Biography:

In the past Thierry Ponchon has collaborated on articles with Alan N. Barkun and Frédéric Prat. One of their most recent publications is Physicochemical determinants of in vitro shock-wave biliary lithotripsy***. Which was published in journal Gastroenterology.

More information about Thierry Ponchon research including statistics on their citations can be found on their Copernicus Academic profile page.

Thierry Ponchon's Articles: (19)

Physicochemical determinants of in vitro shock-wave biliary lithotripsy***

AbstractHuman gallstones were studied by visual inspection, computerized tomographic imaging, and chemical analysis to assess physicochemical characteristics that may determine the outcome of in vitro shock-wave fragmentation. Eighty-five stones (mean diameter: 13.2 ± 5 mm) were each collected from different patients. Fifty-five (65%) calculi were angular and 30 (35%) round or oval-shaped. Three easily obtained measures were derived from each stone's optimal computerized tomographic image including the mean stone density, a measure corresponding to the standard deviation of the mean stone density value which we termed the stone density distribution index and which may reflect the physicochemical heterogeneity of a given gallstone, as well as the density range. After the administration of 2500 shock waves using an electrohydraulic generator, fragmentation was noted in 68 calculi (80%) and was satisfactory in 27 (32%) (where the largest resulting fragment diameters were all ≤5 mm). Strong determinants of satisfactory fragmentation on multivariate analysis included a stone diameter of ≤15 mm, the presence of an angular stone shape, and a stone density distribution index of ≥60 Hounsfield units. The other parameters did not independently determine satisfactory fragmentation. Prospective clinical trials are needed to assess whether these findings result in a better prediction of the success of extracorporeal biliary lithotripsy and a broadening of its indications.

Increased chemocytotoxicity to colon cancer cells by shock wave-induced cavitation

AbstractBackground/Aims: Cavitation has been shown to hinder colon cancer cell proliferation in vitro. This study aimed at investigating the interest of combining cavitation and cytotoxic drugs in vitro. Methods: HT-29 cells were exposed in suspension to cavitation (shock waves plus bubbles) before 5-fluorouracil (FUra) administration. Cytotoxicity was studied by means of clonogenic survival, cell proliferation by [3H]deoxyuridine ([3H] dUdR) incorporation, and influence of the treatments on the cell cycle by cytofluorimetry; the effects of cavitation on RNA incorporation of FUra, cell permeability, and activity of thymidilate synthetase (TS) were also studied. Results: A preliminary exposure to cavitation (as compared with FUra alone) induced decreased colony formation (by up to 2 log in certain conditions) and colony size. Cavitation alone induced increased incorporation of [3H]dUdR during 48 hours and stimulated TS activity, but in the presence of FUra, the concentration of the drug that causes 50% inhibition of control cell growth for [3H]dUdR incorporation was reduced by up to 1 log, and TS inhibition was increased after cavitation as compared with FUra alone. RNA incorporation of [14C]FUra was increased by cavitation, as a consequence of altered cell permeability rather than a direct RNA effect. Seventy-two hours after treatment, cavitation plus FUra decreased by more than 50% the S-phase fraction and also inhibited mitosis. Conclusions: Submitting HT-29 cells to cavitation before treatment by FUra significantly increases the effects of the drug. The action of both agents appears to be partially synergistic with a cycle specificity.

Original ResearchFull Report: Clinical—BiliarySuccessful Management of Benign Biliary Strictures With Fully Covered Self-Expanding Metal Stents

Background & AimsFully covered self-expanding metal stents (FCSEMS) are gaining acceptance for the treatment of benign biliary strictures. We performed a large prospective multinational study to study the ability to remove these stents after extended indwell and the frequency and durability of stricture resolution.MethodsIn a nonrandomized study at 13 centers in 11 countries, 187 patients with benign biliary strictures received FCSEMS. Removal was scheduled at 10–12 months for patients with chronic pancreatitis or cholecystectomy and at 4–6 months for patients who received liver transplants. The primary outcome measure was removal success, defined as either scheduled endoscopic removal of the stent with no removal-related serious adverse events or spontaneous stent passage without the need for immediate restenting.ResultsEndoscopic removal of FCSEMS was not performed for 10 patients because of death (from unrelated causes), withdrawal of consent, or switch to palliative treatment. For the remaining 177 patients, removal success was accomplished in 74.6% (95% confidence interval [CI], 67.5%–80.8%). Removal success was more frequent in the chronic pancreatitis group (80.5%) than in the liver transplantation (63.4%) or cholecystectomy (61.1%) groups (P = .017). FCSEMS were removed by endoscopy from all patients in whom this procedure was attempted. Stricture resolution without restenting upon FCSEMS removal occurred in 76.3% of patients (95% CI, 69.3%–82.3%). The rate of resolution was lower in patients with FCSEMS migration (odds ratio, 0.22; 95% CI, 0.11–0.46). Over a median follow-up period of 20.3 months (interquartile range, 12.9–24.3 mo), the rate of stricture recurrence was 14.8% (95% CI, 8.2%–20.9%). Stent- or removal-related serious adverse events, most often cholangitis, occurred in 27.3% of patients. There was no stent- or removal-related mortality.ConclusionsIn a large prospective multinational study, removal success of FCSEMS after extended indwell and stricture resolution were achieved for approximately 75% of patients. ClincialTrials.gov number, NCT01014390.

