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The majority of patients with familial adenomatous polyposis (FAP) develop duodenal adenomas with a risk of progression to duodenal cancer. Endoscopic management of FAP duodenal adenomas has been proposed as a less-invasive option than surgery, but available data still are limited. Our aims were to assess the feasibility and safety of endoscopic treatment in duodenal polyposis and to evaluate its long-term efficacy in terms of recurrence and malignant degeneration. FAP patients with stage IV duodenal polyposis were enrolled in 5 French centers as part of a national cohort and followed up for a median period of 5.66 years (interquartile range, 6.39 y). Primary outcomes were duodenal surgery-free and cancer-free survival. Two groups of patients were identified according to endoscopic procedures: group 1: resection and or destruction (by argon plasma coagulation) of duodenal polyps, and group 2: papillectomy. Fifty-eight patients were enrolled (29 men; median age, 44 y). Endoscopic therapy was performed in 37 patients in group 1 and in 19 patients in group 2. Duodenal cancer-free and surgery-free survival were 95.8% at 5 years and 92.6% at 10 years. Four patients required surgery and 2 patients developed cancers. In the 58 patients, the calculated Spigelman score decreased from 9.24 points at entry to 6.35 at 5 years and then plateaued. Complications (mostly bleeding and perforation) occurred in 20 patients. In this long-term cohort follow-up evaluation, endoscopic treatment of patients with severe duodenal polyposis appears relatively safe and effective as an alternative to surgery for the prevention of cancer. [ABSTRACT FROM AUTHOR]

Background and Aims Histological healing may represent the ultimate therapeutic goal in ulcerative colitis [UC], but it requires biopsies. Our aim was to develop a non-invasive index able to assess histological disease activity in ulcerative colitis, using probe-based confocal laser endomicroscopy [pCLE]. Methods One hundred patients with quiescent UC were prospectively included in five French centres. After fluorescein intravenous injection, during colonoscopy, the colorectal mucosa was analysed by white light imaging and pCLE, and then biopsied in different locations. Five endoscopists performed central reading of pCLE images blinded to clinical, endoscopic, and histological data. One expert pathologist performed a central histological reading [Nancy index: gold standard]. Univariate and multivariate analyses were performed to identify the endomicroscopic items associated with the presence of histologically active disease. Results Over 1000 pCLE videos sequences performed in 100 UC patients in endoscopic remission [Mayo 0 and 1] were evaluated. We observed that vessel diameter >20 µm, dilated crypt lumen, fluorescein leakage, and irregular crypt architecture were statistically associated with histologically proven inflammation according to the Nancy index. Hence, we built a pCLE index of mucosal inflammation with overall accuracy of 79.6% and overall sensitivity and specificity of, respectively, 57.8% and 82.8%. Negative predictive value, especially when a pCLE index ≤1 was observed, was high [93.1%]. Conclusions Using a robust methodology, large vessel diameter, dilated crypt lumen, fluorescein leakage,and irregular crypt architecture are reliable endomicroscopic items defining the ENHANCE index for real-time assessment of histological disease activity in UC. [ABSTRACT FROM AUTHOR]

Achalasia can be treated very effectively with peroral endoscopic myotomy (POEM), but factors associated with early failure remain to be determined, especially in European cohorts. All consecutive adult patients who underwent a first POEM to treat primary achalasia were included in this multicenter retrospective study. Early failure was defined by an Eckardt score (ES) >3 at 3 months after POEM. When evaluating factors predictive of early failure, 2 cohorts were considered: one consisted of the total population, for whom only basic variables were collected, and the other a cohort built for a case-control study that included matched early-failure and early-success patients (ratio, 1:2). Among 746 patients, the early failure rate was 9.4%. Predictive factors were age ≤45 years (P =.019), achalasia types I and III (P <.001), and the development of a severe adverse event during the procedure (P =.023). In the case-control study, the only additional independent risk factor for early failure was a high pre-POEM ES (P =.001). Only the retrosternal pain subscore was significantly associated with the early failure rate. The early failure rate of POEM used to treat primary achalasia is <10%. Younger age, type I/III achalasia, and a high pre-POEM ES were significantly associated with failure. [Display omitted] [ABSTRACT FROM AUTHOR]

Background and Aims Confocal laser endomicroscopy (CLE) might discriminate mucosal lesions between Crohn's disease (CD) and ulcerative colitis (UC). However, the analysis of CLE images requires time-consuming methods, a long training time, and potential impediments, such as significant interobserver variability. Therefore, we developed a computer-based method to analyze mucosal architecture from CLE images and discriminate between healthy subjects and patients with inflammatory bowel disease (IBD) as well as between UC and CD patients. Methods We retrospectively screened patients who had undergone CLE either for an evaluation of IBD in remission or for colorectal cancer screening (control subjects) between 2009 and 2016. We assessed 14 morphologic and functional parameters in each CLE recording from 23 CD patients, 27 UC patients, and 9 control patients. Next, we constructed 2 scores, 1 for the IBD diagnosis and 1 for the differential diagnosis between UC and CD. Results In IBD patients, the mean intercrypt distance, wall thickness, and fluorescein leakage through the colonic mucosa were significantly increased compared with control patients by 155%, 188%, and 297%, respectively (P <.05). In UC patients, the same parameters were significantly increased by 109%, 117%, and 174%, respectively (P <.05), compared with CD patients. IBD diagnosis had 100% (95%CI, 93%; 100%) sensitivity and 100% (95%CI, 66%; 100%) specificity. IBD differential diagnosis provided discrimination of UC from CD patients with 92% (95%CI, 75%; 99%) sensitivity and 91% (95%CI, 72%; 99%) specificity. Conclusions Confirming these results using prospective validation cohorts can substantiate that computer-based analysis of CLE images may provide new biomarkers for the diagnosis and characterization of IBD. [ABSTRACT FROM AUTHOR]

