grele en mode Quick View.

Introduction En France, la strategie de depistage des polypes et du cancer colorectal (CCR) repose sur la combinaison de la recherche de sang dans les selles et de la coloscopie. La video-capsule specifique du colon (VCC), pourrait etre une alternative a cette strategie [1, 2]. Le but de cette etude prospective, multicentrique francaise etait de comparer les performances diagnostiques de la VCC a celles de la coloscopie dans une population a risque moyen ou eleve de CCR. (analyse intermediaire planifiee apres 105 inclusions/550 prevues). Patients et Methodes Les patients a risque moyen de CCR (50-74 ans) ou a risque eleve (antecedents personnels ou familiaux de neoplasie colique) ont ete inclus dans l’etude. Les criteres d’exclusion etaient une symptomatologie evocatrice de stenose intestinale, une diverticulose colique recemment compliquee et une insuffisance cardiaque et/ou renale evoluee. La VCC et la coloscopie ont ete realisees, chez le meme patient, a 24 heures d’intervalle, selon une methodologie publiee (1, 2). Les donnees ont ete interpretees (niveau de preparation, presence de lesion,…), en double insu, par l’endoscopiste ayant realise la coloscopie et le lecteur de la VCC. En cas de discordance entre les deux interpretations, un comite d’adjudication tranchait. Resultats 105 patients (39 femmes et 66 hommes), âges en moyenne de 60 ± 10 ans ont ete inclus de mai 2007 a fevrier 2008. Trente patients (29 %) etaient a risque moyen de CCR et 75 patients (71 %) a risque eleve. 90 % des VCC etaient excretees dans les 10 heures apres l’ingestion. La preparation du colon etait jugee bonne ou excellente dans 55 % des cas en VCC et 87 % des cas en coloscopie. La prevalence de polype significatif (≥ 6 mm) etait de 25 % pour la VCC et la coloscopie. Les performances de la VCC pour le diagnostic de polype ≥ 6 mm etaient : Sensibilite 55 %, Specificite 87 %, Valeur Predictive Positive 52 % et Valeur Predictive Negative 88 %. Chez les patients ayant une preparation bonne ou excellente, les performances etaient respectivement de 69 %, 84 %, 56 %, et 90 %. Apres adjudication des cas discordants, les performances etaient respectivement de 73 %, 93 %, 73 % et 93 %. Cinq evenements secondaires ont ete observes, en rapport avec la preparation (2 fois) ou la coloscopie (3 fois). La VCC a ete mieux appreciee que la coloscopie (echelle visuelle analogique : 8,80 vs 8,27 p Conclusion Ces resultats montrent l’excellente acceptabilite et tolerance de la VCC pour le depistage et le suivi de lesions neoplasiques colo-rectales. Cependant la preparation etait jugee insuffisante chez pres d’un malade sur deux et a conduit a modifier le protocole de preparation. De plus, les resultats apres adjudication confirment l’importance d’un apprentissage prealable a l’utilisation de cette technique. Malgre ces reserves, la combinaison d’une sensibilite de 73 % et d’une VPN de 93 % pour la detection de polypes de plus de 6 mm semble particulierement prometteuse.

In a double-blind, randomized, comparative trial of the prokinetic drug cisapride and the H2-blocker cimetidine, mucosal healing and changes in symptoms of gastroesophageal reflux were evaluated in patients with erosive reflux esophagitis. The patients were treated with either cisapride, 10 mg four times a day (N = 36) or cimetidine, 400 mg four times a day (N = 37) for six weeks, or for 12 weeks if mucosal healing was not obtained by week 6. Upon entry, two thirds of the patients in each group had grade I (Savary-Miller) esophagitis, and the remainder grade II or III. At the end of treatment, endoscopy showed mucosal healing in 56% (38-72%; 95% confidence interval) of cisapride and 57% (39-73%; 95% confidence interval) of cimetidine patients. After six weeks, both drugs significantly (P less than 0.01) decreased the intensity and frequency of heartburn, regurgitation, and the postural syndrome. No significant intergroup differences were found regarding endoscopic parameters or the improvement of heartburn and regurgitation. Concomitant antacid use was also comparable. Adverse effects were reported by four cisapride and nine cimetidine patients. These results indicate that the effects of cisapride compare well with those of cimetidine in terms of both esophageal mucosal healing and symptom relief.

We report 2 cases of type I glycogen storage disease (Von Gierke's disease) discovered in 2 brothers at the age of 7 and 5 years, respectively. Both developed hepatic adenoma at the age of 19 and 17. Hepatocellular carcinoma occurred in the older brother the discovery of adenoma 4 years after. The frequency of these tumors in patients with type I glycogen storage disease raises problems concerning the treatment and modality of regular surveillance of the liver in these patients. The policy for the detection and treatment of these tumors, and particularly the indications for liver transplantation are discussed.

A case of Peutz-Jeghers syndrome associated with ovarian mucinous cystadenoma and ovarian sex cord tumor with annular tubules is presented. The sec cord tumor with annular tubules was described in 1970 by Scully, who recognized its striking association with the Peutz-Jeghers syndrome. This tumor is an almost constant finding in patients' ovaries with this disorder. Three cases of ovarian mucinous cystadenoma and sex cord tumor with annular tubules associated with Peutz-Jeghers syndrome were found in the literature. Our observation confirms that gynecologic abnormalities are an important manifestation of the syndrome and require careful surveillance.