Abstracts Submitted to ASGE 2000⁎4625 Endoscopic ultrasound and intraductal ultrasonography are complementary for the management of ampullary tumors.

Whipple's resection is the gold standard treatment of the ampullary tumors. Nevertheless endoscopic snare resection (ESR), which is less invasive, can be applied in a curative intent when some criteria are respected : -1- no risk of metastatic lymph node e.g. benign ampullomas or early carcinomas respecting the submucosae -2- no tumoral extension inside the pancreatic and the bile ducts. While endoscopic ultrasound (EUS) stages, with a good accuracy, an ampullary tumor as respecting the muscularis propria (uT1), intraductal ultrasonography (IDUS) is very promising to appreciate the involvement of the submucosae and the existence of an intraductal extension. The combination of the two methods could then allow optimizing the therapeutic choice. AIM: to estimate the clinical impact of EUS +/- IDUS in the management of ampullary tumors PATIENTS AND METHODS: between Jan 99 and Nov 99, 10 patients with ampullary tumors had a pretherapeutic staging. A radial EUS (GFUM20, Olympus Co) was systematically performed. When the staging was uT1 an IDUS (UM-G20-29R, Olympus Co) was done. A Whipple's resection was proposed when final staging was -1- lesion infiltrating the submucosae or more ; -2- tumor extension inside the biliary or pancreatic ducts. An ESR was proposed in the other cases. RESULTS: EUS concluded to a tumor >uT1 in 4 cases. Pathology (Whipple's resection) confirmed the staging (3 pT3; 1 pT2). EUS conclude to a tumor uT1 in 6 cases and IDUS was performed. - In 4 cases tumors were considered without intraductal involvement and respecting the submucosae. ESR was always curative (severe dysplasia; resection margins free of tumor). – In 2 cases IDUS evidenced involvement of the submucosae. 1 with a tumor extension inside the ducts was operated on and diagnosed as pT2. 1 refused surgery and an ESR was performed confirming the involvement of the submucosae (positive resection margins). A moderate pancreatitis was the only ESR complication. CONCLUSION: EUS and IDUS togheter allow an accurate T staging of ampullary tumors. The clinical impact is major: endoscopic snare resection can be applied in a curative intent in early tumors, Whipple's resection in other cases or when ESR is not complete.

Abstracts Submitted to ASGE 2000⁎4642 Plastic or metallic stents for inoperable malignant strictures of the common bile duct? results of a randomised prospective study.

The systematic use of metallic stents (MS) is hampered by their price compared to plastic stents (PS) in biliary obstruction. Aims. 1- to compare cost and efficacy of plastic stents (PS) and metallic stents (MS) in the treatment of inoperable malignant strictures of the common bile duct, 2- to define predictive factors of survival of patients with inoperable malignant biliary stricture. Patients. 118 patients (mean age 75 yrs) with an inoperable malignant stricture of the common bile duct were randomized to receive PS or MS. The characteristics of the 2 groups were comparable. Comparisons were made with chi-2 tests and survival rates compared with a Cox model. Results. There was no significant difference of survival between the 2 groups. Time for first obstruction was longer in patients with PS (median not reached vs 5 months, p=0.007). Number of additional days of hospitalization (173), of days with antibiotics (237), of ERCPs (20) and of abdominal ultrasonographies (18) were significantly higher in the group treated with PS. By multivariate analysis, 2 variables were independent prognostic factors of survival: the ASA classification (p=0.03 ; RR=1.5) and the number of liver metastases (p<0.0001 ; RR=1.5). Combination of these 2 variables allowed to define a group with a short survival (1.9 months) and another group with a longer survival (5.6 months) in which the overall cost of MS was lower than that of PS. Conclusions. MS are more effective for treatment of inoperable malignant stricture of the common bile duct. Combination of 2 predictive prognosis factors (ASA and number of liver metastases) allows to define the best type of stent according to the estimated survival time of patients.