Abstract Background Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. Aim The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. Methods The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. Results Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. Conclusion Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed. [ABSTRACT FROM AUTHOR]

Abstract: We hypothesized that inducing systemic resistances can contribute to the control of the nematode Rotylenchulus reniformis in pineapple. In greenhouse experiments conducted in Martinique, the pineapple cultivars Smooth Cayenne and MD-2 were treated with methyljasmonate (JAME) and salicylic acid (SA), elicitors of induced systemic resistance (ISR) and systemic acquired resistance (SAR). The efficacy of the elicitors was tested by inoculating plantlets grown in individual pots with a monospecific population of R. reniformis reared on Vigna unguiculata. The final nematode populations, 45 days after inoculation on MD-2 treated with JAME were reduced by 67.0% (p = 0.006). Nematode populations on MD-2 plants treated with SA were reduced by 55.8% (p = 0.016). Nematode populations on SC were not reduced by the elicitors. In a second experiment, using split-root systems, JAME was applied to MD-2 plantlets and enzymatic activities involved in plant defense and stress responses were monitored for 14 h after treatment. Additional pots were inoculated with nematodes 24 h after JAME treatment and examined ten days later. Transient stress was observed along with an increase in enzymatic response after inoculation with nematodes. These results showed that the MD-2 was primed through an ISR by JAME. The question now arises whether ISR can be specifically induced only in certain pineapple cultivars. Results are discussed from the perspective of introducing new strategies to manage pineapple nematodes. [Copyright &y& Elsevier]

Abstract: All bananas cultivated for export are Cavendish cultivars and are considered to be very susceptible to both the burrowing nematode Radopholus similis and the lesion nematode Pratylenchus coffeae. Twelve cultivars of Musa spp. genome AAA cv. Grande Naine from mass field selections in Martinique and Guadeloupe were cloned and micro-propagated in tissue culture. Resistance of these sibling cultivars to nematodes was tested in two growth chamber trials and in one 2-year field trial in a former banana field heavily infested with nematodes and without control methods (no guying or nematicide applications). The field trial also included a new synthetic hybrid FB920 that has tolerance to yellow and black Sigatoka and partial resistance to nematodes. Trends were similar in growth chamber and field trials in that all Cavendish cultivars were susceptible to nematode species, although some differences in susceptibility were detected, and in particular roots of the selected cultivar MA13 contained fewer R. similis than the most susceptible cultivars of Cavendish (cvs. Petite naine, Poyo and L93). Cultivar MA13 was also less susceptible than most commercial cultivars to P. coffeae in the growth chamber trials, and a similar but insignificant trend was documented in the field trial. In the field trial, all cultivars experienced severe damage (lengthening of vegetative and reproductive stages, uprooting and reduced yield), which was attributed to the high level of nematode infestation. Although tolerance to nematodes in the field trial was greater for the synthetic new hybrid FB920 than for the Cavendish cultivars, FB920 produces small bunches and tall plants that will prevent its development as a banana for export (but will not prevent its production by small holders). In summary, this study shows that there is useful variation in tolerance to R. similis and P. coffeae among sibling Cavendish cultivars and that growth chamber trials with in vitro-cultivated plants are useful for screening for such susceptibility. [Copyright &y& Elsevier]

The author presents a personal narrative of his experiences as the Chief Executive Officer (CEO) and main shareholder of the French shoe manufacture Samson, which specializes in women comfort shoes since the 1960s, with topics including leather cutting and labor costs and exportation development.

Abstract: During the last decade, new crop systems have been developed in the French West Indies to avoid repeated applications of nematicides in banana fields. These combine fallow or rotation crops and nematode-free in vitro plants. In many fields, however, after 2–4 years, the burrowing nematodes Radopholus similis progressively re-infest banana fields, leading growers to re-apply nematicides. Among different hypotheses for re-infestation, we studied the possibility that nematodes were disseminated by runoff water. The study was conducted in an experimental field on plots that were defined by ditches or marked with flags and weeded or not, prior to replanting with in vitro plants. Results showed that 50–80cm deep ditches efficiently prevent R. similis dissemination and that dispersion by water runoff is the major route of contamination. In contrast, weed management during the fallow period had little influence. [Copyright &y& Elsevier]

Abstract: During a survey of the nematodes associated with weeds in banana fields in Martinique, 41 weed species in 37 genera from 20 plant families were collected to extract nematodes from the roots. Results of this survey showed that 24 weed species were hosts of Radopholus similis, 23 were hosts of Helicotylenchus spp., 13 were hosts of Pratylenchus spp., 13 were hosts of Hoplolaimus seinhorsti, 29 were hosts of Meloidogyne spp. and 24 were hosts of Rotylenchulus reniformis. The presence of the burrowing nematode was more consistently found within three families, the Euphorbiaceae, Poaceae and Solanaceae. In some weed species such as Caladium bicolor, Commelina diffusa, Echinochloa colona and Phenax sonneratii, the levels of nematodes recovered were similar to, or greater than the numbers recovered from Musa roots. These results clearly show that certain weeds can be significant reservoirs of plant parasitic nematodes including R. similis in banana fields. This information is crucial in devising appropriate nematode control measures for use with rotation crops or fallow before re-planting banana fields with nematode free planting material. [Copyright &y& Elsevier]