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Background and study aims Large scale data on esophagogastroduodenoscopy (EGD) in Western countries are scarce. We conducted a prospective study on the diagnostic yield of upper gastrointestinal endoscopy in France. Patients and methods An online questionnaire was sent to all French gastroenterologists practicing endoscopy. Data from EGDs performed during one week were collected. A statistical extrapolation of the results to a whole year was performed. Results 342 gastrointestinal endoscopists, representative of the population of French gastroenterologists, provided data on 2735 EGDs, corresponding to 1 006 316 (95%CI = 937 080−1 075 552) procedures for the entire year. 1770 (64.7%) EGDs were performed under sedation or general anesthesia, and 930 (34%) were associated with a colonoscopy. 896 (32.8%) EGDs were normal. Hiatal hernia and esophagitis were the most frequent esophageal diagnoses, in 496 (18.1%) and 374 (13.7%) cases, respectively. Barrett’s esophagus was diagnosed in 109 (4%) patients. Among gastric lesions, endoscopic gastritis was reported in 572 (20.9%) patients; ulcer, polyps, and suspected malignancy in 78 (2.9%), 62 (2.3%), and 19 (0.7%), respectively. 1597 (58.4%) EGDs included mucosal biopsies, and 141 (5.1%) were associated with a therapeutic procedure. Conclusions We report nationwide prospective data on upper gastrointestinal endoscopy practice in France. Our data suggest that about 300 000 normal EGDs each year in France could potentially be avoided by a diagnostic strategy relying on upper GI capsule endoscopy, providing significant relief on healthcare practitioners.

Patient acceptability of the preparation is a key factor in the success of colonoscopy, yet standard polyethylene glycol solutions are poorly tolerated owing to their high volume (4L) and low palatability. This study compared the efficacy, safety and acceptability of a 2L polyethylene glycol+ascorbate solution with a standard 4-L polyethylene glycol solution.Adults referred for colonoscopy were randomised to 2-L polyethylene glycol+ascorbate (n=202) or 4-L polyethylene glycol solution (n=198). Colon cleansing success was assessed using the Harefield Cleansing Scale(©) and the Aronchick scale. Safety and acceptability were also assessed.Successful cleansing was achieved in 94.1% and 90.9% of subjects with the 2-L and 4-L solutions respectively using the Harefield Cleansing Scale(©) and 94.6% and 90.0% using the Aronchick scale (non significant). Despite better acceptability and tolerability, no superiority over the standard 4-L preparation was demonstrated. Fewer treatment-related adverse events were reported with the 2-L solution (80.2% versus 89.9%, p=0.011). More subjects were willing to take the 2L PEG+ascorbate solution again (87% versus 51%, p0.001), found it easier to drink (80% versus 70%, p=0.025), with a better taste (p=0.01).Two-litre polyethylene glycol+ascorbate solution, with a similar high degree of cleansing and superior acceptability and tolerability, presents an alternative to 4-L polyethylene glycol when compliance is an issue.

Background & Aims Little is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn's disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn's perianal disease followed up in the Cancers Et Surrisque Associe aux Maladies Inflammatoires Intestinales En France (CESAME) cohort. Methods We collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn's disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex. Results Among the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn's lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn's disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03). Conclusions In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer.

One side effect of the immunomodulatory effect of interferon is the possible triggering or exacerbation of systemic or cutaneous sarcoidosis. We report two new cases and offer an exhaustive review of the literature. A 39-year-old man with type C chronic active hepatitis developed new respiratory symptoms and pulmonary infiltrates with hilar and mediastinal adenopathy after 7 months of treatment with pegylated interferon. The evolution was favourable after stopping treatment. The second patient developed cutaneous lesions after 6 months of treatment. Resolution occurred after the discontinuation of the treatment. In these two cases ribavirin was stopped before the first signs of sarcoidosis.