Original ArticlesThe influence of mutation site and age on the severity of duodenal polyposis in patients with familial adenomatous polyposis☆

AbstractBackground: The present study was undertaken to identify factors affecting the severity of the duodenojejunal polyposis in patients with familial adenomatous polyposis. Methods: Duodenojejunal polyposis was evaluated in 41 consecutive patients with familial adenomatous polyposis (mean age 41 years, range 21-63 years), 33 (80%) with known APC mutation, by using a standardized endoscopic protocol. The severity of the polyposis was graded with the Spigelman scoring system (0-12 points), the Spigelman score/age ratio, and the presence or absence of advanced adenomas (>1 cm in diameter and/or high-grade dysplasia). Results: The Spigelman score (median 8, range 3-12) was higher in patients older than 50 years (median 10, range 3-12) as compared with younger patients (median 7.5, range 3-11; p = 0.043). A significant association between age and the presence of advanced adenomas was also observed. Patients with a mutation in the central part of the APC gene (codons 279-1309) had a higher Spigelman score and Spigelman score/age ratio as compared with patients with other mutations: median Spigelman score/age ratio 0.21 (range 0.14-0.40) versus 0.10 (range 0.06-0.20) (p < 0.001). Conclusions: Older age and APC mutation in the central part of the gene are risk factors for the development of severe duodenojejunal polyposis. (Gastrointest Endosc 2002;55:342-7.)

Original Article: Clinical EndoscopyTemporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study

BackgroundManagement of anastomotic biliary strictures after liver transplantation deserves optimization.ObjectiveTo evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting.DesignProspective, multicenter, uncontrolled study.SettingThree French academic hospitals with liver transplantation units and tertiary referral endoscopy centers.PatientsTwenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting.InterventionsPCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal.Main Outcome MeasurementThe ability to remove PCSEMS.ResultsPCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective.LimitationsUncontrolled study with limited follow-up.ConclusionsTemporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.

Original articleClinical endoscopyEndoscopic prediction of deep submucosal invasive carcinoma: validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification

BackgroundA simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful.ObjectiveTo develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma.DesignThe study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training.SettingJapanese academic unit.Main Outcome MeasurementsPerformance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy.ResultsWe expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70).LimitationsSingle Japanese center, use of still images without prospective clinical evaluation.ConclusionThe NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors.

Original articleClinical endoscopyAn international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians

Background and AimsPer-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians.MethodsThis was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed.ResultsA total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I, 17.1%; type II, 35.5%; type III, 17.1%; and unspecified, 30.3%. Overall, 41.1% were treatment naïve, whereas others had previous botulinum toxin injection and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson comorbidity index score was 6.2 ± 2.4, with the majority of patients having American Society of Anesthesiologists Physical Status Classification System (ASA) scores of II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen adverse events occurred in 11 patients (14.5%). There were 3 inadvertent mucosotomies, 6 cases of symptomatic capnoperitoneum and/or capnomediastinum, 2 esophageal leaks, 1 cardiac arrhythmia, and 2 other). The severities of these adverse events were mild (78.6%), moderate (14.3%), and severe (7.1%). Clinical success was achieved in 90.8% of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1 (P < .001), a median follow-up of 256 days, and interquartile range of 66 to 547.ConclusionAlthough the rate of technical success may be somewhat lower and the rate of adverse events slightly higher than previously reported, our data suggest that POEM in octogenarians is safe and effective, supporting its role as a primary modality for achalasia in this patient population.

Systematic review and meta-analysisClinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis

Background and AimsEndoscopic submucosal dissection (ESD) is an endoscopic resection technique for lesions suspicious of superficial malignancy. It is performed using an ESD knife on its own (standard technique) or by the sequential use of a knife and a snare (hybrid technique). The experience with these techniques is different in Asian and non-Asian countries. We performed a systematic review and meta-analysis of available evidence on colorectal ESD.MethodsElectronic databases were searched up to August 2016 for studies evaluating R0, en bloc resection, and adverse event rates of both techniques for the treatment of colorectal lesions. Proportions were pooled by a random effects model.ResultsNinety-seven studies (71 performed in Asia) evaluated the standard technique and 12 studies (7 in Asia) the hybrid technique. The R0 resection rate of the standard technique was 82.9%, and it was significantly lower in non-Asian versus Asian countries: 71.3% versus 85.6%. The en bloc resection rate was 91% and was significantly lower in non-Asian versus Asian countries (81.2% vs 93%, respectively). Surgery was needed in 1.1% of the ESD-related adverse events, with a significant difference between non-Asian and Asian countries (3.1% vs 0.8%). The R0 and en bloc resection rates with the hybrid technique were significantly lower than those achieved with the standard technique: 60.6% and 68.4%, respectively, with similar adverse event rates.ConclusionsIn non-Asian countries the standard ESD technique is still failing to achieve acceptable levels of performance. The hybrid technique showed low R0 resection rates and should not be considered as an adequate alternative to the standard technique.

