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PRSS1 and PRSS2 constitute the only functional copies of a tandemly-arranged five-trypsinogen-gene cluster (i.e., PRSS1, PRSS3P1, PRSS3P2, TRY7 and PRSS2) on chromosome 7q35. Variants in PRSS1 and PRSS2, including missense and copy number variants (CNVs), have been reported to predispose to or protect against chronic pancreatitis (CP). We wondered whether a common trypsinogen pseudogene deletion CNV (that removes two of the three trypsinogen pseudogenes, PRSS3P2 and TRY7) might be associated with CP causation/predisposition.We analyzed the common PRSS3P2 and TRY7 deletion CNV in a total of 1536 CP patients and 3506 controls from France, Germany, India and Japan by means of quantitative fluorescent multiplex polymerase chain reaction.We demonstrated that the deletion CNV variant was associated with a protective effect against CP in the French, German and Japanese cohorts whilst a trend toward the same association was noted in the Indian cohort. Meta-analysis under a dominant model yielded a pooled odds ratio (OR) of 0.68 (95% confidence interval (CI) 0.52-0.89; p = 0.005) whereas an allele-based meta-analysis yielded a pooled OR of 0.84 (95% CI 0.77-0.92; p = 0.0001). This protective effect is explicable by reference to the recent finding that the still functional PRSS3P2/TRY7 pseudogene enhancers upregulate pancreatic PRSS2 expression.The common PRSS3P2 and TRY7 deletion CNV was associated with a reduced risk for CP. This finding provides additional support for the emerging view that dysregulated PRSS2 expression represents a discrete mechanism underlying CP predisposition or protection.

Background The diagnosis of cholangiocarcinoma in patients with a biliary stricture without mass syndrome can be obtained by biliary brushing with a sensitivity of ~50 %. We performed a multicenter randomized crossover trial comparing the aggressive Infinity brush with the standard RX Cytology Brush. The aims were to compare sensitivity for cholangiocarcinoma diagnosis and cellularity obtained. Methods Biliary brushing was performed consecutively with each brush, in a randomized order. Cytological material was studied with blinding to the brush type used and order. The primary end point was sensitivity for cholangiocarcinoma diagnosis; the secondary end point was the abundance of cellularity obtained with each brush, with cellularity quantified in order to determine if one brush strongly outperformed the other. Results 51 patients were included. Final diagnoses were cholangiocarcinoma (n = 43; 84 %), benign (n = 7; 14 %), and indeterminate (n = 1; 2 %). Sensitivity for cholangiocarcinoma was 79 % (34 /43) for the Infinity brush versus 67 % (29/43) for the RX Cytology Brush (P = 0.10). Cellularity was rich in 31/51 cases (61 %) with the Infinity brush and in 10/51 cases (20 %) with the RX Cytology Brush (P Conclusions This randomized crossover trial showed that the Infinity brush is not significantly more effective than the RX Cytology Brush for biliary stenosis without mass syndrome in terms of sensitivity for cholangiocarcinoma diagnosis, but does offer a significantly higher abundance of cellularity.

Objectives The results of only a few endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid pseudopapillary neoplasm (SPN) have been published, and the safety of the procedure has never been investigated. Our study compared the recurrence rate in patients with and without preoperative EUS-FNA. Methods This European multicenter registry-based study was conducted in 22 digestive units, and retrospectively included all patients who underwent complete resection of a pancreatic SPN from 2000 to 2018. Patients with and without initial EUS-FNA were compared, and postsurgery recurrence and the associated risk factors were evaluated. Results A complete resection of a pancreatic SPN was performed in 149 patients (133 women, 89%), with a mean age of 34 (standard deviation, 14) years. There were no significant differences between the with (78 patients) and without (71 patients) EUS-FNA groups, except for age and tumor size and location.Preoperative EUS-FNA allowed pancreatic SPN diagnosis in 63/78 cases (81%). After a mean follow-up of 43 (standard deviation, 36) months, recurrence was noted in 4 patients (2.7%). Preoperative EUS-FNA was not correlated with recurrence, but an older age (P = 0.005) was significant. Conclusions Preoperative EUS-FNA does not affect pancreatic SPN recurrence. In this series, old age was significantly correlated with recurrence.

