224 results on '"Maximilien Barret"'
Search Results
2. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort
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Apostolis Papaefthymiou, Michel Kahaleh, Arnaud Lemmers, Sandro Sferrazza, Maximilien Barret, Katsumi Yamamoto, Pierre Deprez, José C. Marín-Gabriel, George Tribonias, Hong Ouyang, Federico Barbaro, Oleksandr Kiosov, Stefan Seewald, Gaurav Patil, Shaimaa Elkholy, Dimitri Coumaros, Clemence Vuckovic, Matthew Banks, Rehan Haidry, and Georgios Mavrogenis
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Endoscopy Upper GI Tract ,Precancerous conditions & cancerous lesions (displasia and cancer) stomach ,Endoscopic resection (ESD, EMRc, ...) ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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3. Outcomes of endoscopic mucosal resection for large superficial non-ampullary duodenal adenomas
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Maxime Amoyel, Arthur Belle, Marion Dhooge, Einas Abou Ali, Anna Pellat, Rachel Hallit, Benoit Terris, Frédéric Prat, Stanislas Chaussade, Romain Coriat, and Maximilien Barret
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Medicine ,Science - Abstract
Abstract Endoscopic mucosal resection (EMR) is the recommended treatment for superficial non-ampullary duodenal epithelial tumors larger than 6 mm. This endoscopic technique carries a high risk of adverse events. Our aim was to identify the risk factors for adverse events following EMR for non-ampullary duodenal adenomatous lesions. We retrospectively analyzed a prospectively collected database of consecutive endoscopic resections for duodenal lesions at a tertiary referral center for therapeutic endoscopy. We analyzed patients with non-ampullary duodenal adenomatous lesions ≥ 10 mm resected by EMR, and searched for factors associated with adverse events after EMR. 167 duodenal adenomatous lesions, with a median size of 25 (25–40) mm, were resected by EMR between January 2015 and December 2020. Adverse events occurred in 37/167 (22.2%) after endoscopic resection, with 29/167 (17.4%) delayed bleeding, 4/167 (2.4%) immediate perforation and 4/167 (2.4%) delayed perforation. In logistic regression, the size of the lesion was the only associated risk factor of adverse events (OR = 2.81, 95% CI [1.27; 6.47], p = 0.012). Adverse events increased mean hospitalization time (7.7 ± 9 vs. 1.9 ± 1 days, p
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- 2022
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4. Mechanisms of esophageal stricture after extensive endoscopic resection: a transcriptomic analysis
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Maximilien Barret, Ludivine Doridot, Morgane Le Gall, Frédéric Beuvon, Sébastien Jacques, Anna Pellat, Arthur Belle, Einas Abou Ali, Marion Dhooge, Sarah Leblanc, Marine Camus, Carole Nicco, Romain Coriat, Stanislas Chaussade, Frédéric Batteux, and Frédéric Prat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Esophageal stricture is the most frequent adverse event after endoscopic resection for early esophageal neoplasia. Currently available treatments for the prevention of esophageal stricture are poorly effective and associated with major adverse events. Our aim was to identify transcripts specifically overexpressed or repressed in patients who have developed a post-endoscopic esophageal stricture, as potential targets for stricture prevention. Patients and methods We conducted a prospective single-center study in a tertiary endoscopy center. Patients scheduled for an endoscopic resection and considered at risk of esophageal stricture were offered inclusion in the study. The healthy mucosa and resection bed were biopsied on Days 0, 14, and 90. A transcriptomic analysis by microarray was performed, and the differences in transcriptomic profile compared between patients with and without esophageal strictures. Results Eight patients, four with esophageal stricture and four without, were analyzed. The mean ± SD circumferential extension of the mucosal defect was 85 ± 11 %. The transcriptomic analysis in the resection bed at day 14 found an activation of the interleukin (IL)-1 group (Z score = 2.159, P = 0.0137), while interferon-gamma (INFγ) and NUPR1 were inhibited (Z score = –2.375, P = 0.0022 and Z score = –2.333, P = 0.00131) in the stricture group. None of the activated or inhibited transcripts were still significantly so in any of the groups on Day 90. Conclusions Our data suggest that IL-1 inhibition or INFγ supplementation could constitute promising targets for post-endoscopic esophageal stricture prevention.
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- 2023
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5. Diagnostic Yield of Repeat Endoscopic Ultrasound-Guided Fine Needle Biopsy for Solid Pancreatic Lesions
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Baptiste Camus, Anna Pellat, Alexandre Rouquette, Ugo Marchese, Anthony Dohan, Arthur Belle, Einas Abou Ali, Stanislas Chaussade, Romain Coriat, and Maximilien Barret
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EUS FNB ,EUS FNA ,pancreatic neoplasm ,pancreatic ductal adenocarcinoma ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Patients and methods: we performed a retrospective case-control study, including cases with repeat EUS FNB for a solid pancreatic lesion, matched on a 1:2 ratio on age, sex, tumor location and presence of chronic pancreatitis with cases diagnosed on the first EUS FNB. Results: thirty-four cases and 68 controls were included in the analysis. Diagnostic accuracies were 80% and 88% in the repeat and single EUS FNB groups, respectively (p = 0.824). The second EUS FNB had a sensitivity of 80%, a specificity of 75%, a positive predictive value of 96%, and a negative predictive value of 33%. Of the 34 patients in the repeat EUS FNB group, 25 (74%) had a positive diagnosis with the second EUS FNB, 4 (12%) after surgery due to a second negative EUS FNB, 4 (12%) during clinical follow-up, and 1 (3%) after a third EUS FNB. Of the 25 patients diagnosed on the repeat EUS FNB, 17 (68%) had pancreatic adenocarcinomas, 2 (8%) neuroendocrine tumors, 2 (8%) other autoimmune pancreatitis, 2 (8%) chronic pancreatitis nodules, 1 (4%) renal cancer metastasis, and 1 (4%) other malignant diagnostic. There were no complications reported after the second EUS FNB in this study. Conclusion: repeat EUS FNB made a diagnosis in three fourths of patients with solid pancreatic lesions and a first negative EUS FNB, with 26% of benign lesions. This supports the repetition of EUS FNB sampling in this clinical situation.
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- 2023
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6. A new system to prevent SARS-CoV-2 and microorganism air transmission through the air circulation system of endoscopes
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Stanislas Chaussade, Anna Pellat, Felix Corre, Rachel Hallit, Einas Abou Ali, Arthur Belle, Maximilien Barret, Paul Chaussade, and Romain Coriat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Evidence for the modes of transmission of SARS-CoV-2 remains controversial. Recently, the potential for airborne spread of SARS-CoV-2 has been stressed. Air circulation in gastrointestinal light source boxes and endoscopes could be implicated in airborne transmission of microorganisms. Methods The ENDOBOX SC is a 600 × 600 mm cube designed to contain any type of machine used during gastrointestinal endoscopy. It allows for a 100-mm space between a machine and the walls of the ENDOBOX SC. To use the ENDOBOX SC, it is connected to the medical air system and it provides positive flow from the box to the endoscopy room. The ENDOBOX SC uses medical air to inflate the digestive tract and to decrease the temperature induced by the microprocessors or by the lamp. ENDOBOX SC has been investigated in different environments. Results An endoscopic procedure performed without ventilation was interrupted after 40 minutes to prevent computer damage. During the first 30 minutes, the temperature increased from 18 °C to 31 °C with a LED system. The procedure with fans identified variations in temperature inside the ENDOBOX SC from 21 to 26 °C (± 5 °C) 1 hour after the start of the procedure. The temperature was stable for the next 3 hours. Conclusions ENDOBOX SC prevents the increase in temperature induced by lamps and processors, allows access to all necessary connections into the endoscopic columns, and creates a sterile and positive pressure volume, which prevents potential contamination from microorganisms.
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- 2022
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7. Endoscopic submucosal dissection in the duodenum: Ready for prime time?
