Polypectomies et mucosectomies difficiles

Abstract The increasing number of patients taking anticoagulants (ACG) or anti-platelet agents (APA) poses some specific problems for colonoscopic examinations. In fact, no examinations are performed under ACG, except in an emergency, but only after a drug adaptation consisting generally of a brief relay by heparin. In this situation, the real risk is the increased rate of delayed bleeding after polypectomy. In contrast, it is possible to realize colonoscopies with biopsies or even polypectomies for polyps of less than 1 cmwithout stopping aspirin in some patients with high thrombotic risk (more often coronary drug eluting stents) for whom it is not advisable to interrupt the AAP. In all cases, we must underline the importance of a multi-speciality management of the patients under ACG or AAP, the need of a complete information and a post-procedure survey adapted to the increased bleeding risk.     

Intérêt de l’exploration par minisondes d’échoendoscopie pour le diagnostic et l’approche thérapeutique dans l’achalasie

Use of miniature sensors in echoendoscopy in cases of achalasia, a disorder concerning the esophagus and linked to a primary motor disturbance, provides diagnostic and probable prognostic elements in terms of efficacy of endoscopic therapy, which is based on pneumatic dilation. Measurement of wall thickening in the specific muscular tissues, a constant anomaly in this problem, and upward extension of that thickening are fully analysed and measured during this type of high-frequency ultrasonography exploration, contrary to the standard echoendoscopy. Thus, these new elements, added to the known predictive factors of poor long-term response to dilation (young patients, male gender, hyperpressure of the lower esophageal sphincter), could further enhance the pertinence of the therapeutic choice between further dilation therapy and surgery (Heller myotomy).     

Hemorrhagic complication following hepatic puncture biopsy. Value of echography

Ultrasonography allowed to diagnose in emergency an acute intraperitoneal bleeding complicating a percutaneous needle liver biopsy in a woman suffering from diffuse steatosis and to demonstrate the mechanism of bleeding by the visualization of the probable injury of a sus-hepatic vein.