Background and study aims Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate “adequately cleansed” from “inadequately cleansed” CCE still frames. Patients and methods Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R + G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment. Results Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5 % and a specificity of 77.7 %. Regarding the R/(R + G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5 % and a specificity of 62.9 %. Conclusion The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between “adequately cleansed” and “inadequately cleansed” CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.

Background and study aims Bubbles can impair visualization of the small bowel (SB) mucosa during capsule endoscopy (CE). We aimed to develop and validate a computed algorithm that would allow evaluation of the abundance of bubbles in SB-CE still frames. Patients and methods Two sets of 200 SB-CE normal still frames were created. Two experienced SB-CE readers analyzed both sets of images twice, in a random order. Each still frame was categorized as presenting with Results Both SURF and GLCM algorithms had high operating points (Se and Sp over 90 %) and a perfect reproducibility (κ = 1). The validation step showed the GLCM detector strategy had the best diagnostic performances, with a Se of 95.79 %, a Sp of 95.19 %, and a calculation time of 0.037 seconds per frame. Conclusion A computed algorithm based on a GLCM detector strategy had high diagnostic performance allowing assessment of the abundance of bubbles in SB-CE still frames. This algorithm could be of interest for clinical use (quality reporting) and for research purposes (objective comparison tool of different preparations).

Background & Aims There is consensus on the criteria used to define acute severe ulcerative colitis (ASUC) and on patient management, but it has been a challenge to identify patients at risk for colectomy based on data collected at hospital admission. We aimed to develop a system to determine patients’ risk of colectomy within 1 y of hospital admission for ASUC based on clinical, biomarker, and endoscopy data. Methods We performed a retrospective analysis of consecutive patients with ASUC treated with corticosteroids, ciclosporin, or tumor necrosis factor (TNF) antagonists and admitted to 2 hospitals in France from 2002 through 2017. Patients were followed until colectomy or loss of follow up. A total of 270 patients with ASUC were included in the final analysis, with a median follow-up time of 30 months (derivation cohort). Independent risk factors identified by Cox multivariate analysis were used to develop a system to identify patients at risk for colectomy 1 y after ASUC. We developed a scoring system based on these 4 factors (1 point for each item) to identify high-risk (score 3 or 4) vs low-risk (score 0) patients. We validated this system using data from an independent cohort of 185 patients with ASUC treated from 2006 through 2017 at 2 centers in France. Results In the derivation cohort, the cumulative risk of colectomy was 12.3% (95% CI, 8.6–16.8). Based on multivariate analysis, previous treatment with TNF antagonists or thiopurines (hazard ratio [HR], 3.86; 95% CI, 1.82–8.18), Clostridioides difficile infection (HR, 3.73; 95% CI, 1.11–12.55), serum level of C-reactive protein above 30 mg/L (HR, 3.06; 95% CI, 1.11–8.43), and serum level of albumin below 30 g/L (HR, 2.67; 95% CI, 1.20–5.92) were associated with increased risk of colectomy. In the derivation cohort, the cumulative risks of colectomy within 1 y in patients with scores of 0, 1, 2, 3, or 4 were 0.0%, 9.4% (95% CI, 4.3%–16.7%), 10.6% (95% CI, 5.6%–17.4%), 51.2% (95% CI, 26.6%–71.3%), and 100%. Negative predictive values ranged from 87% (95% CI, 82%–91%) to 92% (95% CI, 88%–95.0%). Findings from the validation cohort were consistent with findings from the derivation cohort. Conclusions We developed a scoring system to identify patients at low-risk vs high-risk for colectomy within 1 y of hospitalization for ASUC, based on previous treatment with TNF antagonists or thiopurines, C difficile infection, and serum levels of CRP and albumin. The system was validated in an external cohort.

