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Suite a un fait divers, l’association de la schizophrenie avec la dangerosite (ici : radicalisation) revient sur le devant de la scene mediatique, suscitant des propositions repressives envers les malades mentaux. Il existe cependant d’autres moyens d’accompagner la psychose : psychiatrie de secteur, relation de confiance avec les soignants, equipe contenante… l’accueil de la folie doit et peut rester humain.

Small-bowel capsule endoscopy (SBCE) was introduced 11 years ago by Given Imaging and is becoming the gold standard for small-bowel examination. This major step in the field of digestive medicine has opened the possibility of promising non-invasive explorations of the esophagus, stomach, and colon. SBCE can be used to overcome the inherent limitations of enteroscopy, especially in the West, where the capsule has been available since 2001. Obscure gastrointestinal (GI) bleeding with normal findings on upper and lower endoscopy remains the most important indication, and suspected Crohn's disease is also a well-accepted indication. Findings from a capsule investigation may warrant therapeutic endoscopy, but in many cases, SBCE avoids this useful but time-consuming endoscopic procedure. The use of a colon capsule for colorectal cancer screening when traditional colonoscopy is contraindicated or impossible is undergoing clinical trials. Early results seem promising, but control of colonic motility is still cumbersome, and patient preparation remains the most important drawback. We performed the first clinical trial in humans of a magnetically guided gastric capsule that offers the possibility of investigation with a capsule that can be controlled spatially. To date, we have carried out procedures in more than 400 patients and volunteers, with impressive results compared with high-definition gastroscopy. Even though endoscopy remains the most important tool in the GI field, capsules offer promising new possibilities.

In this chapter, we summarize the large clinical trials on magnetically guided capsule endoscopy. We initially describe this innovative technology. Paul Swain was a pioneer in capsule development, but he used a rather primitive guided system. Based upon this, Olympus Medical System and Siemens Healthcare developed a sophisticated capsule guidance mechanism. Early clinical results were encouraging and more useful than expected. But a large, blinded and randomized trial shows current limitations of guided capsule endoscopy compared to the gold standard: high definition gastroscopy.

The need for standardized language is increasingly obvious, also within gastrointestinal endoscopy. A systematic approach to the description of endoscopic findings is vital for the development of a universal language, but systematic also means structured, and structure is inherently a challenge when presented as an alternative to the normal spoken word. The efforts leading to the "Minimal Standard Terminology" (MST) of gastrointestinal endoscopy offer a standardized model for description of endoscopic findings. With a combination of lesion descriptors and descriptor attributes, this system gives guidance to appropriate descriptions of lesions and also has a normative effect on endoscopists in training. The endoscopic report includes a number of items not related to findings per se, but to other aspects of the procedure, formal, technical, and medical. While the MST sought to formulate minimal lists for some of these aspects (e.g. indications), they are not all well suited for the inherent structure of the MST, and many are missing. Thus, the present paper offers a recommended standardization also of the administrative, technical, and other "peri-endoscopic" elements of the endoscopic report; important also are the numerous quality assurance initiatives presently emerging. Finally, the image documentation of endoscopic findings is becoming more obvious-and accessible. Thus, recommendations for normal procedures as well as for focal and diffuse pathology are presented. The recommendations are "minimal," meaning that expansions and subcategories will likely be needed in most centers. Still, with a stronger common grounds, communication within endoscopy will still benefit.

Safe endoscopic procedures have been a daily concern in every endoscopy unit since the early eighties. At first range, prevention of crossed contamination was the primary goal for endoscopy units’ director. But, step after step, all parts of endoscopy procedures have to be monitored and the use of protocols is now mandatory. In this chapter, we will review: patient information and protocol of all endoscopy related procedures, check list in endoscopic theatre, control in endoscope maintenance and the importance of audit in endoscopy unit.

Video capsule endoscopy is a break through for small bowel exploration. Of course, other application such as the esophagus or colon should be considered. In this chapter, we review the potentials, pitfalls, and expectations of capsule endoscopy applied to the esophagus and colon. We also “dream” of further developments of this new technology.

Background Physicians may be unaware of the severity and extent of gastroesophageal reflux disease (GERD) in their patients. The aim of this study was to evaluate patient-physician agreement concerning proton pump inhibitor (PPI) treatment. Methods 1818 French primary-care physicians and 5174 adult patients with GERD who were taking PPIs answered questions regarding symptoms and treatment satisfaction. Patient-physician agreement was scored using the Kappa (κ) method. Results There was moderate patient-physician agreement for PPI treatment satisfaction (κ = 0.60), PPI prescription adherence (κ = 0.57) and use of over-the-counter gastrointestinal medications (κ = 0.44-0.51). Patient satisfaction with PPI therapy and PPI treatment adherence rates were both ~90%. There was poor patient-physician agreement concerning PPI therapy expectations (κ = 0.22-0.33). Residual reflux symptoms occurred in 61% of patients. Physicians underestimated residual symptom severity compared with their patients (κ = 0.43-0.47), though there was good agreement regarding the presence (κ = 0.62-0.78) and frequency (κ = 0.61-0.66) of these symptoms and their effect on patients' daily life (κ = 0.64). Conclusions Patient-physician agreement regarding PPI therapy for GERD was moderate or good for the presence of residual symptoms and moderate for treatment satisfaction, but poor for treatment expectations. PPI treatment resulted in high satisfaction rates, but residual symptoms were fairly common and their severity was underestimated by physicians.

A Prospective Multicenter Phase II Study to Evaluate Endocynch Suturing System for the Treatment of GERD Thierry Ponchon, Jean Boyer, Jean Charles Grimaud, Jean-Christophe Letard, Jean Escourrou, Frederick Ducrot, Jean Marc Canard, Jean Francois Rey, Group Sfed Only one multicenter prospective study has been published so far on the feasibility of endoscopic suturing for the treatment ofGERD.A newmulticenter prospective study on efficacy and safety of the procedure was conducted. Patients (pts) and methods: Inclusion criteria were: age>18y, symptomatic GERD (GERDHRQL>20 without treatment), continuous and effective PPI therapy for more than 3months, absence of hiatal hernia, Barrett’s or achalasia, bodymass index< 40. During the 2 months prior the procedure, GERD-HRQL score, esophageal 24h pHmetry and manometry were obtained once PPI were stopped for 10 days. 2 or 4 sutures (Endocynch, Bard) were performed on a vertical axis, the upper at the level of the Z line. Follow-up consisted in: questionnaire at 1,3,6 and 12 months (mo), pHmetry, manometry and gastroscopy at 3 mo, gastroscopy at 1 year. Results: 60 pts (mean age: 49, 20 females) were included. Amean of 2.7 sutures per pt was used. Side-effects rapidly resolutive were: retrosternal pain (15%) and dysphagia (18%). The percentage of pts without PPI is 75% at 1mo, 67% at 3 mo, 53% at 6 mo and 50% at 12 mo. The percentage of pts still with PPI but at lower doses is 19%at 1mo, 25%at 3mo, 28%at 6moand 33%at 12mo.GERD-HRQL decreased at 1, 3, 6 and 12mo (p