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Background SARS-CoV-2 is a novel virus currently causing a major pandemic. Recent studies have shown that SARS-CoV-2 has an affinity to ACE2 receptors which are present in the olfactory epithelium as well as the pulmonary and gastrointestinal (GI) systems. It is stipulated that these receptors are responsible for the entry of the virus into cells explaining the respiratory and GI symptoms of this infection. The anosmia related to COVID-19 is likely due to an aberrant immune response to the virus rather than direct damage to the olfactory epithelium. Similarly, achalasia is also believed to result from an aberrant immune response through which there is degeneration of inhibitory neurons in the myenteric plexus. In this case report, we present the first case of achalasia thought to be linked to a SARS-CoV-2 infection in contemporary literature. Aims We hypothesize that SARS-CoV-2 caused an aberrant immune response in our patient, leading him to develop achalasia. We hope to expose clinicians to this potential complication of COVID-19, allowing them to consider it sooner in their differential. Methods The patient’s file was reviewed to extract the relevant information. A second gastroenterologist’s opinion was obtained on the manometry to confirm the diagnosis of type III achalasia. Results A 61-year-old man with a medical history of myasthenia gravis, chronic obstructive pulmonary disease, hypothyroidism, and chronic renal failure was treated in our establishment for a SARS-CoV-2 pneumonia. He experienced new severe dysphagic symptoms, regurgitations, and lost 10 pounds during his hospitalization. He also developed anosmia and diarrhea. A CT-scan of his neck and thorax showed no extrinsic compression of his esophagus. No neoplasm was found on his gastroscopy. A barium study was then conducted showing a stagnation of contrast in the distal third of his esophagus. No relaxation of the inferior gastroesophageal sphincter was noted. A manometry was then performed and confirmed a type III achalasia. The mean lower esophageal sphincter residual pressure was elevated at 43.7 mmHg. A calculated 69% of wet swallows were premature contractions with a distal latency value less than 4.5 seconds. The mean distal contractile integral was 13613 mmHg. This corroborates the spastic nature of type III achalasia. Conclusions Considering that our patient developed anosmia and knowing its pathogenesis in the context of COVID-19, an inappropriate immune response to SARS-CoV-2 could have equally taken place in the esophagus. This inflammatory response might have caused the degeneration of the inhibitory neurons in the myenteric plexus responsible for the achalasia. Furthermore, given the fact that our patient had diarrhea, this suggests that the virus has a GI tropism supporting our hypothesis. We therefore believe that achalasia may be a potential complication of COVID-19. High resolution esophageal motility study showing a type III achalasia pattern. Funding Agencies None

Background Endoscopic submucosal dissection (ESD) is an endoscopic procedure developed in Asian countries to treat early gastric cancer (EGC). Western countries have less experience with this challenging technique. Aims The goal of this study is to evaluate the effectiveness of ESD as a preliminary experience. Methods This is an unicentric retrospective study of all consecutive gastric ESD for adenomas or EGC from 07/2017 to 08/2020. The primary endpoints were en bloc and R0 resection rates. Results Nineteen patients (mean age 74.2 (54–88), sex ratio 3F/16M) and 23 lesions were included. Mean diameter was 25 mm (10–90). Treatment was previously performed in 7 cases (30.4%), by ESD (5) or EMR (2). The procedure, performed under general anaesthesia, lasted on average 148 minutes (45–412). En bloc resections were performed in 16 cases (69.6%); 5 cases (21.7%) were converted to P-EMR and there was a failure to resect the lesion because of deep invasion or perforation in 2 cases (8.7%). Pathologic examination demonstrated 2 low-grade dysplasia, 4 high-grade dysplasia and 15 adenocarcinomas: intramucosal (8), sm1 (2), sm2 (2), sm3 (1) or sm deep (2). R0 and curative resection rates were 43.5% and 39.1% respectively. The complication rate related to the procedure was 30.4% including 5 perforations and 2 delayed bleeding: all were managed endoscopically. Five patients (21.7%) underwent subsequent gastrectomy for non-curative resection (4) or failed resection (1); 3 had no residual disease on final pathology, 1 had high grade dysplasia and 1 had intramucosal adenocarcinoma. One patient went to palliative care because he was unfit for surgery. Follow-up endoscopy was completed in all 17 patients who underwent endoscopic resection (mean 10 months (2–24)). Recurrence occurred in 23.5% (4/17); all were successfully treated by another ESD. Conclusions In our preliminary experience, the rate of en bloc and R0 resection were 70% and 44%. Compared to other studies, these low en bloc and curative resection rates may be explained by technically difficult lesions during the learning curve and might improve with experience. Nevertheless, surgery has been avoided in 13/19 patients (68%) with endoscopic intervention. Funding Agencies None