Background and study aims An objective and reliable scoring system is needed to assess quality of visualization in small bowel (SB) capsule endoscopy (CE), for both clinical practice and research purposes. The aim of this study was to establish and to validate a SB-computed assessment of cleansing (SB-CAC) score. Patients and methods Thirty-three SB-CE were selected. A CAC score, defined as the ratio of the red over green pixels (R/G ratio), was calculated for each frame. Intervals were then determined, ranging from the lowest to the highest ratio among the extracted frames. Twelve frames were randomly selected in each of these intervals. Two hundred eighty-eight frames were shuffled and analyzed twice in random order by two experienced CE readers who were blinded to the CAC scores. Once an “adequately cleansed” or “inadequately cleansed” qualification was allotted to every still frame, a receiver operating characteristic (ROC) curve was created. In case of discrepancy between the two readers, the still frames were excluded. A second dataset of 288 different SB still frames was generated and read twice in random order by two other experienced SB-CE readers, using the same methodology. Results A SB-CAC score threshold of 1.6 best achieved discrimination of adequately from inadequately cleansed frames, with a sensitivity of 92.7 % (95 %CI [89.7 – 95.8]) and a specificity of 92.9 % (95 %CI [89.9 – 95.9]). This threshold was validated using the second dataset, yielding the following performances: sensitivity 91.3 % (95 %CI [87.9 – 94.6]), specificity 94.7 % (95 %CI [92.1 – 97.3]). Conclusion An SB-CAC score of 1.6 has the highest sensitivity and specificity to discriminate “adequately cleansed” from “inadequately cleansed” SB-CE still frames. This constitutes an objective, reproducible, reliable, and automated cleansing score for SB-CE.

Background and study aims: The hemostatic powder TC-325 (Hemospray; Cook Medical, Winston-Salem, North Carolina, USA) has shown promising results in the treatment of upper gastrointestinal bleeding (UGIB) in expert centers in pilot studies. The aim of this study was to evaluate the feasibility and efficacy of TC-325 in a large prospective registry of use in routine practice. Patients and methods: The data of all patients treated with TC-325 were prospectively collected through a national registry. Outcomes were the immediate feasibility and efficacy of TC-325 application, as well as the rates of rebleeding at Day 8 and Day 30. Multivariate analysis was performed to determine predictive factors of rebleeding. Results: A total of 202 patients were enrolled and 64 endoscopists participated from 20 centers. TC-325 was used as salvage therapy in 108 patients (53.5 %). The etiology of bleeding was an ulcer in 75 patients (37.1 %), tumor in 61 (30.2 %), postendoscopic therapy in 35 (17.3 %), or other in 31 (15.3 %). Application of the hemostatic powder was found to be very easy or easy in 31.7 % and 55.4 %, respectively. The immediate efficacy rate was 96.5 %. Recurrence of UGIB was noted at Day 8 and Day 30 in 26.7 % and 33.5 %, respectively. Predictive factors of recurrence at Day 8 were melena at initial presentation and use of TC-325 as salvage therapy. Conclusion: These multicenter data confirmed the high rate of immediate hemostasis, excellent feasibility, and good safety profile of TC-325, which could become the treatment of choice in bleeding tumors or postendoscopic bleeding but not in bleeding ulcers where randomized studies are needed. Trial registration: ClinicalTrials.gov (NCT02595853)

Background Management of anastomotic biliary strictures after liver transplantation deserves optimization. Objective To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting. Design Prospective, multicenter, uncontrolled study. Setting Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers. Patients Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting. Interventions PCSEMSs 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 Measurement The ability to remove PCSEMS. Results PCSEMS 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. Limitations Uncontrolled study with limited follow-up. Conclusions Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.

