EUS-guided transenteric pancreatic duct drainage Giovannini, M.
Baillière's best practice & research. Clinical gastroenterology,
September-December 2022, 2022 Sep-Dec, 2022-09-00, 20220901, Letnik:
60-61
Journal Article
Recenzirano
Endoscopic drainage requires transpapillary access to the pancreatic duct during ERCP. When ERCP failed, EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous technique offers an alternative ...to surgery. Although data has demonstrated that the procedure can be safe and effective, EUS-guided PD drainage remains one of the most technically challenging therapeutic EUS interventions, as evidenced by the multiple considerations on device selection and the risk of severe complications.
Résumé: L’échoendoscopie est une exploration digestive qui combine l’endoscopie à l’échographie. L’approche directe de l’organe à étudier par une sonde à ultrasons permet d’obtenir des informations ...qui ne peuvent être apportées par d’autres explorations comme le scanner ou l’IRM. L’échoendoscopie est l’examen le plus performant pour étudier les voies biliaires et le pancréas. Dans certains cas, elle permet de réaliser des biopsies guidées permettant ainsi d’augmenter la spécificité de l’image échoendoscopique. L’introduction d’échoendoscopes thérapeutiques a permis de développer des techniques d’échoendoscopie interventionnelle comme le drainage de collections pancréatiques, la réalisation d’anastomose entre les voies biliaires ou le canal pancréatique et l’estomac, permettant ainsi d’offrir une alternative à une chirurgie (souvent palliative) lorsque les techniques d’endoscopies standard (CPRE) avaient échoué.
Abstract: Endoscopic ultrasonography is a technique used for examining the digestive tract that combines endoscopy with ultrasonography. The ultrasound tube can get very close to the organ examined, providing information that cannot be accessed using other techniques, such as a CT or MRI scan. Endoscopic ultrasonography is the best technique for examining bile ducts and pancreas. In some cases it is also possible to carry out guided biopsies, thus increasing the precision of the image obtained. The introduction of echoendoscopes has led to their being used to carry out interventions, such as draining the pancreas, bile duct anastomosis and pancreatoenteric anastomosis, thus offering an alternative to surgery (often palliative) where standard endoscopy techniques have failed.
Résumé: Le développement de l’endoscopie thérapeutique représente actuellement une alternative à une nouvelle intervention chirurgicale en cas de complication après une chirurgie hépato-biliaire, ...pancréatique, oeso-gastrique ou recto-colique. Les complications post-opératoires les plus fréquentes sont les sténoses anastomotiques, le lâchage de sutures digestives ou bilio-digestives, les plaies biliaires et les collections abdomino-pelviennes. Nous allons voir successivement la place et les résultats du traitement endoscopiques pour: les sténoses des voies biliaires après chirurgie hépatobiliaireles plaies et fistules des voies biliairesles sténoses et fistules des anastomoses oeso-gastriques ou oeso-jéjunalesles collections et abcès abdomino-pelviens.
Abstract: The development of therapeutic endoscopy currently represents an alternative to further surgical intervention in the event of complication after hepatobiliary, pancreatic, gastrooesophageal and colorectal surgery. The most frequent post-operatory complications are anastomotic stenoses, the release of digestive or biliodigestive sutures, biliary lesions and abdominal-pelvic collections. We will successively look at the role and results of endoscopic treatment for: bile duct stenoses following hepatobiliary surgerybile duct stenoses and fistulasstenoses and fistulas of gastro-oesophageal or jejuno-oesophageal anastomosesabdominopelvic collections and abscesses.
This article is the second of a two-part publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, ...including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. The first part (the Clinical Guideline) focused on the results obtained with EUS-guided sampling, and the role of this technique in patient management, and made recommendations on circumstances that warrant its use. The current Technical Guideline discusses issues related to learning, techniques, and complications of EUS-guided sampling, and to processing of specimens. Technical issues related to maximizing the diagnostic yield (e.g., rapid on-site cytopathological evaluation, needle diameter, microcore isolation for histopathological examination, and adequate number of needle passes) are discussed and recommendations are made for various settings, including solid and cystic pancreatic lesions, submucosal tumors, and lymph nodes. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling. A two-page executive summary of evidence statements and recommendations is provided.
Calcifying pseudoneoplasm of the neuroaxis (CAPNON) is a rare, slow growing, and generally benign fibro osseous mass that can emerge throughout the entire central nervous system (CNS). When ...diagnosed, prompt surgical treatment can determine a good neurological outcome and possibly curative resolution. The objective of the present work is to present a step by step technical report with its video. We present a 37 year old female presented with occipital headache and cervical pain associated with dysphagia, nausea, and gait disturbances. Computed tomography (CT) scan showed a focal calcified lesion on the floor of the IV ventricle projecting toward the vermis with associated supratentorial hydrocephalus and transependymal edema. The telovelar approach was chosen for the procedure. The outcome was favorable, with no complications. Postoperative CT was performed, which revealed no residual lesion. A step by step report of a IV ventricle CAPNON that manifested with hydrocephalus is described.
Chemotherapy is the only systemic treatment approved for pancreatic ductal adenocarcinoma (PDAC), with a selection of regimens based on patients' performance status and expected efficacy. The ...establishment of a potent stratification associated with chemotherapeutic efficacy could potentially improve prognosis by tailoring treatments.
Concomitant chemosensitivity and genome-wide RNA profiles were carried out on preclinical models (primary cell cultures and patient-derived xenografts) derived from patients with PDAC included in the PaCaOmics program (NCT01692873). The RNA-based stratification was tested in a monocentric cohort and validated in a multicentric cohort, both retrospectively collected from resected PDAC samples (67 and 368 patients, respectively). Forty-three (65%) and 203 (55%) patients received adjuvant gemcitabine in the monocentric and the multicentric cohorts, respectively. The relationships between predicted gemcitabine sensitivity and patients' overall survival (OS) and disease-free survival were investigated.
The GemPred RNA signature was derived from preclinical models, defining gemcitabine sensitive PDAC as GemPred+. Among the patients who received gemcitabine in the test and validation cohorts, the GemPred+ patients had a higher OS than GemPred− (P = 0.046 and P = 0.00216). In both cohorts, the GemPred stratification was not associated with OS among patients who did not receive gemcitabine. Among gemcitabine-treated patients, GemPred+ patients had significantly higher OS than the GemPred−: 91.3 months 95% confidence interval (CI): 61.2-not reached versus 33 months (95% CI: 24-35.2); hazard ratio 0.403 (95% CI: 0.221-0.735, P = 0.00216). The interaction test for gemcitabine and GemPred+ stratification was significant (P = 0.0245). Multivariate analysis in the gemcitabine-treated population retained an independent predictive value.
The RNA-based GemPred stratification predicts the benefit of adjuvant gemcitabine in PDAC patients.
•An RNA signature of gemcitabine-sensitivity is developed from in vitro and in vivo models of pancreatic cancer.•The resulting GemPred signature identifies a subgroup of patients who are sensitive to adjuvant gemcitabine.•The predictive value of GemPred is validated in two cohorts on both OS and disease-free survival.
This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling in ...gastroenterology, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB), of submucosal tumors, diffuse esophageal/gastric wall thickening, pancreatic solid masses and cystic-appearing lesions, mediastinal lesions unrelated to lung or esophageal cancer, cancer of the esophagus, stomach, and rectum, lymph nodes of unknown origin, adrenal gland masses, and focal liver lesions. False-positive cytopathological results and needle tract seeding are also discussed. The present Clinical Guideline describes the results of EUS-guided sampling in the different clinical settings, considers the role of this technique in patient management, and makes recommendations on circumstances that warrant its use. A two-page executive summary of evidence statements and recommendations is provided. A separate Technical Guideline describes the general technique of EUS-guided sampling, particular techniques to maximize the diagnostic yield depending on the nature of the target lesion, and sample processing. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling.
The objective of this study was to quantify human milk supply and intake of breastfed infants up to age 12 months. In addition, human milk composition was quantified per energetic macronutrient and ...fatty-acid composition in a subsample of lactating mothers.
One hundred and seventy-four Italian breastfed children were followed using test-weighing and 3-day food protocols from birth to age 12 months. From a subsample of 30 mothers breast milk samples were collected at child ages one (T1), two (T2), three (T3) and six (T6) months, and were analyzed for the amount of protein, digestible carbohydrates, total lipids and fatty-acid composition.
One hundred and forty-two (82%) filled in at least one 3-day food protocol within the first 12 months of life and complied with test-weighing of all milk feeds. The number of valid food protocols declined from 126 infants at 1 month to 77 at 12 months of age. Only galactose, non-protein nitrogen and protein decreased significantly from age 1 to age 6 months of lactation. Maternal body mass index and age affected fatty-acid levels in human milk. Median human milk intake decreased from 625 ml at T1, over 724 ml at T3 to 477 ml/day at T6. Average energy and %energy from protein intake per day increased from 419 kcal (s.d. 99) and 8.4% (1.0) at T1, respectively, to 860 kcal (145) and 16.1% (2.6) at T12.
These data provide a reference range of nutrient intakes in breastfed infants and may provide guidance for defining optimal nutrient intakes for infants that cannot be fully breastfed.
Résumé
L’adénocarcinome pancréatique est une tumeur de très mauvais pronostic, pour laquelle la résection histologiquement complète reste le traitement curatif de référence. Le compte rendu ...anatomopathologique permet de préciser le diagnostic et de donner des informations sur le pronostic de la maladie. En 2015, à l’heure de l’assurance qualité et de l’uniformisation des pratiques, il se doit d’être concis et si possible standardisé pour être au maximum exhaustif. Cet article propose de revenir sur l’approche anatomopathologique du diagnostic de l’adénocarcinome pancréatique et de préciser les items nécessaires devant figurer dans le compte rendu.
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