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Background and study aim Studies on endoscopic mucosal resection (EMR) are mostly based on data from centers with high expertise. We report the average EMR results in a national survey of consecutive patients in France. Methods A 1-year survey was carried out to record immediate outcome data of all EMRs performed, regardless of lesion size or gastrointestinal location. Results Overall, 1335 EMRs in 1210 patients were reported by 241 of the 736 gastroenterologists who performed such procedures (33 %). Resections were done for upper gastrointestinal lesions in 125 cases (41 esophageal, 43 gastric, and 41 duodenal lesions), in 45 % of cases using specific EMR techniques such as ligation, cap, or traction. The technique for resecting the 1210 lower gastrointestinal lesions mostly consisted of saline-assisted polypectomy or EMR, with specific techniques used in only 2.2 %. En bloc resection was less common with esophageal (46 %) or duodenal (54 %) neoplasms than in the lower gastrointestinal tract (73 %); size also had some influence (53 % > 1 cm vs. 92 % ≤ 1 cm). The overall complication rate was 5.2 %; the rate was lower for lesions 1 cm or smaller (0.6 % vs. 4.6 %). Fifty-four early and 17 delayed complications were recorded, in 12 % of upper gastrointestinal and 4.6 % of colonic lesions. Surgery became necessary in 1.6 % for upper and 2.9 % for lower gastrointestinal neoplasms. No association was seen between physician EMR caseload and either en bloc resection rate or complication rate. Conclusions EMR in general, especially saline-assisted polypectomy in the colon, appears to be reasonably safe even when performed by nonexperts. EMR for larger or for upper gastrointestinal lesions should probably be limited to high-volume centers.

L’organisation d’une unite d’endoscopie digestive du futur n’est pas une vision futuriste. C’est une vision pragmatique basee sur des centres d’endoscopies autonomes, c’est-a-dire hors bloc operatoire, fonctionnant en autarcie, capables d’accueillir et de suivre le patient du debut a la fin, capables de realiser n’importe quel geste d’endoscopie a visee diagnostique ou therapeutique.

Il s’agit d’un patient de 57 ans, chez qui a ete decouverte une masse corporeocaudale du pancreas de 97 × 96 mm associee a des lesions secondaires hepatiques et renales, lors du bilan de douleurs abdominales avec alteration de l’etat general. L’echoendoscopie avec cytoponction de la masse retrouve des lesions carcinomateuses. La ponction–biopsie hepatique confirme la localisation hepatique d’un adenocarcinome dont l’aspect histologique et immunohistochimique est en faveur d’une origine primitive excretopancreatique. Cliniquement, le patient etait OMS 1. Il n’y avait pas de fievre ni d’ictere au moment du diagnostic. Un traitement par chimiotherapie a base de folfirinox a ete debute et le patient recoit un total de sept cures en quatre mois. Au moment de sa huitieme cure, le patient fut hospitalise pour fievre avec ictere evoluant depuis 48 heures. Le bilan biologique montrait un syndrome inflammatoire avec une augmentation des transaminases (ASAT 3 × N, ALAT 5 × N) et une elevation majeure des enzymes cholestatiques (phosphatases alcalines 15 × N, gammaglutamyltransferase 50 × N et bilirubine totale 3 × N). La scannographie montre une dilatation des voies biliaires intraet extrahepatiques secondaire a une tumeur pancreatique envahissant la tete du pancreas, avec une voie biliaire principale mesuree a 14 mm, et une majoration en taille des metastases hepatiques et renales (Fig. 1). Une antibiotherapie a base de C3G et metronidazole a ete debutee, et un catheterisme retrograde des voies biliaires a ete realise en urgence pour lever l’obstruction (Figs. 2–5).

Elle n’est pas parfaite et n’entraine pas de protection a 100 % (cancer d’intervalle, risque de complication, examen invasif). Les cancers d’intervalle ont une incidence de 3 a 7 % [2,3]. Les causes de ces cancers d’intervalle sont les polypes ou cancers loupes lors d’une coloscopie incomplete, avec des lesions non vues ou non reconnues, des resections incompletes, un intervalle de surveillance inapproprie ou une sequence polype cancer acceleree (patient a tres haut risque de cancer colorectal).

l’estomac car,en 1 heure,des degâts muqueux peuventapparaitre;en 2 a 4 heures,des degâts musculaires;en8 a 12 heures,une perforation. Leur extraction est simi-laire a celle des objets ronds mais peut,plus rarement,etre realisee de facon electromagnetique. Une fois dansl’estomac,les piles s’eliminent le plus souvent spontane-ment [4-6].