Conventional optical colonoscopy is the reference examination for exploration of the colon. Its morbidity and its poor acceptability have led to the development of alternative techniques. Considerable work has gone into colon imaging, in particular computed tomography (colo-TC). According to the meta-analysis by Mulhall et al, its sensitivity is 85% and its specificity 97% for the detection of polyps>9 mm. A colo-TC is the alternative examination with the best recognized performance. Among the examinations described below, it is the only examination that can be proposed in the case of the failure of or contraindication to optical colonoscopy. Because of the irradiating nature of this technique, magnetic resonance imaging would be preferable if feasible. This technique has appeared more recently, and work on the topic is less abundant. Capsule endoscopy (the Pill-cam) for the small intestine has been adapted to study of the colon. Results of colon capsule endoscopy studies are promising. A European multicenter study of 320 patients found a sensitivity of 64%, specificity of 84%, positive predictive value (PPV) of 60% and negative predictive value (NPV) of 86% for the detection of polyps>6mm. No severe complication was observed. Finally, improvements have been sought for standard colonoscopy: the Aer-O-Scope, Invendoscope, CathCam colonoscopy - all of these alternative colonoscopies are only in their infancy. The characteristics of these methods for exploring the colon vary substantially between techniques, and their respective roles and indications remain to be defined.

Background Gastric electrical stimulation (GES) represents a new therapy in patients with intractable vomiting and nausea. We aimed to determine preoperative factors associated with positive response during GES. Thirty-three consecutive patients received implants for medically refractory nausea or vomiting or both. Study Design Symptoms, Quality of Life (QOL), and gastric emptying (GE) were monitored before and 6 months after implantation. Compared with baseline, dyspeptic symptoms including nausea and vomiting, and QOL all improved at 6 months, yielding a significant weight gain while the GE rate remained unchanged. Twenty-four patients reported improvement; nine remained unimproved at 6 months. Results In multivariate analysis, baseline QOL and appetite alterations were predictive of improvement; previous history of gastric surgery was associated with failure. Surprisingly, patients with initial delayed GE (21 of 33) displayed similar improvement compared with patients with normal GE. Likewise, basal GE was not found to be predictive of positive outcomes, QOL, or symptoms improvement. Conclusions Patients with severe symptoms and altered QOL at inclusion particularly benefit from GES; delay in GE is not predictive of positive outcomes. This suggests that indication for GES should be based on clinical settings rather than initial GE, and then possibly extended to patients with normal GE.

Most colorectal cancers arise from adenomas. Size is considered one of the main criteria in evaluating resectability, and improved therapeutic equipment safely permits resection of very large polyps. The resectability of polyps depends on macroscopic characteristics, such as histopathologic classification and the technique used. Macroscopic pattern is important to appreciate the resectability of a polyp. The use of new endoscopic techniques allows large endoscopic resection. Endoscopic mucosal resection can be considered a safe and curative option for nonpolypoid colorectal neoplasms. This technique is limited to lesions around 2 cm in diameter, and longer lesions often need to be resected by piecemeal mucosectomy. Endoscopic submucosal dissection is considered by Japanese experts to be the optimal technique for selected TisN0 colorectal lesions. Endoscopic submucosal dissection enables the resection of virtually any nonprotruding lesions of the colon when the depth of invasion into the submucosa is less than 1000 μm.