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Maximilien Barret and Maxime Amoyel
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2022
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8. Efficacy of Organ Preservation Strategy by Adjuvant Chemoradiotherapy after Non-Curative Endoscopic Resection for Superficial SCC: A Multicenter Western Study
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Arthur Berger, Guillaume Perrod, Mathieu Pioche, Maximilien Barret, Elodie Cesbron-Métivier, Vincent Lépilliez, Marianne Hupé, Enrique Perez-Cuadrado-Robles, Franck Cholet, Augustin Daubigny, Charles Texier, Einas Abou Ali, Edouard Chabrun, Jérémie Jacques, Timothee Wallenhorst, Jean Baptiste Chevaux, Marion Schaefer, Christophe Cellier, and Gabriel Rahmi
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esophageal squamous cell carcinoma ,endoscopic resection ,adjuvant chemoradiotherapy ,organ preservation ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background. In case of high risk of lymph node invasion after endoscopic resection (ER) of superficial esophageal squamous cell carcinoma (SCC), adjuvant chemoradiotherapy (CRT) can be an alternative to surgery. We assessed long-term clinical outcomes of adjuvant therapy by CRT after non-curative ER for superficial SCC. Methods. We performed a retrospective multicenter study. From April 1999 to April 2018, all consecutive patients who underwent ER for SCC with tumor infiltration beyond the muscularis mucosae were included. Results. A total of 137 ER were analyzed. The overall nodal or metastatic recurrence-free survival rate at 5 years was 88% and specific recurrence-free survival rates at 5 years with and without adjuvant therapy were, respectively, 97.9% and 79.1% (p = 0.011). Independent factors for nodal and/or distal metastatic recurrence were age (HR = 1.075, p = 0.031), Sm infiltration depth > 200 µm (HR = 4.129, p = 0.040), and the absence of adjuvant CRT or surgery (HR = 11.322, p = 0.029). Conclusion. In this study, adjuvant therapy is associated with a higher recurrence-free survival rate at 5 years after non-curative ER. This result suggests this approach may be considered as an alternative to surgery in selected patients.
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- 2023
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9. Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification
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Paul Bonniaud, Jérémie Jacques, Thomas Lambin, Jean-Michel Gonzalez, Xavier Dray, Emmanuel Coron, Sarah Leblanc, Jean-Baptiste Chevaux, Florence Léger-Nguyen, Benjamin Hamel, Isabelle Lienhart, Jérôme Rivory, Thierry Ponchon, Jean-Christophe Saurin, Frédéric Monzy, Romain Legros, Vincent Lépilliez, Fabien Subtil, Maximilien Barret, and Mathieu Pioche
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen’s Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different (P
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- 2022
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10. Endoscopic management of non-ampullary duodenal adenomas
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Maxime Amoyel, Arthur Belle, Marion Dhooge, Einas Abou Ali, Rachel Hallit, Frederic Prat, Anthony Dohan, Benoit Terris, Stanislas Chaussade, Romain Coriat, and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Duodenal polyps are found in 0.1 % to 0.8 % of all upper endoscopies. Duodenal adenomas account for 10 % to 20 % of these lesions. They can be sporadic or occur in the setting of a hereditary predisposition syndrome, mainly familial adenomatous polyposis. Endoscopy is the cornerstone of management of duodenal adenomas, allowing for diagnosis and treatment, primarily by endoscopic mucosal resection. The endoscopic treatment of duodenal adenomas has a high morbidity, reaching 15 % in a prospective study, consisting of bleeding and perforations, and should therefore be performed in expert centers. The local recurrence rate ranges from 9 % to 37 %, and is maximal for piecemeal resections of lesions > 20 mm. Surgical resection of the duodenum is flawed with major morbidity and considered a rescue procedure in cases of endoscopic treatment failures or severe endoscopic complications such as duodenal perforations. In this paper, we review the existing evidence on endoscopic diagnosis and treatment of non-ampullary duodenal adenomas.
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- 2022
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11. COVID-19 and gastrointestinal endoscopy in France: from the first to the second wave
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Maximilien Barret, Arthur Belle, David Bernardini, Anne-Laure Tarrerias, Erwan Bories, Vianna Costil, Bernard Denis, Rodica Gincul, David Karsenti, Stephane Koch, Arthur Laquiere, Thierry Lecomte, Vincent Quentin, Gabriel Rahmi, Michel Robaszkiewicz, Eric Vaillant, Geoffroy Vanbiervliet, Arianne Vienne, Franck Dumeiran, Olivier Gronier, and Stanislas Chaussade
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2021
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12. Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders
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Marion Chartier, Maxime Barat, Anthony Dohan, Arthur Belle, Ammar Oudjit, Einas Abou Ali, Rachel Hallit, Chloé Leandri, Sophie Scialom, Romain Coriat, Stanislas Chaussade, Philippe Soyer, and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Per oral endoscopic myotomy (POEM) of the lower esophageal sphincter has become a major treatment for esophageal motility disorders, especially achalasia. POEM can result in esophageal bleeding or perforation and pleural and mediastinal effusion. Early routine computed tomography (CT) esophagogram is frequently performed to assess these adverse events (AEs) before resuming oral food intake. We sought to evaluate the value of routine CT esophagogram on postoperative day (POD) 1 after POEM. Patients and methods This single-center retrospective study was performed in a tertiary referral center for interventional digestive endoscopy. We included consecutive patients with POEM and routine CT esophagogram on POD 1 between July 2018 and July 2019. Results Fifty-eight patients were included in the study, 79 % of whom had achalasia. Twenty patients (34 %) presented post-endoscopic AEs, including two patients with severe AEs requiring intensive care admission (one compressive pneumothorax and one mediastinitis); no deaths occurred. Of the 58 CT esophagograms performed, only one was normal. The 57 others (98 %) showed at least one abnormal finding: pneumoperitoneum or retroperitoneal air (91 %), pneumomediastinum (78 %), pleural effusion (34 %), pneumothorax (14 %), pneumonia (7 %), pericardial effusion (2 %), and mediastinal collection (2 %). CT esophagograms revealed AEs and modified therapeutic management in eight patients of 58 (14 %), all of whom had clinical symptoms prior to CT. Conclusions POD 1 CT esophagogram after POEM for esophageal motility disorders diagnosed clinically meaningful AEs in 14 % of patients, all associated with persistent clinical symptoms. Routine use of CT esophagogram after POEM in asymptomatic patients is questionable.
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- 2021
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13. Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience
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Rachel Hallit, Mélanie Calmels, Ulriikka Chaput, Diane Lorenzo, Aymeric Becq, Marine Camus, Xavier Dray, Jean Michel Gonzalez, Marc Barthet, Jérémie Jacques, Thierry Barrioz, Romain Legros, Arthur Belle, Stanislas Chaussade, Romain Coriat, Pierre Cattan, Frédéric Prat, Diane Goere, and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively ( p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage ( p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.
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- 2021
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14. Air circulation in a gastrointestinal light source box and endoscope in the era of SARS-CoV-2 and airborne transmission of microorganisms
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Stanislas Chaussade, Einas Abou Ali, Rachel Hallit, Arthur Belle, Maximilien Barret, and Romain Coriat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The role that air circulation through a gastrointestinal endoscopy system plays in airborne transmission of microorganisms has never been investigated. The aim of this study was to explore the potential risk of transmission and potential improvements in the system. Methods We investigated and described air circulation into gastrointestinal endoscopes from Fujifilm, Olympus, and Pentax. Results The light source box contains a lamp, either Xenon or LED. The temperature of the light is high and is regulated by a forced-air cooling system to maintain a stable temperature in the middle of the box. The air used by the forced-air cooling system is sucked from the closed environment of the patient through an aeration port, located close to the light source and evacuated out of the box by one or two ventilators. No filter exists to avoid dispersion of particles outside the processor box. The light source box also contains an insufflation air pump. The air is sucked from the light source box through one or two holes in the air pump and pushed from the air pump into the air pipe of the endoscope through a plastic tube. Because the air pump does not have a dedicated HEPA filter, transmission of microorganisms cannot be excluded. Conclusions Changes are necessary to prevent airborne transmission. Exclusive use of an external CO2 pump and wrapping the endoscope platform with a plastic film will limit scatter of microorganisms. In the era of pandemic virus with airborne transmission, improvements in gastrointestinal ventilation systems are necessary to avoid contamination of patients and health care workers.
