[Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography performed during the same anesthesia session]. / Echo-endoscopie et cholangio-pancréatographie rétrograde endoscopique dans un même temps anesthésique.

OBJECTIVES: To evaluate the feasibility, results and importance of a diagnostic and therapeutic biliary and pancreatic exploration associating endoscopic ultrasonography and endoscopic retrograde cholangio-pancreatography during the same anaesthesia session. METHODS: From November 1997 to October 1998, 179 patients (83 males, 96 females), mean age 62 years (range 22 to 95 years), were investigated in our gastroenterology unit for biliary or pancreatic disorders. Two hundred and sixty two examinations were performed by a single physician for patients under general anaesthesia. In 87 cases (42%), endoscopic retrograde cholangio-pancreatography was performed immediately without prior endoscopic ultrasonography; these patients were not included. When endoscopic retrograde cholangio-pancreatography followed endoscopic ultrasonography, it was performed during the same anaesthesia session. RESULTS: In 118 cases, endoscopic ultrasonography was performed first, followed by endoscopic retrograde cholangio-pancreatography 57 times (48%). The sensitivity of endoscopic ultrasonography was 96.5% and the success of therapeutic endoscopic retrograde cholangio-pancreatography was 100%. Endoscopic retrograde cholangio-pancreatography was necessary for 83% of patients with angiocholitis, 60% with cholestasis, 45% with acute biliary pancreatitis and only 28% with common bile duct stone migration. CONCLUSION: To decrease the number of anaesthesia sessions, endoscopic ultrasonography--endoscopic retrograde cholangio-pancreatography during same anaesthesia session appears to be particularly interesting for the diagnosis and treatment of biliary and pancreatic disorders, in terms of cost, accuracy, morbidity and patient comfort.

[Ambulatory 24-hour home pH-metry: parental and familial reactions. Prospective study of 100 cases]. / La pHmétrie de 24 heures en ambulatoire à domicile: vécu parental et familial. Etude prospective de 100 cas.

BACKGROUND: The ambulatory twenty-four hour esophageal pHmetry is nowadays a common mode of assessment of gastro-esophageal reflux in children. The aim of this study was to evaluate the impact of the test on child and family's ordinary daily life. MATERIAL AND METHODS: One-hundred children (64 boys, 36 girls) were included in this study during a 10-month period from August 1992 until May 1993. Mean age was 2 years 9 months (range: 22 days--12 years). Forms with a list of questions concerning parental understanding of the test, child's reaction after introduction of the pH-electrode, general reactions in the household, and eventual disturbance of the child's temper and appetite, were given to the parents. Six months later, 81 families were contacted by telephone and asked the same questions. Children were divided into three groups: those under 1 year of age (n = 38), from 1 to 4 years (n = 35), and more than 4 years (n = 27). RESULTS: One child aged 2 months had to be admitted to hospital due to the mother's overanxiety. The majority of parents (80%) assumed they knew about the principles of the test, with little change once the test was over. Those whose child had previously been submitted to the test were less apprehensive. When the test was first initiated, 81% of parents feared it would cause some discomfort, either due to pain (69%), or to poor acceptance at home (25%) with the risk of having the catheter accidently removed. Once the catheter had been positioned with the parents close to the child at that time, its presence was judged by them tolerable in 88.9% of cases. Once at home, 84.8% of the parents were not worried, as the child was calm (83.8%) and also due to the possibility for them to get in touch with the physician if necessary (86.9%). No change in routine daily life was reported by 80.8% of the families; in only 19.2% was the child reported to be overwhelmed with the test. When asked if the test should be undertaken another time, 91.9% would still prefer it as a home procedure, the only families requesting it be done in hospital being those with a history of sudden death syndrome. CONCLUSION: pHmetry test as a 24-hour procedure done at home may be the source of some discomfort and anxiety both to the child and parents; yet it appears to be generally well-accepted, both for its non-aggressive and diagnostic value.