L’endoscople d’urgence: les structures,les techniques,le personnel et les statuts

Acta Endoscopica - L’urgence en endoscopie est une situation toujours difficile, qu’elle soit au lit du malade s’il est intransportable, ou au bloc d’endoscopie. Elle...     

Polypectomies et mucosectomies difficiles: quels outils pour quelles lésions ?

Colon mucosectomy is an everyday act for most endoscopists. In most cases, colon mucosectomy can be carried out by using standard equipment: an oval or hexagonal snare, injection of physiological solution with an endoscopic injection needle, and a conventional endoscope. Use the equipment that your operative assistant and you are familiar with; there are some solutions to be learned, and some tools to help you to deal with delicate situations and optimize the chances of successful endoscopic resection: spiked or twisted snares, twin-channel endoscope, injection of adrenalin solution or viscous substance in particular. The quality of the diathermy knife is an essential factor, with inherent regulation of the resection current and the possibility of endocut resection, which enables safe, efficient cutting by reducing the risks of perforation and haemorrhage.     

Treatment and long-term outcome of chronic radiation esophagitis after radiation therapy for head and neck tumors

The natural history of chronic radiation esophagitis occuring in previously normal esophagus is still unknown. We describe here the long-term outcome of chronic esophagitis arising after neck irradiation for oropharynx and larynx carcinomas in 13 consecutive adult patients. The first clinical signs of radiation esophagitis were dysphagia or impossibility of oral intake, which appeared within 26 months (range 2–120 months) after the end of radiation for pyriform fossae carcinoma (N=5), tonsil carcinomaN=2), larynx carcinoma (N=2), pharynx carcinoma (N=2), base of the tongue (N=1), and thyroid carcinomas (N=1). During upper endoscopy, an esophageal stenosis was found in 11 cases and was associated with ulceration in three cases. An isolated esophageal ulceration was present in only two cases. Chronic radiation esophagitis diagnosis was confirmed by histology and durgery in seven cases. In the last six cases, diagnosis was supported by the absence of first cancer relapses within a median follow-up of two years (16 months to nine years) and by endoscopic findings. Seven patients received parenteral or enteral nutrition. Ten patients were treated by peroral dilatation. These treatments allowed nearly normal oral diet in 11/13 patient. Only one patient was lost of follow-up after 20 months. Four patients died from chronic radiation esophagitis. One of these patients died from massive hemorrhage after peroral dilatation. Four patients died of a second carcinoma with no first cancer recurrence. Four patients were alive after dix months to nine years of follow-up. Moderate dysphagia was still present, allowing nearly normal oral feeding. In conclusion, chronic radiation esophagitis is a severe disease with an underestimated frequency. In our study, peroral dilatations appeared to be necessary and were not associated with an increased morbidity.     

EUS results of malignant rectal giant condyloma acuminatum (Buschke-Loewenstein tumor)

Giant condyloma acuminatum is a large, exophytic, cauliflower-like lesion that usually affects the anogenital region. Localisation in the rectum is uncommon and has a high rate of malignant transformation but does not lead to develop distant metastases. For the time, we report the endosonographic appearance of a malignant intrarectal giant condyloma acuminatum.     

Traitement endoscopique des sténoses duodénales malignes par prothèses métalliques expansibles: Résultats chez 11 malades consécutifs

Acta Endoscopica - La pose de prothèses duodénales métalliques par voie endoscopique est une thérapeutique simple, efficace et à faible morbidité des obstructions...