BACKGROUND: Zenker’s diverticulum is a pseudodiverticulum of the mucosa and submucosa occurring in the posterior pharyngoesophagus through Killian’s triangle. Symptoms include dysphagia, secretions, halitosis and weight loss and occur mostly in middle-aged and older adults. Historically, treatment has been extensive neck surgery and eventually rigid endoscopy. Recently, treatment by flexible endoscopic septum division (FESD) has shown excellent success rates with less morbidity(1). AIMS: This study aimed to evaluate the clinical response rate and complications of FESD in our single center. METHODS: We conducted a single center retrospective study of endoscopic Zenker’s diverticulotomy and myomectomy by FESD performed by two different endoscopists between July 2014 and June 2017. RESULTS: Seven patients were included in our analysis, four of which were males. Mean age of patients was 83.7 years (range 73–92). Two patients that were taking an anticoagulant (1 Apixaban, 1 Enoxaparin) and three on Aspirin had stopped their medication the appropriate number of days prior to the procedure. Indication for procedure included severe dysphagia in 6 patients and regurgitation in 1 patient. Patients also complained of regurgitation (3 patients), secretions (2), odynophagia (1), food impaction (1), and weight loss (1). All procedures were performed with a Dual knife (Olympus). Mean diverticular size was 3.3 cm (range 2–6 cm). Mean procedural time was 23.7 min (range 10–36 min). Minimal procedural bleeding occurred in two cases and no perforation was noted. Four procedures were conducted under general anesthesia and 3 under conscious sedation. Mean follow up duration was 2 months for 6 patients (range 1–5 months), one patient was lost on follow-up. Four patients reported complete recovery of initial symptoms, and two major improvement. No patient required a second procedure or surgery. CONCLUSIONS: In our retrospective analysis of flexible endoscopic diverticulotomy, we showed a good response rate, with no severe complication rendering this procedure very safe and effective for symptomatic Zenker’s diverticulum. FUNDING AGENCIES: None

Le Dual-Knife® (Olympus) est un nouveau couteau frequemment utilise pour la dissection sous-muqueuse du fait de sa surete et de sa precision. L’objet de cette etude etait d’evaluer l’efficacite et la tolerance du traitement endoscopique du diverticule de Zenker avec le Dual-Knife® assiste d’un diverticuloscope (Cook®). De fevrier 2009 a octobre 2011, 21 patients (14 hommes et sept femmes) dont l’âge moyen etait de 70,7 ± 10,2 ans, presentant un diverticule de Zenker symptomatique, ont ete inclus dans une etude prospective multicentrique non randomisee. La myotomie du muscle cricopharyngien etait realisee avec le Dual-Knife® apres exposition du septum diverticulaire grâce au diverticuloscope. En fin de procedure, un ou deux clips etaient positionnes a l’extremite distale de la dissection. Tous les patients decrivaient des symptomes incluant une dysphagie (n = 15; 71,4 %), des regurgitations et/ou troubles de la deglutition (n = 19; 90 %). Seize patients (75 %) avaient un diverticule dont la profondeur etait superieure ou egale a 30 mm. Toutes les complications etaient notees. Les symptomes des patients (dysphagie, regurgitation, troubles de la deglutition et inhalations) etaient evalues lors de consultations de surveillance regulieres ou par telephone. Le test utilise determine la probabilite que les deux parametres soient fortement lies au seuil p = 0,05 (test CMH). Une p-value inferieure a 0,05 indique une forte liaison entre les deux parametres, donc on accepte l’hypothese qu’il n’y a pas d’effet traitement. Les donnees ont ete analysees a l’aide du logiciel SAS (version 9.2; SAS Institute Inc, Cary, NC). Tous les patients ont ete traites avec succes lors de la premiere session. Nous n’avons eu aucune complication grave. Une hemorragie immediate a ete traitee endoscopiquement avec succes a l’aide d’une pince d’hemostase. Tous les patients sont sortis dans les 48 heures suivant l’intervention. A un mois et au moment de l’evaluation de suivi (7,85 mois [3–12]), la dysphagie et les regurgitations etaient significativement ameliorees (p = 0,48/0,18 et 0,68/,041 respectivement). Dix-huit patients (85,7 %) n’avaient plus aucun symptome. Pour trois patients, la dysphagie et/ou les regurgitations persistaient de manieres plus moderees. La dysphagie et/ou les regurgitations ont recidive pour deux patients (9,5 %). Un deuxieme traitement endoscopique a ete necessaire et un patient a ete opere. Au final, le traitement endoscopique etait efficace dans 90,4 % des cas. La diverticulotomie endoscopique au Dual-Knife® aide du diverticuloscope est une alternative therapeutique sure et efficace pour des patients atteints d’un diverticule de Zenker symptomatique.