Le traitement pr6ventif des ldsions n6oplasiques coliques dans la PAF est la colectomie avec r6tablissement de la continuit6 selon 2 modalit6s : anastomose il6o-anale (AIA) ou anastomose il6o-rectale. Le risque de cancer persiste pour le tractus digestif restant. L'endoscopie est l'une des modalit6s de recherche de ces ldsions et elle permet 6galement parfois leur traitement. De fa~on g6n6rale, toute difficult6 darts la mise en oeuvre de la proc6dure endoscopique ou darts l'interprdtation du r6sultat histologique doit conduire fi demander un avis aupres d'dquipes expdrimentdes.

La pratique d’une endoscopie digestive de qualite necessite un plateau technique. Ce plateau est adapte au volume d’actes et au nombre des praticiens. Cette description est basee sur la reflexion du comite d’evaluation technologique de la Societe Francaise d’Endoscopie Digestive et peut etre utilisee pour l’installation ou la modernisation d’un plateau technique.

Background and study aims Endoscopic biliary stenting is now a well-established treatment method in patients with unresectable malignant biliary obstruction. Despite advances with metal stents, the problem of stent occlusion has not yet been resolved. Covered metal stents could reduce the occlusion rate by preventing tumor ingrowth, but have not been well evaluated. A prospective multicenter study was therefore conducted to evaluate the efficacy and disadvantages of covered Wallstents. Patients and methods Covered Wallstents were implanted endoscopically in 62 patients with inoperable distal malignant biliary obstruction. Complications, stent patency, and patient survival were analyzed. Results Stent insertion was achieved in 61 of the 62 patients (98.4 %). Procedure-related complications were observed in four patients, consisting of minor pancreatitis (n = 2) and abdominal pain due to stent expansion (n = 2). There was no procedure-related mortality. Seven patients died too early for proper assessment, so that a total of 54 patients were ultimately evaluated. Stent dysfunction occurred in 17 of the 54 patients (31.5 %). The reasons for dysfunction were proximal tumor overgrowth (n = 5), migration (n = 3), lithiasis or food impaction (n = 3), cholangitis without the need for a repeat biliary intervention (n = 5), and unknown (n = 1). The median period of stent patency was 142 days. No tumor ingrowth was observed. Acute cholecystitis was diagnosed in five patients (10 %) and was responsible for one death. Three stents were successfully removed. Conclusions Covered biliary metal stents are effective for the drainage of distal malignant biliary obstruction, with a dysfunction rate apparently similar to that of uncovered stents. However, the risk of acute cholecystitis appears to be a major concern with this type of stent in patients with gallbladder in situ. Further comparative studies are needed.

BACKGROUND AND STUDY AIMS This study was designed to prospectively compare the diagnostic yield of the M2A endoscopic capsule with that of video push-enteroscopy in exploring the small intestine in patients with obscure digestive bleeding. PATIENTS AND METHODS Patients with either occult or overt obscure digestive bleeding and a negative endoscopic work-up underwent a double intestinal investigation, with video push-enteroscopy and a wireless capsule, performed blindly by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions, i. e. those having the potential for bleeding. RESULTS 60 patients (27 men, 33 women; age 58 +/- 18 years; hemoglobin 9.4 +/- 2.5 g/dl) were included, 32 with occult and 28 with overt bleeding. Results were analyzed for 58 patients, who completed both examinations. Lesions were detected in 43 patients: with both techniques in 19, only by capsule in 21, and, conversely, only by push-enteroscopy in 3 ( P = 0.04). Final diagnoses were as follows: a P2 lesion with high bleeding potential in 28 patients (19 angiomata, 6 ulcerations, 2 tumors, 1 case of intestinal varices); a P1 lesion with intermediate bleeding potential in 15 patients (2 patients with mucosal erosions, 13 patients with mucosal red spots); and there were normal findings from 15 procedures. No procedure induced any complication. CONCLUSION The use of the wireless endoscopy capsule detects significantly more clinically relevant intestinal lesions than video push-enteroscopy in patients with obscure digestive bleeding, raising the diagnostic yield to 67.2 %. Its influence on the clinical outcome for patients needs further investigation.