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- 2021
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15. Management of esophageal strictures after endoscopic resection for early neoplasia
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Einas Abou Ali, Arthur Belle, Rachel Hallit, Benoit Terris, Frédéric Beuvon, Mahaut Leconte, Anthony Dohan, Sarah Leblanc, Solène Dermine, Lola-Jade Palmieri, Romain Coriat, Stanislas Chaussade, and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. Methods: We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. Results: Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett’s neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0–4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2–7); range 1–17; p = 0.02], and in the case of circumferential resection [4.0 (3.0–7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. Conclusion: Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.
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- 2021
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16. The Role of Magnetic Resonance Imaging in the Management of Esophageal Cancer
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Anna Pellat, Anthony Dohan, Philippe Soyer, Julie Veziant, Romain Coriat, and Maximilien Barret
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esophageal cancer ,magnetic resonance imaging ,staging ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Esophageal cancer (EC) is the eighth more frequent cancer worldwide, with a poor prognosis. Initial staging is critical to decide on the best individual treatment approach. Current modalities for the assessment of EC are irradiating techniques, such as computed tomography (CT) and positron emission tomography/CT, or invasive techniques, such as digestive endoscopy and endoscopic ultrasound. Magnetic resonance imaging (MRI) is a non-invasive and non-irradiating imaging technique that provides high degrees of soft tissue contrast, with good depiction of the esophageal wall and the esophagogastric junction. Various sequences of MRI have shown good performance in initial tumor and lymph node staging in EC. Diffusion-weighted MRI has also demonstrated capabilities in the evaluation of tumor response to chemoradiotherapy. To date, there is not enough data to consider whole body MRI as a routine investigation for the detection of initial metastases or for prediction of distant recurrence. This narrative review summarizes the current knowledge on MRI for the management of EC.
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- 2022
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17. Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients
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Charlotte Juin, Maximilien Barret, Arthur Belle, Einas Abouali, Sarah Leblanc, Ammar Oudjit, Anthony Dohan, Romain Coriat, and Stanislas Chaussade
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic treatment of Zenker’s Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1–5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1–3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0–4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.
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- 2020
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18. Endoscopic full-thickness resection of early colorectal neoplasms using an endoscopic submucosal dissection knife: a retrospective multicenter study
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Marie-Anne Guillaumot, Maximilien Barret, Jérémie Jacques, Romain Legros, Mathieu Pioche, Jérome Rivory, Gabriel Rahmi, Vincent Lepilliez, Edouard Chabrun, Sarah Leblanc, and Stanislas Chaussade
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Patients and methods Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Results Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Conclusion Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.
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- 2020
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19. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study
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Olaya I. Brewer Gutierrez, Robert A. Moran, Pietro Familiari, Mohamad H. Dbouk, Guido Costamagna, Yervant Ichkhanian, Stefan Seewald, Amol Bapaye, Joo Young Cho, Maximilien Barret, Nikolas Eleftheriadis, Mathieu Pioche, Bu' Hussain Hayee, Marcel Tantau, Michael Ujiki, Rosario Landi, Martina Invernizzi, In Kyung Yoo, Sabine Roman, Amyn Haji, H. Mason Hedberg, Nasim Parsa, Francois Mion, Lea Fayad, Vivek Kumbhari, Anant Agarwalla, Saowanee Ngamruengphong, Omid Sanaei, Thierry Ponchon, and Mouen A. Khashab
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.
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- 2020
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20. Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer
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Solène Dermine, Mahaut Leconte, Sarah Leblanc, Bertrand Dousset, Benoit Terris, Arthur Berger, Anne Berger, Gabriel Rahmi, Vincent Lepilliez, Olivier Plomteux, Philippe Leclercq, Romain Coriat, Stanislas Chaussade, Frédéric Prat, and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. Patients and methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins ( n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion ( n = 3 and 9), adenocarcinoma with deep submucosal invasion ( n = 11), poorly differentiated tumor ( n = 6) and lymphovascular invasion ( n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status ( n = 3) or lymph node metastases ( n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.
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- 2019
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21. Radiofrequency ablation for cholangiocarcinoma: Do we need to be more precise?
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Einas Abou Ali and Maximilien Barret
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2019
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22. Utility of CT to Differentiate Pancreatic Parenchymal Metastasis from Pancreatic Ductal Adenocarcinoma
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Maxime Barat, Rauda Aldhaheri, Anthony Dohan, David Fuks, Alice Kedra, Christine Hoeffel, Ammar Oudjit, Romain Coriat, Maximilien Barret, Benoit Terris, Ugo Marchese, and Philippe Soyer
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carcinoma ,pancreatic ductal ,pancreatic neoplasms ,tomography ,X-ray computed ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: To report the computed tomography (CT) features of pancreatic parenchymal metastasis (PPM) and identify CT features that may help discriminate between PPM and pancreatic ductal adenocarcinoma (PDAC). Materials and methods: Thirty-four patients (24 men, 12 women; mean age, 63.3 ± 10.2 [SD] years) with CT and histopathologically proven PPM were analyzed by two independent readers and compared to 34 patients with PDAC. Diagnosis performances of each variable for the diagnosis of PPM against PDAC were calculated. Univariable and multivariable analyses were performed. A nomogram was developed to diagnose PPM against PDAC. Results: PPM mostly presented as single (34/34; 100%), enhancing (34/34; 100%), solid (27/34; 79%) pancreatic lesion without visible associated lymph nodes (24/34; 71%) and no Wirsung duct enlargement (29/34; 85%). At multivariable analysis, well-defined margins (OR, 6.64; 95% CI: 1.47–29.93; p = 0.014), maximal enhancement during arterial phase (OR, 6.15; 95% CI: 1.13–33.51; p = 0.036), no vessel involvement (OR, 7.19; 95% CI: 1.512–34.14) and no Wirsung duct dilatation (OR, 10.63; 95% CI: 2.27–49.91) were independently associated with PPM. The nomogram yielded an AUC of 0.92 (95% CI: 0.85–0.98) for the diagnosis of PPM vs. PDAC. Conclusion: CT findings may help discriminate between PPM and PDAC.
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- 2021
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23. Application of a self-assembling peptide matrix prevents esophageal stricture after circumferential endoscopic submucosal dissection in a pig model.
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Sarra Oumrani, Maximilien Barret, Benoit Bordaçahar, Frédéric Beuvon, Guillaume Hochart, Aurélie Pagnon-Minot, Romain Coriat, Frédéric Batteux, and Frédéric Prat
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Medicine ,Science - Abstract
IntroductionCircumferential endoscopic submucosal dissection (ESD) allows to treat large esophageal superficial neoplasms, however with a high occurrence of severe esophageal strictures. In a previous work, we demonstrated that the application of a prototype of self-assembling peptide (SAP) matrix on esophageal wounds after a circumferential-ESD delayed the onset of esophageal stricture in a porcine model. The aim of this work was to consolidate these results using the commercialized version of this SAP matrix currently used as a hemostatic agent.Animals and methodsEleven pigs underwent a 5 cm-long circumferential esophageal ESD under general anesthesia. Five pigs were used as a control group and six were treated with the SAP. In the experimental group, 3.5 mL of the SAP matrix were immediately applied on the ESD wound. Stricture rates and esophageal diameter were assessed at day 14 by endoscopy and esophagram, followed by necropsy and histological measurements of inflammation and fibrosis in the esophageal wall.ResultsAt day 14, two animals in the treated group had an esophageal stricture without any symptom, while all animals in the control group had regurgitations and an esophageal stricture (33 vs. 100%, p = 0.045). In the treated group, the mean esophageal diameter at day 14 was 9.5 ± 1 mm vs. 4 ± 0.6 mm in the control group (p = 0.004). Histologically, the neoepithelium was longer in the SAP treated group vs. the control (3075 μm vs. 1155μm, p = 0.014). On immunohistochemistry, the expression of alpha smooth muscle actin was lower in the treated vs. control group.ConclusionApposition of a self-assembling peptide matrix immediately after a circumferential esophageal ESD reduced by 67% the occurrence of a stricture at day 14, by promoting reepithelialization of the resected area.