Introduction La resection muqueuse endoscopique (EMR) est un traitement curatif des cancers epidermoides (SCC) superficiels de l’œsophage. L’objectif de cette etude etait d’evaluer l’evolution a long terme et la survie des patients traites par EMR.

In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome.We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected.A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P0.001).The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.

Background and study aims Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation. Patients and methods We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination. Results Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58). Conclusion Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.

Introduction L'enteroscopie a double ballon (EDB) a l'inverse de l'enteroscopie poussee, permet, en theorie, la realisation de polypectomie dans l'intestin grele. Si la rentabilite diagnostique de l'EDB est mieux connue, la faisabilite et les complications de la polypectomie du grele restent mal evaluees. Nous rapportons notre experience chez 10 patients pour qui un traitement endoscopique de polypes du grele a ete realise. Patients et Methodes De Janvier 2004 a Septembre 2006, 10 EDB hautes ont ete realisees pour traitement endoscopique de polypes du grele parmi 246 EDB (4%) respectivement pour syndrome de Peutz Jeghers (n=4), HNPCC (n=2), Adenomatose hepatique familiale (n=1), anemie ferriprive (n=2), et melena (n=1). Nous rapportons l'analyse retrospective de ces dossiers. Resultats Vingt-huit polypes etaient visualises chez 10 patients (1–10), sessiles dans 7 cas et pedicules dans 21 cas, de 27mm de diametre moyen (3–50), localises dans le duodenum (n=8), jejunum proximal (n=10), jejunum median (n=4), et jejunum distal (n=6). Chez 1 patient, le traitement endoscopique a ete recuse en raison du nombre important de polypes (n=10). Un traitement endoscopique a ete effectue pour 17/18 polypes. Une resection endoscopique a l'anse diathermique a ete realisee dans 13/18 cas (72,2%) dont 2 selon la technique de mucosectomie. Une destruction au plasma argon (APC) a ete effectuee dans 4 cas (22,2%). La resection etait complete dans 12/13 cas. Une analyse histologique etait disponible pour 21 des 28 polypes (75%) correspondant a 17 hamartomes dont 3 avec contingent adenomateux en dysplasie de bas grade, 3 adenomes (2 en dysplasie de bas grade et 1 en dysplasie de haut grade), et 1 lipome. Une histologie n'etait pas obtenue pour 7/28 polypes en raison d'un traitement par APC (n=4), de l'absence de recuperation du polype (n=2) et d'une procedure interrompue (n=1). Le traitement endoscopique etait considere comme satisfaisant chez 8 patients sur 10. Un traitement chirurgical complementaire etait propose chez 2 patients. Deux cas d'hemorragie post polypectomie d'evolution favorable et un cas de pancreatite aigue Balthazar D ont ete observees. Conclusion La resection endoscopique de polypes de l'intestin grele est possible avec l'EDB. Elle devrait permettre une prise en charge plus adaptee des patients a haut risque de cancer de l'intestin grele, comme les syndromes de Peutz-Jegher, HNPCC ou autres polyposes.

We show how it is possible to get 360/spl deg/ views from a special omni-directional stereo pair of cameras swivelling about the vertical axis and the technique to reconstruct the environment for this special sensor. The aim of the study is to develop a special device designed for this specific application in order to simplify the operations of calibration and stereo matching. We simplify the 2D calculus for the system. The approach described here does not require any specific environment. The goal of this project is to build maps of an unknown environment and to give a 3D real time representation of the environment.

