[Update on bowel endometriosis]. / L'endométriose digestive.

UPDATE ON BOWEL ENDOMETRIOSIS Endometriosis is a relatively common female disease with increasing incidence, probably because of better diagnostic tools and a better understanding of the pathology. We will focus our subject on bowel endometriosis, specially the recto-sigmoid localization, whose diagnostic and therapeutic management is multidisciplinary. Bowel endometriosis is rare, still not completely understood in gastroenterology consultations, that is why it seems interesting to make an update on this pathology, probably widely underestimated.

L'ENDOMÉTRIOSE DIGESTIVEL'endométriose est une maladie féminine relativement fréquente, dont l'incidence augmente avec le temps, probablement du fait de techniques diagnostiques plus performantes et de l'amélioration des connaissances. La prise en charge de l'endométriose digestive, dont la localisation la plus fréquente est rectosigmoïdienne, doit être pluridisciplinaire. Il semble important de s'intéresser à cette affection, assez rarement rencontrée en consultation de gastroentérologie et probablement largement sous-estimée.

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma.

There is a lack of prospective data about second-line treatments for metastatic pancreatic ductal adenocarcinoma patients. This is partially due to recent changes in first-line chemotherapy treatments. Despite this dearth of information, 50.0% of the patients who experience failure with first-line folinic acid, 5-fluorouracil, irinotecan and oxaliplatin (folfirinox) treatment are eligible for additional chemotherapy. In this setting, gemcitabine is widely used without any standard recommendations available. The present study evaluated 42 patients who received gemcitabine subsequent to a first-line treatment of folfirinox between January 2008 and December 2012 at the Centre Léon Bérard (Lyon, France). Clinical data, biological data and tumor characteristics were retrospectively analyzed to identify prognostic factors for successful treatment with gemcitabine. In total, 11 patients (26.2%) experienced control of their cancer with gemcitabine treatment. However, there was no predictive marker for their response to the drug. The median overall survival was 3.6 months from gemcitabine initiation [95% confidence interval (CI), 2.1-5.1]. The median length of gemcitabine treatment was 1.5 months (95% CI, 0.3-13.3). Among the 11 patients who were successfully treated with gemcitabine, 6 were resistant to first-line folfirinox treatment. Patients who were non responsive to folfirinox had a higher probability of success with gemcitabine compared with patients that responded to folfirinox (54.5 vs. 21.4%, respectively; P=0.061). The present study did not identify any clinical or biological marker with a predictive value for successful gemcitabine treatment. Furthermore, successful gemcitabine treatment was not correlated with patients' response to first-line folfirinox treatment. This suggests an absence of cross-resistance in the chemotherapy protocols and provides evidence for effective cancer treatment with the second-line gemcitabine therapy.

High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs.

BACKGROUND: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. METHODS: This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. RESULTS: All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). CONCLUSION: This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.

Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions.

BACKGROUND AND STUDY AIM: Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20  mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD. PATIENTS AND METHODS: We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS.  RESULTS: 11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm(2). Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9/11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4/11 patients (36.4%) with resolution after 1-5 dilations. CONCLUSION: Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.

[Autochtonous hepatitis E, an emerging infection: case report]. / Hépatite E autochtone, une pathologie émergente: à propos d'un cas.

Hepatitis E is rare in France but its increasing frequency makes it an emerging infection. Autochtonous hepatitis E is prevalent, largely confined to older men and currently caused by gentotype 3f. Patients with unexplained hepatitis should be tested by hepatitis E, even in the absence of travel from endemic areas. The diagnosis is based on serological testing (including detection of specific antibodies IgM and IgG, and sometimes by determination of antibody avidity) and nucleic acid amplification techniques which might used first.