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- 2019
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24. EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model
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Maximilien Barret, Sarah Leblanc, Alexandre Rouquette, Stanislas Chaussade, Benoit Terris, and Frédéric Prat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Introduction Two devices are currently available to perform pancreatic radiofrequency ablation (P-RFA). Potential clinical indications might extend from the treatment of pancreatic cystic lesions to ablation of small pancreatic solid lesions or cytoreduction of advanced pancreatic adenocarcinomas, but more preclinical data from animal models are needed to optimize P-RFA operation. Methods P-RFA was performed under laparotomy and under endoscopic ultrasonographic guidance on the liver and pancreatic parenchyma of four live swine using the Habib EUS RFA (EMcision Ltd, London, UK) probe and the EUS-RA needle (Taewoong Medical, Gyeonggi-do, South Korea). Animals were sacrificed 2 hours after the procedure. Influence of tuning ablation time and power on tissue ablation were studied by histopathological assessment of the maximal depth of tissue damage on representative slides for each P-RFA shot. Results The Habib probe in the liver parenchyma resulted in tissue necrosis increasing within the range of 1.9 ± 0.5 mm (Power = 8 W, Time = 120 s) to 2.5 ± 1 mm (Power = 10 W, Time = 120 s). In the pancreatic parenchyma, tissue damage ranged from 3.1 ± 0.4 mm (Power = 8 W, Time = 120 s) to 2.3 ± 0.1 mm (12 W, 120 s) in depth. EUS RFA ablation of the liver parenchyma resulted in tissue damage ranging from 1.6 ± 0.2 mm (Power = 30 W, Time = 11 s) to 1.5 ± 0.1 mm (Power = 70 W, Time = 9 s); in the pancreas, ablation depth ranged from 3.6 ± 0.5 mm (Power = 30 W, Time = 15 s) to 3.8 ± 0.4 mm (Power = 70 W, Time = 11 s). Conclusion Both devices allow for effective ablation of pancreatic tissue within 1.5 to 3.8 mm around the RFA electrode, with a modest influence of tuning power settings. Specific settings are recommended for each of the devices studied. Ablation of larger lesions may require more repeat P-RFA shots in different locations rather than a simple modulation of ablation parameters.
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- 2019
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25. Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract
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Solène Dermine, Maximilien Barret, Caroline Prieux, Sophie Ribière, Sarah Leblanc, Marion Dhooge, Catherine Brezault, Vered Abitbol, Benoit Terris, Frédéric Beuvon, Alexandre Rouquette, Bertrand Dousset, Sébastien Gaujoux, Philippe Soyer, Anthony Dohan, Jean-Emmanuel Bibault, Romain Coriat, Frédéric Prat, and Stanislas Chaussade
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background The recent development of endoscopic resection for superficial gastrointestinal cancers could justify the need for a dedicated oncological multidisciplinary meeting (MDM). The aim of our study was to evaluate the impact of the dedicated MDM on the management of superficial cancers of the digestive tract. Methods A dedicated MDM was developed at our tertiary referral center. A retrospective review of the MDM conclusions for all patients referred from March 2015 to March 2017 was performed. Outcomes measurements were the outcomes of endoscopic resection, and the concordance rate between the MDM recommendations, European Society of Gastrointestinal Endoscopy (ESGE) guidelines, and final patient management. Results In total, 153 patients with a median age of 69 years were included. Half of the patients had major comorbidities. The mean lesion size was 25 mm, and R0 and curative resection rate were 73.9 % and 56.9 %, respectively. Forty-three patients had an indication for surgery after endoscopic resection. The concordance rate between ESGE guidelines and MDM recommendation was 92.2 %, and 12 patients did not receive the treatment recommended due to comorbidities. Conclusion A MDM dedicated to superficial tumors helped tailor the ESGE guidelines to each patient in order to avoid unnecessary surgery.
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- 2018
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26. Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement
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Solène Dermine, Thomas Lévi-Strauss, Einas Abou Ali, Arthur Belle, Sarah Leblanc, Jean-Emmanuel Bibault, Amélie Barré, Lola-Jade Palmieri, Catherine Brezault, Marion Dhooge, Benoit Terris, Anthony Dohan, Philippe Soyer, Arthur Berger, Gabriel Rahmi, Romain Coriat, Stanislas Chaussade, and Maximilien Barret
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superficial esophageal cancer ,endoscopic mucosal resection ,endoscopic submucosal dissection ,chemoradiotherapy ,close follow-up ,organ preservation ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Esophagectomy is recommended after endoscopic resection of an early esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. Patients and Methods: This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by chemoradiotherapy or follow-up in case of surgical contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS), cancer specific survival (CSS) and toxicity of chemoradiotherapy. Results: Forty-one patients (36 with squamous cell carcinoma and 5 with adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by chemoradiotherapy or radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the chemoradiotherapy group at the end of the follow-up. Serious adverse events related to chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. Conclusions: Our study shows that close follow-up may be an alternative to systematic esophagectomy after endoscopic resection of early esophageal cancer with a predicted high risk of lymph node involvement.
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- 2020
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27. Mirizzi’s syndrome in Roux-en-Y bypass patient successfully treated with cholangioscopically-guided laser lithotripsy via percutaneous gastrostomy
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Nassim Hammoudi, Bertrand Brieau, Maximilien Barret, Benoit Bordacahar, Sarah Leblanc, Romain Coriat, Stanislas Chaussade, and Frédéric Prat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Obesity and bariatric surgery are major risk factors in gallstone disease. In patients with a past history of Roux-en-Y gastric bypass, Mirizzi’s syndrome is a challenging endoscopic situation because of the modified anatomy. Here we report the first case of a patient with a Roux-en-Y gastric bypass treated by intracorporeal lithotripsy with a digital single-operator cholangioscope following an endoscopic retrograde cholangiopancreatography (ERCP) using a percutaneous gastrostomy access.
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- 2018
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28. A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections
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Mathieu Pioche, Marine Camus, Jérôme Rivory, Sarah Leblanc, Isabelle Lienhart, Maximilien Barret, Stanislas Chaussade, Jean-Christophe Saurin, Frederic Prat, and Thierry Ponchon
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Endoscopic resections have low morbidity and mortality. Delayed bleeding has been reported in approximately 1 – 15 % of cases, increasing with antiplatelet/anticoagulant therapy or portal hypertension. A self-assembling peptide (SAP) forming a gel could protect the mucosal defect during early healing. This retrospective trial aimed to assess the safety and efficacy of SAP in preventing delayed bleeding after endoscopic resections. Methods: Consecutive patients with endoscopic resections were enrolled in two tertiary referral centers. Patients with a high risk of bleeding (antiplatelet agents, anticoagulation drugs with heparin bridge therapy, and cirrhosis with portal hypertension) were also included. The SAP gel was applied immediately after resection to cover the whole ulcer bed. Results: In total, 56 patients were included with 65 lesions (esophagus [n = 8], stomach [n = 22], duodenum [n = 10], ampullary [n = 3], colon [n = 7], and rectum [n = 15]) in two centers. Among those 65 lesions, 29 were resected in high risk situations (9 uninterrupted aspirin therapy, 6 heparin bridge therapies, 5 cirrhosis and portal hypertension, 1 both cirrhosis and heparin bridge, 3 both cirrhosis and uninterrupted aspirin, 3 large duodenal lesions > 2 cm, and 2 early introduction of clopidogrel at day 1). The resection technique was endoscopic submucosal dissection (ESD) in 40 cases, en bloc endoscopic mucosal resection (EMR) in 16, piecemeal EMR in 6, and ampullectomy in 3. The mean lesion size was 37.9 mm (SD: 2.2 mm) with a mean area of 6.3 cm2 (SD: 3.5 cm2). No difficulty was noted during application. Four delayed overt bleedings occurred (6.2 %) (3 hematochezia, 1 hematemesis) requiring endoscopic hemostasis. The mean hemoglobin drop off was 0.6 g/dL (– 0.6 to 3.1 g/dL). No adverse events occurred. Conclusion: The use of this novel extracellular matrix scaffold may help to reduce post-endoscopic resection bleedings including in high risk situations. Its use is easy and safe but further comparative studies are warranted to completely evaluate its effectiveness.