We report here the case of a 37-year-old woman and her daughter (now 12 years old) with genetically proven hereditary cationic trypsinogen (PRSS1) deficiency pancreatitis. The two patients were treated in a similar manner: endoscopic extraction of large obstructive stones located mainly in the head of the pancreas upstream of a stricture of the distal (cephalic) pancreatic duct and associated with extreme dilation (10–15mm) of the pancreatic duct, manifesting as bouts of mild acute pancreatitis and abdominal pain that could not relieved with analgesics (●" Fig.1–3). Both patients underwent pancreatic sphincterotomy, hydrostatic dilation of the pancreatic duct stricture with a 6-mm Hurricane RX Biliary Dilation Balloon (Boston Scientific, Natick, Massachusetts, USA), removal of the stone fragments with a Dormia basket, and placement of an 8-mm-diameter, 60-mm-long fully covered self-expandable metal stent (SEMS) (WallFlex Biliary RX Stent; Boston Scientific) to dilate the stricture and facilitate removal of the remaining stone fragments (●" Fig.4 and ●" Fig.5). The mother’s stent was left in place for 1 month and the daughter’s for 2 weeks. After stent removal, the mother experienced one episode of abdominal pain, with no further symptomatic relapse so far. Because of two flares of recurrent mild pancreatitis, the daughter underwent additional endoscopic therapeutic sessions; these consisted of a second stricture dilation, followed by placement of another fully covered SEMS for 3 months (same device) and subsequent placement of a 10-Fr plastic stent (Johlin Stent; Cook Medical, Winston-Salem, North Carolina, USA), which was withdrawn 3 months later. Since this procedure, the daughter has remained asymptomatic and has resumed school attendance uneventfully. Optimal stenting modalities have not been detailed in the rare reports devoted to patients with this condition [1–5]. The use of fully covered SEMS was of particular interest in these two patients, who presented with similar findings (short distal stricture and unusually large upstream dilation), because these stents can facilitate the removal of large stones and reduce the discrepancy between duct size in the head and body of the pancreas, a major factor in stone formation.

Summary Background : Impedance-pH monitoring is the most sensitive method for detection and characterization of gastro-oesophageal reflux episodes. Normal values from European subjects are lacking. Aim : To build a database of gastro-oesophageal reflux patterns from French and Belgian healthy subjects. Methods : Seventy-two healthy subjects (35 men, mean age 35 years, 18–72) underwent 24-h ambulatory impedance-pH studies. Gastro-oesophageal reflux episodes were detected using impedance and characterized by pH as acid, weakly acidic, or weakly alkaline. Analysis was performed visually and effects of age, gender and intra-individual reproducibility were evaluated. Results : The total number of gastro-oesophageal reflux episodes was 44 (25,58,75) of which 59% were acid, 28% were weakly acidic and 10% weakly alkaline. Half of gastro-oesophageal reflux episodes were mixed (liquid/gas) and 22% reached 15 cm above the lower oesophageal sphincter. The bolus clearance time was 11 s while acid was chemically cleared in 34 s. Male gender was associated with increased number and proximal extent of total and acid gastro-oesophageal reflux. Repeated studies in 27 subjects showed good reproducibility for number, acidity and air–liquid composition of reflux (Kendall's W-values = 0.72–0.85). Conclusions : This study demonstrates good reproducibility of 24-h ambulatory impedance-pH studies and provides values of reflux patterns in healthy subjects for comparisons with European gastro-oesophageal reflux disease patients.

Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents.Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS).The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N = 24), and BS-FCMS were used in group 2 (N = 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months' recurrence rate and stent-related morbidity.Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p = 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p = 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6-12 months) and 1 month (group 2, 0.1-6 months). Study limitations include its nonrandomized design.The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.

The management of colorectal polyps10mm in diameter is controversial. Our aim was to evaluate the rate and risk factors for advanced adenomas and high grade neoplasia amongst small (6-9 mm) and diminutive (1-5mm) colorectal polyps.Endoscopic and pathological reports of colonoscopies performed in our centre were collected prospectively. Advanced adenoma was defined by presence of a villous component and/or high grade dysplasia; high grade neoplasia by presence of high grade dysplasia and/or intramucosal carcinoma.1468 patients were included (53.1% male, mean age 59.5±14 years); 414 polyps10mm were detected, 9.9% advanced adenomas and 1.7% high grade neoplasia. Amongst small polyps, 25 (35.2%) were advanced adenomas, mainly due to villous features, and 3 (4.2%) were high grade neoplasia. Polyp size was associated with advanced adenomas (odds ratio=8.47).The rate of advanced adenomas amongst small polyps was 35%, mainly due to the presence of villous features. Polyp size was identified as a risk factor of advanced adenoma amongst polyps10mm. Given these results, we believe that polypectomy should be warranted for patients presenting with small polyps at computed tomography colonography.