In 19 patients, extraction of bile duct stones through the papilla using a Dormia basket or a mechanical lithotripter was not possible following endoscopic sphincterotomy. After the insertion of a nasobiliary drain, extracorporeal lithotripsy was performed with intravenous sedation using an ultrasonographic stone localization system. The number and location of stones were first determined by retrograde cholangiography. At the time of lithotripsy, saline was injected in the bile ducts to modify the acoustic impedance of tissues surrounding the stones, and subsequent ultrasonography was effective in localizing all stones present in 4 of 5 (80%) patients with intrahepatic stones, and 13 of 14 (93%) with common bile duct stones. In 10 patients (53%), fragmentation was satisfactory and the bile ducts were cleared completely. The mean single stone diameter was significantly smaller in successful cases of fragmentation compared with failures (22.8 ± 6.6 mm vs. 40 ± 10 mm). The results in patients with multiple stones were significantly worse than those in patients with single stones of similar size (25% vs. 100% successful fragmentation). Reasons for this difference in results included the small size of the focal area and the reduced ability of ultrasonography (1) to adequately visualize multiple calculi individually and (2) to assess the degree of stone destruction. Care was taken to first await the resolution of infection or the correction of coagulation abnormalities when present; no morbidity following extracorporeal lithotripsy was observed. Despite its 3-step approach (endoscopic sphincterotomy, lithotripsy, and endoscopic extraction), the need for only intravenous sedation and the absence of patient immersion in water render this technique attractive for elderly and frail patients.

Introduction La qualite de la preparation colique reste l’element essentiel pour la detection et la resection des polypes. Le but de ce travail etait d’evaluer a l’aide d’enregistrements systematiques des coloscopies, les facteurs influencant la qualite de la preparation colique et ses modalites d’examen, independamment du type de produit utilise. Materiels et methodes Cette enquete prospective a ete realisee par des gastro-enterologues endoscopistes seniors. L’analyse statistique descriptive etait faite sans tenir compte du produit utilise pour la preparation. La recherche de l’influence de facteurs a ete faite en analyse univariee en utilisant le Chi2 ou le test exact de Fisher. La qualite de la preparation etait evaluee d’une part par le remplissage d’une grille : « de tres mauvaise a excellente » (de 1 a 5), par l’endoscopiste et d’autre part, par l’analyse des enregistrements visualises par des relecteurs. Resultats 1 019 coloscopies ont ete enregistrees. L’âge de realisation des coloscopies etait de 14 a 91 ans. Les coloscopies etaient realisees en ambulatoire dans 97 % des cas. Un regime sans residus etait prescrit dans 79 % des cas le plus souvent pendant 3 jours (94 %). Il influencait de maniere significative (p Conclusion La qualite de la preparation colique semblait meilleure lorsque les examens etaient pratiques l’apres-midi (role de la derniere prise dans les heures precedant la coloscopie). La prescription d’un regime sans residus ameliore significativement la preparation. Les coloscopies etaient considerees a refaire dans 6 % des cas. Le temps de descente est respecte seulement dans 60 % des actes. La variabilite inter-observateur confirme que l’enregistrement systematique de la coloscopie est necessaire, afin d’ameliorer les pratiques cliniques et de realiser des actes en accord avec les recommandations de la SFED.

