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La dilatation œsophagienne des stenoses benignes reste une technique simple, efficace et sure. Elle permet le plus souvent d’eviter la chirurgie notamment chez le sujet âge, eventuellement au prix de dilatation espacees (1 an en moyenne).

La CPA est un traitement symptomatique efficace des cancers du rectum, avec un faible taux de complications. Elle semble particulierement utile chez les patients en cours de RT +/− CT preoperatoire chez lesquels elle permet d'eviter les occlusions et de diminuer considerablement le syndrome rectal.

En cas de complication de la CSCC ou de LR, la CPRE est un moyen efficace de diagnostic et de traitement. En presence d’un ictere, de douleurs biliaires ou d’anomalies du bilan hepatique, la CPRE peut donc etre pratiquee de premiere intention, sans necessite d’examens d’imagerie prealables et sans tentative de traitement chirurgical.

Ces resultats preliminaires suggerent que la CPA est un traitement efficace des rectites radiques tant du point de vue endoscopique que clinique. L’efficacite est obtenue rapidement avec une diminution majeure des symptomes cliniques et endoscopiques des la premiere seance. Les effets secondaires semblent pouvoir etre limites, dans cette indication, par l’utilisation d’une faible puissance de tir.

La CPA est un traitement symptomatique efficace des dysphagies d'origine neoplasique, avec un faible taux de complications. Elle semble particulierement utile chez les patients en cours de RT+CT. En situation purement palliative, elle permet souvent la reprise d'une alimentation solide.

Cette etude a pour but de verifier si le maintien prolonge d'une sonde naso-gastrique chez les malades de reanimation peut favoriser le developpement d'une œsophagite peptique. 21 malades ont eu une fibroscopie a leur entree en reanimation et entre le 15e et le 30e jour. L'œsophagite apparait tres frequente des le debut de la maladie et seul un malade n'a pas presente de lesion inflammatoire au cours de l'evolution. La biopsie œsophagienne systematique permet d'ameliorer la rentabilite diagnostique de l'endoscopie. Cette grande frequence semble etre en liaison avec la diminution de la tonicite du sphincter inferieur de l'œsophage.

Seven cases of acute cholecystitis (4 women and 3 men, mean age 73 years) were observed in a series of 192 patients treated by endoprosthesis for cancerous obstruction of the bile ducts between october, 1984 and october, 1986. The suspected clinical diagnosis was confirmed by ultrasonography. Cholecystostomy was performed by percutaneous puncture under ultrasonic guidance. A catheter was positioned in the gallbladder by the Seldinger technique in 3 cases and by the trocar technique in 4 cases. Pain in the right hypochondrium was relieved in all patients immediately after emptying of the gallbladder. Five patients were cured. One patient developed purulent peritonitis which was treated by surgery. A female patient died of her pancreatic cancer 3 days after cholecystostomy. Provided a number of precautions are taken to prevent leakage of the infected bile into the peritoneal cavity, percutaneous cholecystostomy is the treatment of choice for acute cholecystitis consecutive to biliary endoprosthesis.

Twenty-one patients whose condition required mechanical ventilation with nasogastric intubation were investigated for oesophagitis before the 3rd day and on the 15th day of treatment, including endoscopy and biopsy. Lesions of oesophagitis were detected in 14 cases during the initial examination and in 19 cases on the second endoscopy. The course of the lesions varied from one patient to another and appeared to be unrelated to the course of the primary disease. Oesophagitis in these patients is probably due to frequent episodes of gastro-oesophageal reflux encouraged by cough, impaired consciousness and the presence of a tube. Reflux may also be the cause of inapparent and recurrent lung aspiration.

From October 1983 to October 1985, 53 patients with malignant biliary obstruction were referred to our institution for a transhepatic biliary stent. One or two endoprostheses were inserted in 46 patients (87 p. 100). Stent insertion was usually performed in two sessions, after two or three days of external drainage. There were 23 men and 23 women. Their mean age was 70.6 years +/- 12 years (m +/- DS). Fourty-two patients (91 p. 100) were referred after failure of an endoscopic or surgical drainage procedure; fourty-four p. 100 of the patients had stage II or III high periportal obstruction. Five cases of severe early complications (11 p. 100) and 8 delayed complications requiring in-hospital treatment (17 p. 100) were observed. Among the latter, 7 were due to plugging of the endoprosthesis. All patients were unfit for surgery either because at a high operative risk or because of the extent of the cancer. Our results showed that percutaneous biliary drainage can be achieved in a high percentage of cases following failure of a surgical or endoscopic drainage procedure. The endoscopic transpapillary approach, which allows the insertion of 12 French endoprostheses in one session should be tried first. Percutaneous biliary drainage should be performed as a complementary procedure when endoscopic drainage has failed or in stage II or III high periportal obstruction associated with persistent jaundice or cholangitis.

A 94-year old woman presented with gallstone formation above a stenotic choledoco-duodenal anastomosis, responsible for episodes of cholangitis. After percutaneous biliary tract drainage, the anastomosis was dilated with an angioplasty catheter. As several stones persisted despite washing out, percutaneous cholangioscopy was performed. To introduce a small fibroscope into the biliary canals, transhepatic dilation up to 28 F was necessary. The last stones were pushed into the duodenum with the endoscope. Freedom of the biliary tract and patency of the anastomosis were ascertained.

In order to evaluate the responsibility of pancreas divisum in the occurrence of pancreatitis, we studied retrospectively 1,808 endoscopic retrograde pancreatograms. Eighty-seven pancreas divisum (4.8 p. 100) were found in 50 males and 37 females, mean age 53.3 +/- 16.8 yrs. Acute pancreatitis was significantly more frequent (p less than 0.001) in this group (19.6 p. 100) than in the patients with fused pancreas (4.3 p. 100). The difference was also significant (p less than 0.01) for idiopathic recurrent acute pancreatitis. Histologic lesions in the dorsal pancreas were in favor of a retentional mechanism of pancreatitis. Sphincterotomy of the accessory papilla, proposed to improve the drainage of the dorsal pancreas, was performed in 11 patients (10 endoscopic, 1 surgical). This treatment, repeated in case of secondary stenosis of the accessory papilla, was successful in 5 out of 8 patients with acute pancreatitis followed up from 12 to 30 months. After reviewing the literature, secondary stenosis of accessory papilla was found significantly less frequently (p less than 0.05) after surgical sphincterotomy or sphincteroplasty (4 out of 46, 8.6 p. 100) than after endoscopic sphincterotomy (6 out of 22, 27.2 p. 100). Treatment, preferentially surgical, should be proposed only to patients with idiopathic recurrent pancreatitis before constitution of chronic non reversible pancreatitis.

International audience; Extracorporeal lithotripsy was performed in 5 patients whose stones in the main bile duct could not be extracted despite wide endoscopic sphincterotomy, conventional extraction techniques (basket and balloon catheter) and attempts at mechanical lithotripsy. Fragmentation of the stones was obtained in one session in 4 patients. The fragments were spontaneously expelled in 2 patients, while additional endoscopic manoeuvres (mechanical lithotripsy, extraction after installation of a temporary prosthesis) were necessary in the other 2 patients. Failure in the 5th patient was due to the impossibility to focus the point of convergence of the shock wave on the stones. No complication related to the technique was observed.