Conventional optical colonoscopy is the reference examination for exploration of the colon. Its morbidity and its poor acceptability have led to the development of alternative techniques. Considerable work has gone into colon imaging, in particular computed tomography (colo-TC). According to the meta-analysis by Mulhall et al, its sensitivity is 85% and its specificity 97% for the detection of polyps9 mm. A colo-TC is the alternative examination with the best recognized performance. Among the examinations described below, it is the only examination that can be proposed in the case of the failure of or contraindication to optical colonoscopy. Because of the irradiating nature of this technique, magnetic resonance imaging would be preferable if feasible. This technique has appeared more recently, and work on the topic is less abundant. Capsule endoscopy (the Pill-cam) for the small intestine has been adapted to study of the colon. Results of colon capsule endoscopy studies are promising. A European multicenter study of 320 patients found a sensitivity of 64%, specificity of 84%, positive predictive value (PPV) of 60% and negative predictive value (NPV) of 86% for the detection of polyps6mm. No severe complication was observed. Finally, improvements have been sought for standard colonoscopy: the Aer-O-Scope, Invendoscope, CathCam colonoscopy - all of these alternative colonoscopies are only in their infancy. The characteristics of these methods for exploring the colon vary substantially between techniques, and their respective roles and indications remain to be defined.

Oesophageal pH-impedance monitoring allows detection of acid and non-acid gastro-oesophageal reflux (GOR) events. Visual analysis of impedance recording requires expertise. Our aim was to evaluate the efficacy of an automated analysis for GOR assessment. Seventy-three patients with suspected GORD underwent 24-h oesophageal pH-impedance monitoring. Recordings analysis was performed visually (V) and automatically using Autoscan function (AS) of Bioview software. A symptom index (SI) > or =50% was considered for a significant association between symptoms and reflux events. AS analysis detected more reflux events, especially non-acid, liquid, pure gas and proximal events. Detection of oesophageal acid exposure and acid reflux events was similar with both analyses. Agreement between V and AS analysis was good (Kendall's coefficient W > 0.750, P < 0.01) for all parameters. During pH-impedance studies, 65 patients reported symptoms. As compared to visual analysis, the sensitivity and specificity of a positive SI determined by AS were respectively 85.7% and 80% for all reflux events, 100% and 98% for acid reflux and 33% and 87.5% for non-acid reflux. Despite good agreement with visual analysis, automatic analysis overestimates the number of non-acid reflux events. Visual analysis remains the gold standard to detect an association between symptoms and non-acid reflux events.

Combined esophageal pH-impedance monitoring allows detection of nearly all gastroesophageal reflux episodes, acid as well as nonacid. However, the role of nonacid reflux in the pathogenesis of symptoms is poorly known. The aim of this study was to evaluate the diagnostic yield of this technique in patients with suspected reflux symptoms while on or off PPI therapy.The recordings of 150 patients recruited at seven academic centers with symptoms possibly related to gastroesophageal reflux were analyzed. Reflux events were detected visually using impedance (Sandhill, CO) and then characterized by pHmetry as acid or nonacid reflux. The temporal relationship between symptoms and reflux episodes was analyzed: a symptom association probability (SAP)or =95% was considered indicative of a positive association.One hundred fifty patients were included, 102 women (mean age 52 +/- 14 yr, range 16-84). Among the 79 patients off PPI, five did not report any symptom during the recording period. A positive SAP was found in 41 of the 74 symptomatic patients (55.4%), including acid reflux in 23 (31.1%), nonacid reflux in three (4.1%), and acid and nonacid in 15 (20.3%). In the group of patients on PPI (N = 71, 46 women, mean age 51 +/- 15 yr), 11 were asymptomatic during the study, SAP was positive in 22 of the 60 symptomatic patients (36.7%), including acid reflux in three (5.0%), nonacid reflux in 10 (16.7%), and acid and nonacid in nine (15.0%). The symptoms most frequently associated with nonacid reflux were regurgitation and cough.Adding impedance to pH monitoring improves the diagnostic yield and allows better symptom analysis than pHmetry alone, mainly in patients on PPI therapy. The impact of this improved diagnostic value on gastroesophageal reflux disease management remains to be investigated by outcome studies.