Introduction De recentes etudes et revues de la litterature ont mis en avant l’importance, pour les gastroenterologues, de selectionner une preparation colique adaptee a leurs patients a risque. Materiels et Methodes Une etude randomisee, multicentrique, en simple aveugle a ete conduite afin de comparer l’efficacite, la securite d’emploi et l’acceptabilite de 2L de macrogol + electrolytes + ascorbate (MEA) versus 4L de macrogol + electrolytes (ME). Les patients en ambulatoire, âges de 18 a 85 ans, etaient tires au sort pour boire 2L de MEA (n = 210) ou 4L de ME (n = 205) la veille au soir de la coloscopie. Une prise complementaire de liquide clair etait autorisee. Le sous-groupe des patients a risque comprenait : les patients âges (65-85 ans), les insuffisants renaux (clairance de la creatinine ≤ 80 mL/min) et les patients ayant des antecedents de pathologie cardiovasculaire. Resultats 415 patients en ambulatoire etaient randomises dans le groupe MEA ou le groupe ME. 91 sujets etaient âges de 65 a 85 ans (41 avec MEA, 50 avec ME), 133 sujets avaient des antecedents de pathologie cardiovasculaire (66 sous MEA, 67 sous ME), 135 sujets (69 avec MEA et 66 avec ME) avaient une insuffisance renale (IR) legere (clairance de la creatinine comprise entre 50 et 80 mL/min) et 18 sujets (13 avec MEA, 5 avec ME) une IR moderee a severe (clairance de la creatinine ≤ 50 mL/min). Le succes du lavage colique, dans ces sous groupes, etait similaire pour MEA et ME. La tolerance globale (evaluee par les sujets sur une echelle visuelle analogique) etait significativement meilleure avec MEA chez les patients avec des antecedents cardiovasculaires et chez les insuffisants renaux (IR legere). Les effets indesirables (EI) relies au traitement etaient comparables dans les differents sous-groupes quelle que soit la preparation. Aucun EI serieux ou pouvant conduire a l’arret du traitement n’etait observe. Davantage de sujets dans les sous groupes de patients âges, cardiovasculaires et insuffisants renaux (IR legere) souhaitaient reprendre le MEA pour une nouvelle coloscopie. Conclusion MEA etait bien tolere chez les patients âges, les sujets ayant des antecedents de pathologie cardiovasculaire et les insuffisants renaux. Aucun de ces facteurs de risque n’a influence l’efficacite de la preparation. Cette analyse en sous groupe confirme que la preparation par MEA est bien adaptee pour une utilisation chez les patients a risque.

Self Expending Metallic Stents (SEMS) with Antireflux Valve for Distal Esophageal Carcinoma: Results of a Randomized Trial Marc Le Rhun, Emmanuel Ben Soussan, Emmanuel Coron, Anne Le Sidaner, Thierry Barrioz, Dimitri Coumaros, Jean-Michel Nguyen, Bertrand Vedrenne, Philippe Bichard, Christian Boustiere, Frederic Prat D’Endoscopie Digestive Societe Francaise Aims: SEMS are commonly used in the palliation of dysphagia in patients with inoperable esophageal carcinoma. However they predispose to gastroesophageal reflux when deployed across the gastroesophageal junction. The aims of this study were 1) to assess the influence of the antireflux valve on trans-prothetic reflux (primary outcome) and 2) to compare the results of SEMS with and without antireflux valve in terms of reflux symptoms, quality of life (QOL), improvement of dysphagia and complications (secondary outcomes). Patients and Methods: Thirty eight patients (age 71 G 12 years ; sex ratio 5) with malignant strictures of the distal esophagus or gastric cardia (53% adenocarcinomas) were enrolled in 9 centers. Carcinomas were locally advanced (47%) or generalized. After randomization, patients received either a covered SEMS without antireflux valve (CHOOSTENT , Life Europe) associated to standard PPI therapy and postural advice (n Z 19) or a similar type of SEMS including an antireflux device (DOSTENT , Life Europe) (n Z 19). Trans-prosthetic reflux was assessed at day 2 using a radiological score based on barium esophagography performed after Trendelenburg maneuver and graded from 0 (no reflux) to 12 (maximum). Monthly telephone interviews were conducted for: a) OMS scoring from 0 (excellent) to 5 (poor) b) QOL assessment (based on the Reflux-Qual Simplifie scoring system) from 0 (poor) to 100 (excellent) c) dysphagia scoring from 0 (no dysphagia) to 5 (complete dysphagia) and d) regurgitation scoring from 0 (no regurgitation) to 16 (maximum). Results :No difference was noted in terms of age, sex, size of lesion, prosthesis length (12 G 2.5 cm) and need for dilation (30%) prior to SEMS placement. No difficulty to place SEMS nor complication were noted. QOL and dysphagia were improved in both groups. Mean survival was similar in both groups (180 days). Results according to the type of SEMS were as follows: (table 1) Conclusions: These two types of SEMS are equally effective on the palliation of dysphagia and improvement of QOL. However, SEMS with antireflux valve are more efficient to prevent trans-prosthetic gastroesophageal reflux but at the cost of an increased likehood of migrations.