Retraction noticeRetraction notice to “Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years: an international multicenter study”: [YMGE 85 (2017) 927-933]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).This article has been retracted due to overlapping/duplicate material.Data from some patients from this study have previously been published in other journals without cross-referencing. Twenty patients overlap with a paper by Kumbhari et al.1 Thirty-five patients overlap with the study by Ngamruengphong et al.2

Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study☆☆☆★

AbstractBackground: Before considering a nonsurgical method of management of a bile duct stenosis, a tissue diagnosis is highly desirable. In a prospective study we have evaluated the feasibility and reliability of endobiliary brush cytology and biopsies performed at the time of endoscopic retrograde cholangiography.Methods: Two hundred thirty-three consecutive patients underwent an attempt at endobiliary brush cytology and biopsies of bile duct stenosis when no mass was detected on ultrasound and CT scan.Results: The material for cytology was sufficient for analysis in 210 cases (90%) and biopsies were obtained in 128 cases (55%). One hundred fifteen patients had both cytology and biopsies (49%). For the diagnosis of malignant stenosis, the sensitivity was 35% for cytology, 43% for biopsies, and 63% for the combination of cytology and biopsies. For both cytology and biopsies, the specificity was 97%. In the cases of cancer primarily involving the bile ducts, the sensitivity was 86% when combining both cytology and biopsies.Conclusions: Endobiliary sampling is technically difficult and has a limited sensitivity for the diagnosis of malignant biliary stenosis. Biopsies should be combined with cytology to increase the sensitivity. (Gastrointest Endosc 1995;42:565-72.)

Biopsies of the ampullary region in patients suspected to have sphincter of Oddi dysfunction☆☆☆★★★♢

AbstractTumors of the ampulla of Vater that develop within the ampulla can go unrecognized during endoscopic examination. Patients with intra-ampullary tumors may present with a clinical picture very similar to that of sphincter of Oddi dysfunction. We wished to determine what percentage of patients initially diagnosed with sphincter of Oddi dysfunction are later found to have an intra-ampullary neoplasm. Sixty-nine consecutive patients were considered to have sphincter of Oddi dysfunction and subsequently were treated with endoscopic sphincterotomy. No gallstones were found in the gallbladder or bile duct. Patients returned for biopsies of the ampulla at least 10 days after the endoscopic sphincterotomy. Three patients (4.3%) were found to have ampullary adenocarcinoma. Thirty-six had normal results of biopsy analysis and 30 had inflammatory or fibrotic changes on biopsy specimens. No objective criteria (clinical, biologic, endoscopic, or radiographic) that would help to distinguish between an ampullary tumor and sphincter of Oddi dysfunction were identified. Biopsies of the ampulla should be performed in all patients suspected of having sphincter of Oddi dysfunction and treated by endoscopic sphincterotomy. (Gastrointest Endosc 1995;42:296-300.)

Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance☆☆☆

AbstractBackground: With a pediatric endoscope, esophagogastroduodenoscopy (EGD) can be performed via a nasal route in adults. To evaluate this new procedure, we conducted a randomized comparative study of the feasibility of diagnostic transnasal EGD and assessed the factors influencing its quality and tolerance (endoscope diameter or route). Methods: Transnasal EGD was attempted in 100 patients to assess its feasibility. For the analysis of quality and tolerance, 150 patients were randomized as follows into 3 groups according to the route of examinations: (1) oral route with 9.8 mm diameter standard videoendoscope; (2) oral route with 6.0 mm diameter pediatric videoendoscope; (3) transnasal route with 6.0 mm diameter pediatric videoendoscope. The operator assessed the quality of examination by standard scores. Patients quantified pain intensity, nausea, and choking sensation. Results: Transnasal EGD was feasible in 82% of patients. The quality of the examination was significantly lower with pediatric endoscope. No difference was noted concerning pain intensity, but nausea and choking sensation were significantly reduced when the nasal route was used. Conclusions: Transnasal EGD is feasible in the routine practice of diagnostic EGD. The nasal route, and not endoscope diameter (6.0 mm vs 9.8 mm diameter), is the determining factor that explains increased patient tolerance during transnasal EGD. Technical improvements in pediatric videoendoscopes are required. (Gastrointest Endosc 1999;49:285-91)