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- 2016
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29. A new device to expedite endoscopic submucosal dissection procedures: a randomized animal study of efficacy and safety (with videos)
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Sarah Leblanc, Maximilien Barret, Andreas Brehm, Alexandre Rouquette, Marine Camus, Erich Wintermantel, and Frederic Prat
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: Endoscopic submucosal dissection (ESD) is a recognized method for the curative treatment of superficial neoplasia, but its use is limited by lengthy procedures and the lack of versatility of existing knives. We developed a prototype ESD device with the ability to work as a needle, hook, or “scythe.” This new device was compared to regular ESD knives in a randomized animal study. Patients and methods: Eight pigs underwent two gastric ESD procedures each, similar in size and difficulty, one with a regular ESD device and the other with the new device. The order and location of each ESD, as well as the performing operator, were randomized. Primary judgment criterion was safety of procedures. Overall and submucosal dissection procedure times were measured. Time-to-surface ratios were measured and estimated for ESDs larger than those performed. Histopathology of the resected tissue and remaining stomach was done after each experiment. Results: No complications were observed throughout the study and all resections were completed en-bloc and uneventfully. The submucosal extension of resections was similar with both the standard and the new devices. A comparison of time-consumption between groups did not show statistically significant differences, but a dramatic reduction of procedure duration was observed in some procedures with the new device; based on observed data, a potential time-saving of up to 66 % was anticipated, with a relatively short learning curve. Conclusions: This new versatile device proved to be as safe as regular ESD knives, and seems likely to help reduce the duration of the procedure.
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- 2015
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30. Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection.
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Maximilien Barret, Carlos Alberto Pratico, Marine Camus, Frédéric Beuvon, Mohamed Jarraya, Carole Nicco, Luigi Mangialavori, Stanislas Chaussade, Frédéric Batteux, and Frédéric Prat
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Medicine ,Science - Abstract
The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model.In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD.The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78-1.72), 1.19 mm (0.28-1.95), and 1.65 mm (0.7-1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35.The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study.
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- 2014
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31. Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey.
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Maximilien Barret, Christian Boustiere, Jean-Marc Canard, Jean-Pierre Arpurt, David Bernardini, Philippe Bulois, Stanislas Chaussade, Denis Heresbach, Isabelle Joly, Jean Lapuelle, René Laugier, Gilles Lesur, Patrice Pienkowski, Thierry Ponchon, Bertrand Pujol, Bruno Richard-Molard, Michel Robaszkiewicz, Rémi Systchenko, Fatima Abbas, Anne-Marie Schott-Pethelaz, Christophe Cellier, and Société Française d'Endoscopie Digestive
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Medicine ,Science - Abstract
IntroductionColonoscopy can prevent deaths due to colorectal cancer (CRC) through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France.MethodsAn online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR) or the diagnosis of polyps or cancer were assessed.ResultsA total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122) procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001), age over 50 (p=0.0001), personal or family history of CRC or colorectal polyps (pConclusionsFor the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.
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- 2013
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32. Towards a robust and compact deep learning system for primary detection of early Barrett’s neoplasia: Initial image‐based results of training on a multi‐center retrospectively collected data set
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Kiki N. Fockens, Jelmer B. Jukema, Tim Boers, Martijn R. Jong, Joost A. van der Putten, Roos E. Pouw, Bas L. A. M. Weusten, Lorenza Alvarez Herrero, Martin H. M. G. Houben, Wouter B. Nagengast, Jessie Westerhof, Alaa Alkhalaf, Rosalie Mallant, Krish Ragunath, Stefan Seewald, Peter Elbe, Maximilien Barret, Jacobo Ortiz Fernández‐Sordo, Oliver Pech, Torsten Beyna, Fons van der Sommen, Peter H. de With, A. Jeroen de Groof, Jacques J. Bergman, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism
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Oncology ,Gastroenterology - Abstract
Introduction: Endoscopic detection of early neoplasia in Barrett's esophagus is difficult. Computer Aided Detection (CADe) systems may assist in neoplasia detection. The aim of this study was to report the first steps in the development of a CADe system for Barrett's neoplasia and to evaluate its performance when compared with endoscopists. Methods: This CADe system was developed by a consortium, consisting of the Amsterdam University Medical Center, Eindhoven University of Technology, and 15 international hospitals. After pretraining, the system was trained and validated using 1.713 neoplastic (564 patients) and 2.707 non-dysplastic Barrett's esophagus (NDBE; 665 patients) images. Neoplastic lesions were delineated by 14 experts. The performance of the CADe system was tested on three independent test sets. Test set 1 (50 neoplastic and 150 NDBE images) contained subtle neoplastic lesions representing challenging cases and was benchmarked by 52 general endoscopists. Test set 2 (50 neoplastic and 50 NDBE images) contained a heterogeneous case-mix of neoplastic lesions, representing distribution in clinical practice. Test set 3 (50 neoplastic and 150 NDBE images) contained prospectively collected imagery. The main outcome was correct classification of the images in terms of sensitivity. Results: The sensitivity of the CADe system on test set 1 was 84%. For general endoscopists, sensitivity was 63%, corresponding to a neoplasia miss-rate of one-third of neoplastic lesions and a potential relative increase in neoplasia detection of 33% for CADe-assisted detection. The sensitivity of the CADe system on test sets 2 and 3 was 100% and 88%, respectively. The specificity of the CADe system varied for the three test sets between 64% and 66%. Conclusion: This study describes the first steps towards the establishment of an unprecedented data infrastructure for using machine learning to improve the endoscopic detection of Barrett's neoplasia. The CADe system detected neoplasia reliably and outperformed a large group of endoscopists in terms of sensitivity.
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- 2023
33. Management of antiaggregants and anticoagulants in endoscopy (SFED 2023 document based on BSG/ESGE 2021 recommendations)
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David Karsenti, Isaac Fassler, Maximilien Barret, Rodica Gincul, Gabriel Rahmi, Anne-Laure Imbert Tarrerias, Éric Vaillant, Adrien Sportes, and Olivier Gronier
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Hepatology ,Gastroenterology - Published
- 2023
34. Impact of a multidisciplinary tumor board dedicated to early gastrointestinal cancers
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Claire Ginestet, Rachel Hallit, Felix Corre, Arthur Belle, Einas Abou Ali, Antoine Assaf, Chloé Leandri, Stanislas Chaussade, Anthony Dohan, Jean-Emmanuel Bibault, Mahaut Leconte, Mehdi Karoui, Benoit Terris, Romain Coriat, and Maximilien Barret
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Hepatology ,Gastroenterology - Published
- 2023
35. Mechanisms of esophageal stricture after extensive endoscopic resection: a transcriptomic analysis
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Maximilien Barret, Ludivine Doridot, Morgane Le Gall, Frédéric Beuvon, Sébastien Jacques, Anna Pellat, Arthur Belle, Einas Abou Ali, Marion Dhooge, Sarah Leblanc, Marine Camus, Carole Nicco, Romain Coriat, Stanislas Chaussade, Frédéric Batteux, and Frédéric Prat
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Pharmacology (medical) - Abstract
Background and study aims Esophageal stricture is the most frequent adverse event after endoscopic resection for early esophageal neoplasia. Currently available treatments for the prevention of esophageal stricture are poorly effective and associated with major adverse events. Our aim was to identify transcripts specifically overexpressed or repressed in patients who have developed a post-endoscopic esophageal stricture, as potential targets for stricture prevention. Patients and methods We conducted a prospective single-center study in a tertiary endoscopy center. Patients scheduled for an endoscopic resection and considered at risk of esophageal stricture were offered inclusion in the study. The healthy mucosa and resection bed were biopsied on Days 0, 14, and 90. A transcriptomic analysis by microarray was performed, and the differences in transcriptomic profile compared between patients with and without esophageal strictures. Results Eight patients, four with esophageal stricture and four without, were analyzed. The mean ± SD circumferential extension of the mucosal defect was 85 ± 11 %. The transcriptomic analysis in the resection bed at day 14 found an activation of the interleukin (IL)-1 group (Z score = 2.159, P = 0.0137), while interferon-gamma (INFγ) and NUPR1 were inhibited (Z score = –2.375, P = 0.0022 and Z score = –2.333, P = 0.00131) in the stricture group. None of the activated or inhibited transcripts were still significantly so in any of the groups on Day 90. Conclusions Our data suggest that IL-1 inhibition or INFγ supplementation could constitute promising targets for post-endoscopic esophageal stricture prevention.