A Novel Hemostatic Powder for the Endoscopic Treatment of Gastrointestinal Bleeding: Results From a Multicenter Prospective Study Performed in Routine Practice (the ‘Graphe' Registry) Sami Haddara, Julien Branche, Stephane Lecleire, Jeremie Jacques, Laurent Heyries, Jocelyn Privat, Philippe Bichard, Philippe Grandval, Yann Lebaleur, Ulriikka Chaput, Stephane Koch, Jonathan Levy, Bruno Godart, Antoine Charachon, Jean-Francois Bourgaux, Emmanuel Coron

Mo1385 Diagnostic and Therapeutic Impacts of Elective Colonoscopy Following Acute Sigmoid Diverticulitis Abdullah Alatawi, Karine Pautrat, Philippe Soyer, Violaine Ozenne, Ulriikka Chaput, Rea Lo Dico, Christelle Duteil, Patrice D. Valleur, Philippe R. Marteau, Xavier Dray* Digestive Diseases, APHP, Lariboisiere Hospital, & Denis Diderot, Paris 7 University, Paris, France; Abdominal Imaging, APHP, Lariboisiere Hospital, & Denis Diderot, Paris 7 University, Paris, France; Epidemiology, APHP, Lariboisiere Hospital, Paris, France Introduction: The diagnosis of acute sigmoid diverticulitis (ASD) is mainly based on clinical, biological and CT-scan findings. Elective colonoscopy is sometimes proposed after medical treatment, to rule out differential diagnosis and to detect associated conditions (such as advanced adenomas and cancer) before surveillance or elective surgery is considered. Aims and Methods: In this 6-year, monocentric, retrospective study, we aimed to evaluate the diagnostic and therapeutic impact of elective colonoscopy in patients with recent onset of ASD. Clinical, radiological, and endoscopic data from patients who had an elective colonoscopy after medical treatment admitted for ASD were reviewed. Endpoints were (i) overall adenoma detection rate (ADR), (ii) advanced adenoma detection rate ( 10mm diameter, villous lesions 25%, high-grade dysplasia), (iii) therapeutic impact (as defined by changes in the surgical strategy, based on endoscopic findings). Results: From January 2005 to January 2011, 252 patients admitted in our institution for ASD. Among them, 121 (48%, 67 women, mean age 62 year) had an elective colonoscopy after conservative treatment of ASD. Past medical history included previous colonoscopy (25 patients, 20.8%), previous onset of ASD (27 patients, 22.4%), familial history of digestive cancer (7 patients, 5,5%). CT-scan displayed patterns of tumor-like lesions of the sigmoid in 7 patients (5.5%), sigmoid stenosis in 10 patients (8.3%), peri-sigmoidal abscess in 21 patients (18%). Elective colonoscopy was performed in a mean time of 62 days after admission for ASD. Colonoscopy was not completed in 8 patients, because of sigmoid stenosis in 7 cases. In one patient with incomplete colonoscopy, a tumor upstream the sigmoid stenosis was suspected on the initial CT-scan, and adenocarcinoma was confirmed during elective surgery (and therefore not credited as a therapeutic change based on colonoscopy). Colonoscopy was total in 113 (93.3%) patients. No endoscopic complication was observed. Adenoma, advanced adenoma, and adenocarcinoma detection rates were 13.2%, 1.6% and 0.8%, respectively. The therapeutic impact of colonoscopy was 0.8%. Conclusion: Elective colonoscopy following medical treatment of ASD has low diagnostic rates for adenomas, for advanced adenomas and for colorectal cancer, and therefore rarely modifies the therapeutic strategy. It should be proposed after ASD only in highly selected patients, those presenting with reasonable doubt on initial CT-scan, and those with identified risk factors for advanced adenomas and adenocarcinoma of the colon.

