[Impact of esophageal manometry before anti-reflux surgery]

Esophageal hypomotility is frequent in patients with gastroesophageal reflux disease [GERD]. To precise the frequency and the patterns of esophageal manometric abnormalities in GERD patients referred before anti-reflux surgery, to determine the frequency of post-operative dysphagia and to look for associated factors with high risk of dysphagia, with special interest on pre-operative esophageal manometric study. We conducted a retrospective study based on patients having anti-reflux surgery and pre-operative esophageal manometry. Post-operative dysphagia was prospectively assessed during the follow-up. We studied 33 patients [mean age: 46 years; sex ratio: 0.4]. Pre-operative esophageal manometry was abnormal in 1/3 of cases, with a high prevalence of non specific motor disorders and hypomotility. Nor epidemiological, clinical or pH metric factor was associated with the risk of motor esophageal abnormalities. Post-operative dysphagia was noted in 21% of the cases, with any correlation with results of pre-operative manometry. Esophageal hypomotility is frequent in patients with GERD; and not associated with a higher risk of post-operative dysphagia after anti-reflux surgery

[Endoscopic ultrasonography versus helical CT in diagnosis and staging of pancreatic cancer]

Compare the performances of EUS to helical CT in the diagnosis and staging of pancreatic adenocarcinoma. Forty two consecutive patients [mean age 63 years; 25 men, 17 women] who had surgical exploration and histologically proved pancreatic cancer were retrospectively included. All our patients underwent with endoscopic ultrasonography [EUS] and helical computed tomography [helical CT]. Data analysis compared helical CT, EUS with the surgical data with or without histological study in diagnosis, staging and resectability of pancreatic cancer. Surgical findings were used as gold standard. For positive diagnosis EUS was more sensitive 100% [CI:93-100] than helical CT 88% [CI:77-95]. But helical CT was more specific 89% [CI:64-98] than EUS 83% [CI:58-96] for small tumors whose diameter is below 2,5 cm in which EUS was more sensitive in their detection [100% versus 83%]. In evaluating venous involvement EUS was more sensitive than helical CT [96% versus 50%; p<0.05], while CT was more specific [81% versus 75%; p<0.05]. Regarding lymph nodes invasion, the two imaging technique had the same sensibility [56%] with better specificity for helical CT [83% versus 75%; p<0.05]. The accuracy of EUS in identifying the T and N stages were 80% and 67% respectively, while helical CT have an accuracy of 50% and 71% respectively. EUS and helical CT correctly identified all resectable tumors while EUS was more accurate than helical CT in detecting non resectable tumors 94% versus 69%.EUS remains superior to helical CT in positive diagnosis of pancreatic adenocarcinoma especially for small tumors and also for the diagnosis of venous invasion and in identifying non resectable tumors. The two techniques have the same accuracy in the detection of lymph node involvement

Place de la ligature elastique dans la prevention secondaire de l'hemorragie digestive par rupture de varices oesophagiennes. Etude prospective de 102 cas

The aim of this study was to assess the efficacy and morbidity of endoscopic variceal ligation for the prophylaxis of rebleeding from oesophageal varices. This work is a prospective study including 102 patients having had at] least one episode of variceal bleeding. The mean age is 52,5 years. Oesophageal varices were eradicated in 83,3% of cases after an average of 3,5 sessions. Recurrence of oesophageal varices after eradication was observed in 22% after an average follow-up of 7 months. 10 patients died before eradication of oesophageal varices from causes unrelated to the technique. The endoscopic variceal ligation is effective for eradication of oesophageal varices, with a low morbidity. This technique appears to be a method of choice in the prophylaxis of rebleeding from oesophageal varices

densite minerale osseuse au cours de la maladie de Crohn: Apport de l'osteodensitometrie chez 53 patients

Fifty-three patients with Crohn disease were included in A prospective study. Bone mineral density was measured at the Femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sek, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58,5% of cases. The ileum location and the corticotherapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy