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Sleeve gastrectomy (SG) is the most commonly performed bariatric surgical procedure worldwide. However, the impact of SG on Barrett’s esophagus (BE) remains unknown. The main objective was to determine the rate of BE 5 years after SG. Patients, operated in 2012 by SG in one center, who preoperatively and postoperatively (5 years) underwent upper gastrointestinal endoscopy (UGIE), 24-h pH monitoring, and esophageal manometry, were included. A total of 59 (81.4% of females) patients were included. Preoperative mean age and body mass index were 45.2 ± 11.7 years and 45.2 ± 8.1 kg/m2 respectively. Preoperative 24-h pH monitoring reported gastroesophageal reflux disease (GERD) in 18 (30.5%) patients. The mean total body weight loss at 5 years was 16.1 ± 11.2%. No significant difference was observed between preoperative and postoperative de Meester’s score (20.2 ± 27.1 and 21.0 ± 21.5 respectively (p = 0.91)) nor between preoperative and postoperative number of acid reflux episodes per 24 h (65.1 ±

Background: Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear. Objective: The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. Methods: All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy. Results: A total of 227 patients were included. The resections were en bloc in 64.8% of cases. The mean lesion size was 20 mm (range: 3–80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size > 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%. Conclusion: Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size > 2 cm were associated with local recurrence.

Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 – 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 – 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

Endoscopic submucosal dissection is currently regarded as the method of choice for the resection of superficial tumours. The objective of our study was to evaluate prospectively the efficiency of an endoscopic submucosal dissection training course using live anaesthetised pigs.Fourteen novice endoscopists participated in three gastric endoscopic submucosal dissection training courses on anaesthetised pigs. Each trainee resected five 'fake' antral lesions. Resected specimen sizes, endoscopic submucosal dissection speeds and the complication rate were evaluated prospectively.Among the 70 procedures performed, 58 could be analysed. There was a strong increase in endoscopic submucosal dissection speed (from 9.7 mmThere is a clear benefit from endoscopic submucosal dissection training courses on animal models. Improved endoscopist capability is evident from the third endoscopic submucosal dissection. These data validate the indispensable nature of dedicated training courses and echo the European Society of Gastrointestinal Endoscopy proposition for multistep learning, beginning on animal models.

Carbapenemase-producing Klebsiella pneumoniae (OXA-48 CPE) were identified in five patients who underwent an endoscopy with the same duodenoscope in October 2015. The endoscope was the only epidemiological link between these cases. A transient contamination of the duodenoscope following a failure in the disinfection process may have been the cause of transmission.

International audience; The role of human papillomavirus (HPV) in Barrett's esophagus (BE) has been examined but remains unclear. The purpose of the study is to dispute the connection between HPV and BE in a prospective case-control study. Biopsies were performed above and inside the Barrett's segment for BE patients and in the distal third of the esophagus for control patients for histological interpretation and for virological analysis. Biopsies for virological analysis were placed in a virus transport medium and immediately frozen in liquid nitrogen. Virological analysis involved real-time PCR using the SyBr® green protocol with modified SPF10 general primers. A total of 180 patients (119 control and 61 BE, respectively) were included. In BE patients, 31, 18, and 12 patients had, respectively, no dysplasia, low-grade dysplasia, and high grade dysplasia. Overall, nine were found to be HPV positive: five were control patients and four BE patients. HPV positive status was not associated with BE. No factors were associated with HPV, in particular the degree of BE dysplasia. HPV infection appears unlikely to be significant in the etiology of BE compared with control patients. (ClinicalTrials.gov, Number NCT02549053).

Background Probe-based confocal laser endomicroscopy enables microscopic examination of the digestive mucosa. Aims (1) To identify and validate quantitative endomicroscopic criteria for evaluation of the colonic mucosa and (2) to compare these criteria between healthy and Crohn's disease patients in clinical remission. Methods Six healthy controls and ten Crohn's disease patients in clinical remission were included in this prospective study. Methylene blue-stained biopsies of the right colon and corresponding endomicroscopic images were analyzed. Major axis, minor axis, and major axis/minor axis ratio of crypt lumens were quantified. Results Quantitative assessment was performed on 21 ± 4 crypt lumens per patient. Major axis/minor axis ratio values measured with endomicroscopy or methylene blue-stained biopsies were linearly correlated ( r = 0.63, p = 0.01). All macroscopically inflamed mucosa had values of major axis/minor axis ratio higher than the median of controls. Interestingly, 50% (3/6) of Crohn's disease patients with macroscopically normal mucosa had also a higher ratio than pooled controls. Histological analysis showed that 6/7 patients with major axis/minor axis ratio superior to 1.7 had microscopic inflammation. Conclusion Probe-based confocal laser endomicroscopy allows quantitative analysis of colonic pit structure. Endomicroscopic analysis of major axis/minor axis ratio allows the detection of microscopic residual inflammation with greater accuracy than standard endoscopy in Crohn's disease patients in clinical remission.

Les progres technologiques recents obtenus en termes d’imagerie, de miniaturisation et d’informatique ont permis l’avenement d’une nouvelle forme d’endoscopie diagnostique combinant la haute resolution, les colorations virtuelles et la realisation de biopsies optiques. Ces technologies innovantes offrent la possibilite de depister precocement des zones dysplasiques au sein d’un endobrachyoesophage (EBO) au cours de la surveillance et de cibler les biopsies, voire a terme de guider le traitement endoscopique en temps reel. En effet, la plupart des etudes cliniques actuellement publiees demontrent d’ores et deja d’excellentes valeurs de sensibilite et de specificite par rapport a l’examen standard en lumiere blanche. Dans cette mini-revue, nous aborderons les aspects techniques et les resultats des grandes etudes cliniques concernant les techniques de chromoscopie virtuelle et d’endomicroscopie confocale appliquees a l’EBO afin d’en expliquer l’interet en pratique clinique.

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Question: A 43-year-old woman, with an unremarkable medical history, was admitted for chronic diarrhea. Colonoscopy was performed to evaluate the diarrhea. Perianal examination before the procedure revealed a 2.5 2 1.5-cm lesion extruding from the anus (Figure A) but reducible on digital examination. On top of the lesion was a 5-mm patch of a different appearing surface with a granular pattern (Figure B). Subsequent colonoscopy was otherwise normal, although the polyp was confirmed on retroflexion (Figure C). What is your diagnosis for this lesion? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

A case is reported of a 40-year-old woman with a past history of bariatric surgery with vertical banding gastroplasty. Migrating band was observed during upper GI endoscopy performed for pyrosis. Before undergoing another bariatric intervention, migrated band had to be removed. This procedure was successfully performed endoscopically using argon plasma coagulation. No complication occurred. This case highlights that migrated band could be easily and safely removed without the need of specific or dedicated endoscopic tool.

A case is reported of a 76-year-old man with a past history of atrial fibrillation. A radiofrequency ablation procedure was suggested following several failed cardioversion attempts. However, an esophagopericardial fistula complicated the procedure. This life-threatening complication was successfully managed using both the placement of a covered esophageal stent and surgical pericardial and mediastinal drainage. In fact, no persisting fistula could be detected when the esophageal stent was removed seven weeks later. Atrioesophageal and esophagopericardial fistulas are two of the most severe complications associated with cardiological radiofrequency ablation procedures. They are responsible for majority of the deaths associated with this procedure. Despite the extremely high morbimortality associated with cardiothoracic surgery in such conditions, this treatment is the gold-standard for the management of such complications. This case report emphasizes the importance and efficacy of the endoscopic approach as part of a multidisciplinary management approach to this serious adverse event following radiofrequency ablation for atrial fibrillation.

Mo1537 Quantitative Morphological and Functional Assessement of Colonic Mucosa Using Probe-Based Confocal Laser Endomicroscopy Nicolas Musquer, Sabrina Coquenlorge, Arnaud Bourreille, Jean Paul Galmiche, Michel Neunlist, Emmanuel Coron Centre Hospitalier Universitaire, Nantes, France; INSERM U913, Nantes, France; Massachussets General Hospital, Boston, MA Background and aims: Probe-based confocal laser endomicroscopy (pCLE) allows studying the digestive mucosa at a sub-cellular level. Most studies use subjective criteria to make a presumptive histological diagnosis. However, whether pCLE is an accurate method to perform quantitative analysis of the mucosa remains to be determined. Our aims were 1) to identify and validate quantitative criteria for pCLE evaluation of the colonic mucosa, and 2) to compare these criteria between normal and Crohn’s disease (CD) patients in clinical remission. Patients and methods: A total of 6 control and 10 CD patients were included. Control patients had no personal or family history of CD. CD patients were all in clinical remission. pCLE procedures were performed during colonoscopy under general anesthesia, using a high-resolution confocal miniprobe (Mauna Kea Technologies, France) to image the right colon. Immediately following pCLE, biopsies were taken in the same location, for both standard histology (transverse sections) and methylene blue-stained biopsies (MBSB). MBSB were used as our reference method for quantitative assessment because they were imaged ‘en face’ with an inverted microscope. Both pCLE and MBSB images were analyzed using Image J software (NIH, USA). The following parameters were quantified: 1) Major and minor axis of the crypt lumen (Ma/ma values), and 2) fluorescence intensity ratio (FIR) between the crypt lumen and the surrounding crypt cells. Correlation between pCLE and MBSB was assessed by the Spearman rank test and ANOVA. Results: Quantitative assessment was performed on 21 4 crypt lumen per patient and per method. Overall, Ma/ma values measured with pCLE were significantly larger than those obtained with MBSB, but were linearly correlated (r 0.71, p 0.003; n 16). pCLE values were significantly smaller in controls than in CD patients (1.64 0.12 vs 3.45 1.95, n 16; p 0.005). All controls had identical values. In contrast, 6/10 CD patients had values larger to those of controls. Finally, FIR was not significantly different in controls and CD patients (0.55 0.62 vs 0.77 0.37, p 0.14; n 16). In controls, individual values of FIR were identical as compared to the mean value of FIR of all controls. In contrast, 3/10 CD patients had FIR values significantly increased as compared to the mean values of FIR from controls. Conclusion: pCLE allows quantifying of colonic crypt lumen morphology and fluorescein intensity, and allows differentiating between CD patients in clinical remission and controls. Provided computerized analysis confirms these results on a larger study, pCLE-based crypt lumen measurements might be used as a potential quantitative biomarker.

International audience; Background: Analysis of serum biomarkers for the assessment of atrophic gastritis (AG), considered as gastric precancerous lesion, is of growing interest and recommended by current guidelines. Our aim was to evaluate the diagnostic performance of a panel of biomarkers (GastroPanel®) for the detection of AG in France, a country of a low gastric cancer (GC) incidence. Material and Methods: In this prospective, multicenter, cross-sectional study, consecutive patients considered at increased risk of GC and undergoing upper endoscopy with gastric biopsies were included. Blood samples were collected for the analysis of GastroPanel® (association of Pepsinogens I and II, Gastrin-17, and Helicobacter pylori serology) using ELISA. The results of GastroPanel® were compared to the results of histology considered as the reference. Results: Between 2016 and 2019, 344 patients (148 cases with AG, 196 controls without AG) were included. Sensitivity, specificity, positive, and negative predictive values for the detection of AG by GastroPanel® were of 39.9% (95% CI 31.9; 48.2), 93.4% (95% CI 88.9; 96.4), 81.9 (95% CI 71.1; 90.0), and 67.3 (95% CI 61.4; 72.8), respectively. The sensitivity was significantly higher for the detection of severe AG [60.8% (95% CI 46.1; 74.6) P =.015] and corpus AG [61.0% (95% CI 49.2; 72.0), P =.004]. Diagnostic performances of GastroPanel® tended to be better than those of Pepsinogen I alone, but the difference did not reach statistical significance (P =.068). Conclusion: Serum pepsinogen and GastroPanel® tests show promising results for the detection of AG, especially of corpus AG and severe AG, in patients at high risk of GC in France.