Background: Although the efficacy of gastric electrical stimulation has been reported in short-term studies, there is a lack of data on the long-term improvement of nausea and vomiting by gastric electrical stimulation in patients with delayed or normal gastric emptying. Methods: Thirty-one patients were implanted at our centre for medically refractory severe and chronic nausea and/or vomiting. Patients were evaluated at baseline, 6 months then 5 years after implantation (mean follow-up 80 ± 4 months) using a symptomatic and quality of life scores. Key results: Amongst the 31 patients, 4 were lost to follow-up, 6 explanted due to lack of improvement, and 1 patient died. Out of the 20 patients evaluated over 5 years, the quality of life score showed 27% improvement (p < 0.01), including nausea (62%; p < 0.01), vomiting (111%; p = 0.03), satiety (158%; p < 0.01), bloating (67%; p < 0.01) and epigastric pain (43%; p = 0.03). Over 5 years, 15/20 patients reported a 50% improvement with a global satisfaction rated at 64 ± 6%. Therefore, 15/27 patients (56%) were improved by gastric electrical stimulation over 5 years in intention to treat. Improvement of nausea 6 months after implantation was predictive of 5-year success of gastric electrical stimulation (p = 0.04). Finally, patients with delayed gastric emptying or with normal gastric emptying rate before surgery were similarly improved over 5 years (60% versus 50% respectively). Conclusion: Gastric electrical stimulation is safe and effective in the long term in patients with medically refractory nausea and vomiting, with an efficacy over 50% beyond 5 years in intention to treat. Gastric emptying measured before implantation did not influence the response rate over 5 years. Gast © 2012 Editrice

International audience; Background & AimsThere is consensus on the criteria used to define acute severe ulcerative colitis (ASUC) and on patient management, but it has been a challenge to identify patients at risk for colectomy based on data collected at hospital admission. We aimed to develop a system to determine patients’ risk of colectomy within 1 y of hospital admission for ASUC based on clinical, biomarker, and endoscopy data.MethodsWe performed a retrospective analysis of consecutive patients with ASUC treated with corticosteroids, ciclosporin, or tumor necrosis factor (TNF) antagonists and admitted to 2 hospitals in France from 2002 through 2017. Patients were followed until colectomy or loss of follow up. A total of 270 patients with ASUC were included in the final analysis, with a median follow-up time of 30 months (derivation cohort). Independent risk factors identified by Cox multivariate analysis were used to develop a system to identify patients at risk for colectomy 1 y after ASUC. We developed a scoring system based on these 4 factors (1 point for each item) to identify high-risk (score 3 or 4) vs low-risk (score 0) patients. We validated this system using data from an independent cohort of 185 patients with ASUC treated from 2006 through 2017 at 2 centers in France.ResultsIn the derivation cohort, the cumulative risk of colectomy was 12.3% (95% CI, 8.6–16.8). Based on multivariate analysis, previous treatment with TNF antagonists or thiopurines (hazard ratio [HR], 3.86; 95% CI, 1.82–8.18), Clostridioides difficile infection (HR, 3.73; 95% CI, 1.11–12.55), serum level of C-reactive protein above 30 mg/L (HR, 3.06; 95% CI, 1.11–8.43), and serum level of albumin below 30 g/L (HR, 2.67; 95% CI, 1.20–5.92) were associated with increased risk of colectomy. In the derivation cohort, the cumulative risks of colectomy within 1 y in patients with scores of 0, 1, 2, 3, or 4 were 0.0%, 9.4% (95% CI, 4.3%–16.7%), 10.6% (95% CI, 5.6%–17.4%), 51.2% (95% CI, 26.6%–71.3%), and 100%. Negative predictive values ranged from 87% (95% CI, 82%–91%) to 92% (95% CI, 88%–95.0%). Findings from the validation cohort were consistent with findings from the derivation cohort.ConclusionsWe developed a scoring system to identify patients at low-risk vs high-risk for colectomy within 1 y of hospitalization for ASUC, based on previous treatment with TNF antagonists or thiopurines, C difficile infection, and serum levels of CRP and albumin. The system was validated in an external cohort.