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- 2022
36. Follow-up after endoscopic resection for early gastric cancer in 3 French referral centers
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Bernadette de Rauglaudre, Mathieu Pioche, Fabrice Caillol, Jean-Philippe Ratone, Anna Pellat, Romain Coriat, Jerôme Rivory, Thomas Lambin, Laetitia Dahan, Marc Giovanini, and Maximilien Barret
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- 2022
37. Endoscopic resection of early esophageal tumors in the context of cirrhosis or portal hypertension: a multicenter observational study
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Mathilde Simonnot, Pierre H Deprez, Mathieu Pioche, Eliane Albuisson, Timothée Wallenhorst, Fabrice Caillol, Stephane Koch, Emmanuel Coron, isabelle archambeaud, Jeremie Jacques, Paul Basile, Ludovic Caillo, thibault degand, Vincent Lépilliez, Philippe Grandval, Adrian Culetto, Geoffroy Vanbiervliet, Marine Camus Duboc, Olivier Gronier, Carina Leal, Jérémie Albouys, Jean-Baptiste Chevaux, Maximilien Barret, and Marion Schaefer
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Gastroenterology - Abstract
Background: Liver cirrhosis and esophageal cancer share several risk factors, such as alcohol intake and overweight. Endoscopic resection is the gold standard treatment for superficial tumors. Portal hypertension and coagulopathy may increase the bleeding risk in these patients. This study aims to assess the safety and efficacy of endoscopic resection for early esophageal neoplasia in patients with cirrhosis or portal hypertension. Methods: This retrospective multicentric international study included consecutive patients with cirrhosis or portal hypertension who underwent endoscopic resection in the esophagus from January 2005 to March 2021. Results: 134 lesions in 112 patients were treated, in 101 (77%) cases by endoscopic submucosal dissection. Most patients (128/134 cases, 96%) had liver cirrhosis, with esophageal varices in 71 procedures. To prevent bleeding, 7 patients underwent a transjugular intrahepatic portosystemic shunt, 8 had endoscopic band ligation (EBL) before resection, 15 received vasoactive drugs, 8 a platelet transfusion and 9 underwent EBL during the resection procedure. The complete macroscopic resection rate, en-bloc resection rate and curative resection rate were 92%, 86%, and 63%, respectively. Three perforations, 8 delayed bleedings, 8 sepsis, 6 cirrhosis decompensations within 30 days and 22 esophageal strictures occurred. No adverse event required surgery. In univariate analyses, cap-assisted endoscopic mucosal resection was associated with more delayed bleeding (p=0.01). Conclusions: In case of liver cirrhosis or portal hypertension, endoscopic resection of early esophageal neoplasia in patients appears to be effective and should be considered in expert centres with choice of resection technique following ESGE guidelines without undertreatment.
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- 2023
38. Contrast extravasation on computed tomography angiography in patients with hematochezia or melena: Predictive factors and associated outcomes
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Maximilien Barret, Benjamin G. Chousterman, Ugo Marchese, Philippe Soyer, Maxime Barat, Raphael Dautry, Anthony Dohan, David Fuks, Eimad Shotar, Romain Coriat, and Alice Kedra
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Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Melena ,medicine ,Humans ,Contrast extravasation ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,musculoskeletal, neural, and ocular physiology ,Angiography ,General Medicine ,Odds ratio ,Middle Aged ,Extravasation ,Hematochezia ,Blood units ,Female ,Radiology ,medicine.symptom ,Gastrointestinal Hemorrhage ,business ,psychological phenomena and processes ,Extravasation of Diagnostic and Therapeutic Materials - Abstract
PURPOSE The purpose of this study was to identify variables associated with extravasation on computed tomography angiography (CTA) in patients with hematochezia/melena and compare the outcome of patients with extravasation on CTA to those without extravasation. MATERIAL AND METHODS Ninety-four patients (51 men, 38 women; mean age, 69 ± 16 [SD] years) who underwent CTA within 30 days of hematochezia/melena were included. Variables associated with extravasation on CTA were searched using univariable and multivariable analyses. Outcomes of patients with visible extravasation on CTA were compared with those without visible extravasation. RESULTS One hundred and one CTA examinations were included. Extravasation was observed on 26/101 CTA examinations (26%). At multivariable analysis the need for vasopressor drugs (odds ratio [OR], 7.6; P = 0.040), high transfusion requirements (> 2 blood units) (OR, 7.1; P = 0.014), CTA performed on the day of a hemorrhagic event (OR, 46.2; P = 0.005) and repeat CTA (OR, 27.8; P = 0.011) were independently associated with extravasation on CTA. Extravasation on CTA was followed by a therapeutic procedure in 25/26 CTAs (96%; 26 patients) compared to 13/75 CTAs (17%; 68 patients) on which no extravasation was present (P < 0.001). No patients (0/26; 0%) with contrast extravasation on CTA died while 8 patients (8/61; 13%) without contrast extravasation died, although the difference was not significant (P = 0.099). CONCLUSION Extravasation on CTA in the setting of hematochezia or melena is especially seen in clinically unstable patients who receive more than two blood units. Presence of active extravasation on CTA leads to more frequent application of a therapeutic procedure; however, this does not significantly affect patient outcome.
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- 2022
39. Today’s Mistakes and Tomorrow’s Wisdom in Endoscopic Treatment and Follow-Up of Barrett’s Esophagus
- Author
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Maximilien, Barret
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Gastroenterology ,Surgery ,Review Article - Abstract
Background: Endoscopic therapy has replaced esophagectomy for the management of early Barrett’s neoplasia, allowing for the curative treatment of intramucosal adenocarcinoma, dysplastic Barrett’s esophagus (BE), and the prevention of metachronous recurrences. Summary: Endoscopic therapy relies on the resection of any visible lesion, suspicious of harboring cancer, followed by the eradication of the residual BE, potentially harboring dysplastic foci. Currently, endoscopic mucosal resection (EMR) using the multiband mucosectomy technique is the gold standard for the resection of visible lesions. Endoscopic submucosal dissection (ESD) is feasible with comparable complication rates to EMR, but longer procedural times. It is still limited to EMR failures or suspected submucosal adenocarcinoma. Eradication of residual BE mainly relies on radiofrequency ablation, with over 90% efficacy in expert centers. Despite initial complete eradication of BE, intestinal metaplasia and dysplasia recur in time, justifying prolonged endoscopic surveillance. Key Messages: The first step of the therapeutic endoscopy for BE is a careful diagnostic evaluation, searching for visible(s) lesion(s). EMR is the recommended resection technique for visible lesions. ESD has not demonstrated its superiority on EMR in routine practice. Endoscopic follow-up after Barrett’s eradication therapy is mandatory.