This paper presents a new method of camera calibration for a panoramic stereovision sensor based on a cylindrical projective geometry. The multidirectional sensor allows us to get peripheral information about unknown environments, the architecture simplifies considerably computation. The device needs no calculation of epipolar lines. The calibration method derives directly from the benefits of the chosen architecture of the sensor and is not based on computation of vanishing points like former methods, which can only be an approximation and introduces uncertainty in the calibration process. Our calibration is based on the theory of projective vectors but uses simple geometry based on colinearity and orthogonality of vectors existing in the scene.

AIM: To investigate the feasibility of small bowel polypectomy using double balloon enteroscopy and to evaluate the correlation with capsule endoscopy (CE). METHODS: This is a retrospective review of a single tertiary hospital. Twenty-five patients treated by enteroscopy for small bowel polyps diagnosed by CE or other imaging techniques were included. The correlation between CE and enteroscopy (correlation coefficient of Kendall for the number of polyps, intra-class coefficient for the size and coefficient of correlation kappa for the location) was evaluated. RESULTS: There were 31 polypectomies and 12 endoscopic mucosal resections with limited morbidity and no mortality. Histological analysis revealed 27 hamartomas, 6 adenomas and 3 lipomas. Strong agreement between CE and optical enteroscopy was observed for both location (Kappa value: 0.90) and polyp size (Kappa value: 0.76), but only moderate agreement was found for the number of polyps (Kendall value: 0.47). CONCLUSION: Double balloon enteroscopy is safe for performing polypectomy. Previous CE is useful in selecting the endoscopic approach and to predicting the difficulty of the procedure.

Introduction L’enteroscopie double ballon permet le traitement endoscopique des lesions hemorragiques de l’intestin grele, detectees par la video-capsule endoscopique. Le taux de recidive hemorragique apres traitement endoscopique varie de 20 a 50 % selon les etudes, mais le devenir a long terme des patients traites reste mal connu. Patients et Methodes Etude retrospective de tous les patients ayant eu une enteroscopie double ballon de janvier 2004 a decembre 2007 dans un CHU referent. Le suivi des malades, en particulier le taux de recidive hemorragique, a ete evalue a 1 an par contact aupres des medecins referents ou des patients. Resultats 403 enteroscopies double ballon (322 hautes et 81 basses) ont ete realisees chez 335 patients consecutifs (H/ F = 191/144, âge moyen 58 ans (17-85)), pour diverses indications ; 90 % des patients avaient eu un examen prealable par video-capsule endoscopique. 74 % des indications concernaient un probleme d’hemorragie digestive : saignement digestif obscur dans 39 % (n = 157) et anemie ferriprive dans 35 % (n = 141). 44 % (n = 178) des enteroscopies double ballon etaient associees a un traitement endoscopique chez 153 patients dont 135 a visee hemostatique. Parmi ces 135 patients, il existait des angiodysplasies dans 95 % (n = 129), un ulcere de Dieulafoy dans 3,7 % (n = 5), des angiomes ( Blue rubber bleb nevus syndrome ) dans 2,3 % (n = 3) et des ulceres dans 2,3 % (n = 3) des cas. Les traitements endoscopiques pratiques etaient une coagulation au plasma argon dans 98,5 % (n = 133) ou un autre traitement hemostatique dans 3,7 % (n = 5) des cas. Sur les 135 patients traites, 91 etaient suivis a 1 an, 3 etaient decedes avant 1 an et 41 perdus de vue. Le taux de recidive de l’hemorragie ou de l’anemie a un an etait de 30,7 % dont les 3/4 ont beneficie d’un nouveau geste endoscopique. La morbidite de l’enteroscopie double ballon therapeutique etait de 4,2 % (douleurs abdominales, saignements minimes necessitent la mise de clips et 1 cas de pancreatite aigue Balthazar D) et la mortalite de 0 %. Conclusion L’enteroscopie double ballon permet un traitement (le plus souvent par coagulation au plasma argon) durable des lesions hemorragiques de l’intestin grele chez environ 70 % des patients traites et doit etre proposee comme premiere option therapeutique du fait de sa relative efficacite et de sa faible morbidite.