Original articleContribution of magnetic resonance cholangiopancreatography to the management of patients with suspected common bile duct stonesApport de la bili-IRM en première intention en cas de suspicion de lithiase de la voie biliaire principale

SummaryObjectivesTo evaluate the value of magnetic resonance cholangiography (MRC) as a systematic first-line investigation in the management of patients with suspected common bile duct stones.MethodsNinety-nine consecutive patients with clinical suspicion of choledocolithiasis were prospectively explored by MRC. All MRCs were interpreted by two radiologists with knowledge of the patient's clinical condition and laboratory results. In case of discrepancy, a third opinion was obtained to reach consensus. The definitive diagnosis was established on the basis of endoscopic exploration of the common bile duct (n = 40), clinical and biological follow-up at 6 months (n = 55) or other investigations (n = 4). The clinician's level of confidence, management options implemented, and impact of management decisions were used to assess the contribution of MRC. The diagnostic accuracy of MRC for common bile duct stones was also determined.ResultsAt the observed level of confidence (85.9%), MRC identified a differential diagnosis in 7.1% of patients avoiding unnecessary endoscopic exploration in 59.6%. Systematic first-line MRC enabled appropriate management in 83.8% of patients. The sensitivity, specificity, and positive and negative predictive values of MRC for the diagnosis of common bile duct stones were 95.7%, 98.7%, 95.7% and 98.7%, respectively, with excellent inter-observer agreement (kappa = 0.915).ConclusionMagnetic resonance cholangiography can be used to efficiently screen patients who may need further invasive exploration of the common bile duct. It specifically identifies patients requiring therapeutic ERCP.

Digestive EndoscopyTreatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: An international prospective multicentre registry

AbstractBackgroundDuodenal stenting has become a broadly accepted first line of treatment for patients with advanced malignant gastroduodenal obstruction as these patients are difficult to treat and are poor surgical candidates.AimsTo document duodenal stent performance for palliative management of malignant gastroduodenal obstruction.MethodsMulticentre, single arm, prospective registry documenting peroral endoscopic duodenal stenting procedures in 202 patients.ResultsTechnical success achieved in 98% (CI, 95%, 99%) of stent placements. Increase of Gastric Outlet Obstruction Score by at least 1 point compared to baseline was achieved in 91% (CI, 86%, 95%) of patients persisting for a median of 184 days (CI, 109, 266). By day 5 (CI, 4, 6) after stent placement, 50% of patients experienced a score increase of at least 1 point.Improvement from 14% of patients at baseline tolerating soft solids or low residue/normal diet to 84% at 15 days, 86% at 30 days, 81% at 90 days, 79% at 180 days, and 70% at 270 days. Complications included stent ingrowth and/or overgrowth (12.4%), transient periprocedural symptoms (3%), bleeding (3%), stent migration (1.5%), and perforation (0.5%).ConclusionsSafety and effectiveness of duodenal stenting for palliation of malignant gastroduodenal obstruction was confirmed in the largest international prospective series to date.

Digestive EndoscopyA motivational phone call improves participation to screening colonoscopy for those with a positive FIT in a national screening programme (NCT 03276091)

AbstractBackgroundA large proportion of individuals with a positive faecal immunologic test (FIT) will never undergo the recommended colonoscopy despite a full sequence of reminders.AimsThis prospective study aimed to recruit refractory individuals by a motivational personalised phone call given by a screening physician.MethodsWe evaluated the impact of a motivational phone call given by a physician of the screening organisation in order to convince patients with positive FIT to undergo a colonoscopy.Results115 individuals with a positive FIT were targeted. After GP phone call, it was ascertained that 15 had had a colonoscopy, one died, one moved outside the region, and the GP refused the study phone call for 13. Finally, we attempted to call 85 individuals; 24 could not be reached, 5 colonoscopies had been performed, and thus 56 individuals were included. The main reason for colonoscopy refusal (33.9%) was wrong advice from the GP or the gastroenterologist. Among those included, 33.9% (19/56) underwent the colonoscopy within 22.7 months after FIT; 1 invasive cancer, 18 adenomas and 9 serrated sessile lesions were found.ConclusionMotivational phone call performed by a physician from the screening organisation is effective to recruit a third of refractory individuals. Education for GPs and gastroenterologists is necessary to increase participation to colonoscopy and to avoid the performance of an inappropriate secondary FIT. Trial Registration: NCT 03276091.

Original article“First look” unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation

SummaryBackground and aimsWith small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB).Patients and methodsOne hundred and forty-five consecutive patients (mean age, 66 ± 18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as “first look”. Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed.ResultsUnsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant.ConclusionsOur results strongly support that “first look” unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.

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