- Published
- 2022
40. The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection: An individual Patient Data Meta-Analysis
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Mio Matsumoto, Femke Atsma, Maximilien Barret, Jochim S. Terhaar sive Droste, F. Desideri, Gijs Kemper, Chun-Wei Chen, Kazutomo Togashi, Wey-Ran Lin, Romain Coriat, Erwin J M van Geenen, Peter D. Siersema, Sarah B. Umar, Karl Kwok, Eduardo Albéniz, Daniel G. Luba, Brian Lim, Ruud W. M. Schrauwen, Gottumukkala S. Raju, Ayla S. Turan, Douglas K. Rex, Suryakanth R. Gurudu, Heiko Pohl, Masato Aizawa, Brian S. Lee, and Francisco C. Ramirez
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medicine.medical_specialty ,medicine.medical_treatment ,Colonic Polyps ,Endoscopic mucosal resection ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Postoperative Hemorrhage ,law.invention ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,All institutes and research themes of the Radboud University Medical Center ,Randomized controlled trial ,law ,Antithrombotic ,medicine ,Humans ,Prospective Studies ,Retrospective Studies ,Clipping (audio) ,Hepatology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Odds ratio ,Colonoscopy ,Surgical Instruments ,Polypectomy ,Surgery ,surgical procedures, operative ,Colorectal Polyp ,business - Abstract
Background & Aims Nonpedunculated colorectal polyps are normally endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common major adverse event. Clipping the resection defect has been suggested to reduce delayed bleedings. Our aim was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure, and antithrombotic use. Methods An individual patient data meta-analysis was performed. Studies on prophylactic clipping in nonpedunculated colorectal polyps were selected from PubMed, Embase, Web of Science, and Cochrane database (last selection, April 2020). Authors were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed models were used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders. Results Data of 5380 patients with 8948 resected polyps were included from 3 randomized controlled trials, 2 prospective, and 8 retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44–0.88; number needed to treat = 32), especially with antithrombotics (OR, 0.59; 95% CI, 0.35–0.99; number needed to treat = 23; subgroup of anticoagulants/double platelet inhibitors: n = 226; OR, 0.40; 95% CI, 0.16–1.01; number needed to treat = 12). Prophylactic clipping did not benefit distal polyps ≥20 mm with antithrombotics (OR, 1.41; 95% CI, 0.79–2.52). Conclusions Prophylactic clipping reduces delayed bleeding after resection of nonpedunculated, proximal colorectal polyps ≥20 mm, especially in patients using antithrombotics. No benefit was found for distal polyps. Based on this study, patients can be identified who may benefit from prophylactic clipping. (PROSPERO registration number CRD42020104317.)
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- 2022
41. Endoscopic tissue sampling - Part 2
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Katharina Biermann, Maximilien Barret, Roos E. Pouw, Peter T. Schmidt, Michael Vieth, Edoardo Savarino, Raf Bisschops, Marietta Iacucci, Tomas Hucl, Mário Dinis-Ribeiro, Gert De Hertogh, Matthew D. Rutter, Manon C.W. Spaander, Marnix Jansen, Jeanin E. van Hooft, László Czakó, Krisztina B Gecse, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Pathology, and Gastroenterology & Hepatology
- Subjects
medicine.medical_specialty ,business.industry ,Colon ,Gastroenterology ,Transverse colon ,Rectum ,Sigmoid colon ,medicine.disease ,Inflammatory bowel disease ,Ulcerative colitis ,Endoscopy, Gastrointestinal ,Primary sclerosing cholangitis ,Chromoendoscopy ,medicine.anatomical_structure ,Microscopic colitis ,medicine ,Humans ,Radiology ,business ,Precancerous Conditions - Abstract
Recommendations 1 ESGE suggests performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis.Weak recommendation, low quality of evidence. 2 ESGE recommends taking two biopsies from the right hemicolon (ascending and transverse colon) and, in a separate container, two biopsies from the left hemicolon (descending and sigmoid colon) when microscopic colitis is suspected.Strong recommendation, low quality of evidence. 3 ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. Strong recommendation, moderate quality of evidence. 4 ESGE suggests that, in high risk patients with a history of colonic neoplasia, tubular-appearing colon, strictures, ongoing therapy-refractory inflammation, or primary sclerosing cholangitis, chromoendoscopy with targeted biopsies can be combined with four-quadrant non-targeted biopsies every 10 cm along the colon. Weak recommendation, low quality of evidence. 5 ESGE recommends that, if pouch surveillance for dysplasia is performed, visible abnormalities should be biopsied, with at least two biopsies systematically taken from each of the afferent ileal loop, the efferent blind loop, the pouch, and the anorectal cuff.Strong recommendation, low quality of evidence. 6 ESGE recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus; for those with no evident endoscopic signs of inflammation, advanced imaging technologies may be useful in identifying areas for targeted biopsies to assess histologic remission if this would have therapeutic consequences. Strong recommendation, low quality of evidence. 7 ESGE suggests not biopsying endoscopically visible inflammation or normal-appearing mucosa to assess disease activity in known Crohn’s disease.Weak recommendation, low quality of evidence. 8 ESGE recommends that adequately assessed colorectal polyps that are judged to be premalignant should be fully excised rather than biopsied.Strong recommendation, low quality of evidence. 9 ESGE recommends that, where endoscopically feasible, potentially malignant colorectal polyps should be excised en bloc rather than being biopsied. If the endoscopist cannot confidently perform en bloc excision at that time, careful representative images (rather than biopsies) should be taken of the potential focus of cancer, and the patient should be rescheduled or referred to an expert center.Strong recommendation, low quality of evidence. 10 ESGE recommends that, in malignant lesions not amenable to endoscopic excision owing to deep invasion, six carefully targeted biopsies should be taken from the potential focus of cancer.Strong recommendation, low quality of evidence.
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- 2021
42. Reply to Danese et al
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Carlo Felix Maria Jung, Rachel Hallit, Annegret Müller-Dornieden, Mélanie Calmels, Diane Goere, Ulriikka Chaput, Marine Camus, Jean Michel Gonzalez, Marc Barthet, Jérémie Jacques, Romain Legros, Thierry Barrioz, Fabian Kück, Ali Seif Amir Hosseini, Michael Ghadimi, Steffen Kunsch, Volker Ellenrieder, Edris Wedi, and Maximilien Barret
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Gastroenterology - Published
- 2022
43. Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma
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Paul Doumbe-Mandengue, Anna Pellat, Arthur Belle, Einas Abou Ali, Rachel Hallit, Frédéric Beuvon, Benoit Terris, Stanislas Chaussade, Romain Coriat, and Maximilien Barret
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Hepatology ,Gastroenterology - Published
- 2023
44. Per Oral Endoscopic Myotomy for Zenker’s Diverticulum
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Arnon Lambroza, Amy Tyberg, Carlos Robles-Medranda, Roberto Oleas, Prashant Kedia, Romy Bareket, Amol Bapaye, Rachel Hallit, Nikolas Eleftheriadis, Abdelhai Abdelqader, David P. Lee, Mihajlo Gjeorgjievski, Michel Kahaleh, Haroon Shahid, Chiemeziem Eke, Hojin Sun, Bryce Bushe, Daniel Marino, Ana L. Madrigal Méndez, Monica Gaidhane, Daniel Kats, Noah Y. Mahpour, Maximilien Barret, Avik Sarkar, Ian Greenberg, and Jose Nieto
- Subjects
Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Zenker Diverticulum ,business.industry ,Technical success ,Per-oral endoscopic myotomy ,Gastroenterology ,Length of hospitalization ,Mean age ,Endoscopic management ,medicine.disease ,Surgery ,Zenker's diverticulum ,Treatment Outcome ,medicine ,Humans ,Female ,business ,Adverse effect ,Digestive System Surgical Procedures ,Aged ,Myotomy ,Procedure time - Abstract
Introduction Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy. Methods Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed. Results A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. Conclusions A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
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- 2021
45. A robust and compact deep learning system for primary detection of early Barrett's neoplasia outperforms general endoscopists
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Kiki Fockens, Jelmer Jukema, Martijn Jong, Tim G. Boers, Joost Van Der Putten, Roos E. Pouw, Bas L. Weusten, Martin H. Houben, Wouter B. Nagengast, Jessie Westerhof, L. Alvarez Herrero, A. Alkhalaf, Krish Ragunath, Maximilien Barret, Jacobo Ortiz-Fernandez-Sordo, Oliver Pech, Torsten Beyna, Stefan Seewald, Fons Van Der Sommen, P.H.N. De With, Jeroen De Groof, Jacques Bergman, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
46. Successful treatment of hemorrhagic radiation esophagitis with radiofrequency ablation
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Flavius-Stefan Marin, Rachel Hallit, Romain Coriat, Stanislas Chaussade, Frédéric Prat, and Maximilien Barret
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Radiofrequency Ablation ,Gastroenterology ,Catheter Ablation ,Humans ,Esophagitis ,Hemorrhage - Published
- 2022
47. Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases
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Aurélie Charissoux, J Rivory, Maximilien Barret, Mathieu Pioche, Jean Marc O'Brien, Guillaume Perrod, Thierry Ponchon, Olivier Guillaud, Alexandre Jaouen, Gabriel Rahmi, Frédéric Prat, Nicolas Benech, Thomas Walter, Jérémie Jacques, Jean-Christophe Saurin, Romain Legros, Vincent Lepilliez, and Valérie Hervieu
- Subjects
Male ,Risk ,medicine.medical_specialty ,Esophageal Mucosa ,Esophageal Neoplasms ,Oesophageal adenocarcinoma ,Lymph node metastasis ,Adenocarcinoma ,Barrett Esophagus ,03 medical and health sciences ,0302 clinical medicine ,Barrett's Adenocarcinoma ,Humans ,Medicine ,Neoplasm Invasiveness ,Endoscopic resection ,Lymph node ,Aged ,Retrospective Studies ,lymph node metastasis ,business.industry ,fungi ,Gastroenterology ,food and beverages ,Endoscopy ,Middle Aged ,Barrett's oesophagus ,medicine.anatomical_structure ,Oncology ,histological features ,Lymphatic Metastasis ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,submucosal invasion ,oesophageal adenocarcinoma ,Original Article ,Female ,030211 gastroenterology & hepatology ,Esophagoscopy ,France ,Radiology ,Lymph ,business ,Follow-Up Studies - Abstract
Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma. Methods We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible. Results In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%). Conclusion Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series., Key Summary Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.Curative endoscopic resections have been reported in selected OAC invading the first 500 mm of the submucosa, but surgical series showed an LNM risk ranging from 0% to 50%, making endoscopic resection a questionable curative treatment.High‐risk histological features were not associated with LNM in intramucosal tumours.LNM occurred only for tumours invading the submucosa with a depth ≥1200 mm or with high‐risk histological features regardless of the depth of invasion.Endoscopic resection may be a valid and curative therapeutic option for all intramucosal tumours and for submucosal oesophageal adenocarcinoma with an invasion depth ≤1000 mm and low‐risk histological features.
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- 2021
48. Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial
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Jean Escourrou, Frédéric Prat, Romain Legros, Nadira Kaddour, Edouard Chabrun, Marc Le Rhun, Michael Bensoussan, Hendy Abdoul, Frank Zerbib, Thierry Ponchon, Maximilien Barret, E Metivier-Cesbron, Stanislas Chaussade, Gabriel Rahmi, Fabrice Caillol, P. Bauret, Lea Jilet, Geoffroy Vanbiervliet, Jérémie Jacques, Marc Giovannini, Julien Branche, Benoit Terris, Mathieu Pioche, René Laugier, Christian Boustière, Franck Cholet, Emmanuel Coron, and Sarah Leblanc
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Male ,medicine.medical_specialty ,Hospitals, Low-Volume ,Time Factors ,Esophageal Neoplasms ,Radiofrequency ablation ,Adenocarcinoma ,Endoscopy, Gastrointestinal ,law.invention ,Barrett Esophagus ,law ,medicine ,Humans ,In patient ,Prospective Studies ,Watchful Waiting ,Trial registration ,Aged ,Radiofrequency Ablation ,business.industry ,Gastroenterology ,Intestinal metaplasia ,Middle Aged ,medicine.disease ,Endoscopic ablation ,Surgery ,Low grade dysplasia ,Treatment Outcome ,Dysplasia ,Barrett's oesophagus ,Disease Progression ,Female ,business ,Hospitals, High-Volume - Abstract
ObjectiveDue to an annual progression rate of Barrett’s oesophagus (BO) with low-grade dysplasia (LGD) between 9% and 13% per year endoscopic ablation therapy is preferred to surveillance. Since this recommendation is based on only one randomised trial, we aimed at checking these results by another multicentre randomised trial with a similar design.DesignA prospective randomised study was performed in 14 centres comparing radiofrequency ablation (RFA) (maximum of 4 sessions) to annual endoscopic surveillance, including patients with a confirmed diagnosis of BO with LGD. Primary outcome was the prevalence of LGD at 3 years. Secondary outcomes were the prevalence of LGD at 1 year, the complete eradication of intestinal metaplasia (CE-IM) at 3 years, the rate of neoplastic progression at 3 years and the treatment-related morbidity.Results125 patients were initially included, of whom 82 with confirmed LGD (76 men, mean age 62.3 years) were finally randomised, 40 patients in the RFA and 42 in the surveillance group. At 3 years, CE-IM rates were 35% vs 0% in the RFA and surveillance groups, respectively (pConclusionRFA modestly reduced the prevalence of LGD as well as progression risk at 3 years. The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted against surveillance in patients with BO with confirmed LGD.Trial registration numberNCT01360541.
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- 2021
49. How to Measure Detection Rate During Colonoscopy: PDR, ADR, SDR, or All Three?
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Maximilien Barret and Einas Abou Ali
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medicine.medical_specialty ,medicine.diagnostic_test ,Adenoma ,Colorectal cancer ,business.industry ,Serrated polyp ,Gastroenterology ,Colonoscopy ,medicine.disease ,Resection ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Radiology ,Detection rate ,Distal colon ,business - Abstract
Our aim was to clarify the respective role and significance of the adenoma detection rate (ADR) among other colonoscopy detection metrics such as the polyp detection rate (PDR) or the serrated polyp detection rate (SDR). PDR is easy to measure, but affected by the resection of hyperplastic lesions in the distal colon, or non-neoplastic colorectal mucosa, and cannot be considered a reliable detection metric. The use of SDR is limited by the heterogeneity of the serrated lesions. In 2021, the ADR remains sole recommended detection metric, inversely correlated to interval colorectal cancer and death, and correlated to most other colonoscopy detection metrics.
- Published
- 2021
50. Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery
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Rachel Hallit, Steffen Kunsch, Michael Ghadimi, T. Barrioz, Jérémie Jacques, Fabian Kück, Jean-Michel Gonzalez, Maximilien Barret, Volker Ellenrieder, D. Goéré, U. Chaput, Romain Legros, Annegret Müller-Dornieden, Edris Wedi, Mélanie Calmels, Carlo Jung, Ali Seif Amir Hosseini, Marc Barthet, and Marine Camus
- Subjects
medicine.medical_specialty ,Leak ,Univariate analysis ,business.industry ,Gastroenterology ,Anastomotic Leak ,Confidence interval ,Oncologic surgery ,3. Good health ,Surgery ,Esophagectomy ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,030220 oncology & carcinogenesis ,Anastomotic leaks ,medicine ,Drainage ,Humans ,Upper gastrointestinal ,030211 gastroenterology & hepatology ,Upper gastrointestinal surgery ,business ,Negative-Pressure Wound Therapy ,Retrospective Studies - Abstract
Background Endoscopic internal drainage (EID) with double-pigtail stents or low negative-pressure endoscopic vacuum therapy (EVT) are treatment options for leakage after upper gastrointestinal oncologic surgery. We aimed to compare the effectiveness of these techniques. Methods Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtail stents were changed every 4 weeks; EVT was repeated every 3–4 days until leak closure. Results 35 EID and 27 EVT patients were included, with a median (interquartile range [IQR]) leak size of 0.75 cm (0.5–1.5). Overall treatment success was 100 % (95 % confidence interval [CI] 90 %–100 %) for EID vs. 85.2 % (95 %CI 66.3 %–95.8 %) for EVT (P = 0.03). The median (IQR) number of endoscopic procedures was 2 (2–3) vs. 3 (2–6.5; P = 0.003) and the median (IQR) treatment duration was 42 days (28–60) vs. 17 days (7.5–28; P Conclusion EID and EVT provide high closure rates for upper gastrointestinal anastomotic leaks. EVT provides a shorter treatment duration, at the cost of a higher number of procedures.
- Published
- 2021
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