A new gastric impedancemeter for detecting the development of a visceral edema: a proof-of-concept study on an experimental endotoxemic shock.

Visceral congestion and edema are important features of advanced heart failure. Monitoring the evolution of fluid content in the gastric wall might provide an index of the development of this phenomenon and therefore constitute an innovative marker to early detect acute decompensated heart failure episodes. The evolution of the fluid content in the gastric wall is measured using a device implanted in the submucosa layer of the fundic region of the stomach. The device composed of two electrodes measures the bioimpedance values that reflects the water content of the tissue.An in-vivo experiment in a pig was carried out to validate the feasibility of detecting the gastric bioimpedance variations during the development of an experimental acute visceral edema caused by an endotoxemic shock. Our preliminary results confirm the possibility to monitor the bioimpedance variations due to moderate changes in tissue water content (10%) with a two-electrode configuration device implanted in the submucosa of the stomach.

Evaluation of a new packaging process for non-autoclavable endoscopes: results for the first 100 microbiological samples.

BACKGROUND: A new process for packaging endoscopes (SureStore®, Medical Innovations Group) immediately after they exit from washing and disinfection in an automated endoscope reprocessor (AER) allows for endoscopes to be stored for up to 15 days. AIM: To describe the microbiological quality of samples from gastrointestinal endoscopes following this process. METHODS: Three-month prospective study using microbiological sampling from a stock of 38 gastrointestinal endoscopes carried out in a French University Hospital. The compliance rate (proportion of samples ≤25 cfu with no pathogenic micro-organisms) and the rate of sterile samples (proportion of germ-free samples) were calculated. We then used multivariate analysis to determine the factors associated with the maintenance of sterility. FINDINGS: One hundred samples were taken from stored endoscopes: 31 stored for ≤3 days, 34 stored between 3 and 7 days, and 35 after storage between 7 and 15 days. The compliance rate was 98% and the sterile sample rate was 60%. Only the time between leaving the AER and packaging was significantly associated with the sterility of samples (P = 0.02). The probability of having a sterile sample decreased 17-fold when the endoscope was packaged >2 h after leaving the AER (P = 0.04) compared to an endoscope packaged within 1 h after leaving the AER. CONCLUSION: The SureStore process seems capable of satisfactorily maintaining compliance (98%) of samples taken from endoscopes stored for up to 15 days. The delay in packaging should not exceed 1 h, as the rate of sterile samples decreases thereafter.

Long-term follow-up after biliary stent placement for postcholecystectomy bile duct strictures: a multicenter study.

BACKGROUND AND STUDY AIMS: Endoscopic stenting is a recognized treatment of postcholecystectomy biliary strictures. Large multicenter reports of its long-term efficacy are lacking. Our aim was to analyze the long-term outcomes after stenting in this patient population, based on a large experience from several centers in France. METHODS: Members of the French Society of Digestive Endoscopy were asked to identify patients treated for a common bile duct postcholecystectomy stricture. Patients with successful stenting and follow-up after removal of stent(s) were subsequently included and analyzed. Main outcome measures were long-term success of endoscopic stenting and related predictors for recurrence (after one stenting period) or failure (at the end of follow-up). RESULTS: A total of 96 patients were eligible for inclusion. The mean number of stents inserted at the same time was 1.9±0.89 (range 1-4). Stent-related morbidity was 22.9% (n=22). The median duration of stenting was 12 months (range 2-96 months). After a mean follow-up of 6.4±3.8 years (range 0-20.3 years) the overall success rate was 66.7% (n=64) after one period of stenting and 82.3% (n=79) after additional treatments. The mean time to recurrence was 19.7±36.6 months. The most significant independent predictor of both recurrence and failure was a pathological cholangiography at the time of stent removal. CONCLUSION: Endoscopic stenting helps to avoid surgery in more than 80% of patients bearing postcholecystectomy common bile duct strictures. However, a persistent anomaly on cholangiography at the time of stent removal is a strong predictor of recurrence and may lead to consideration of surgery.

[Critical study of the analysis of lactoferrin in duodenal fluid in the diagnosis of chronic pancreatitis]. / Etude critique du dosage de la lactoferrine du liquide duodénal dans le diagnostic des pancréatites chroniques.

In a prospective study we have measured the lactoferrin level of duodenal juice under secretin plus caerulein pancreatic stimulation in 78 subjects. Subjects was divided in 4 groups as follows: 27 controls, 11 pancreatic disease without chronic pancreatitis (CP), 17 CP and 23 suspicions of CP. Lactoferrin was assayed by radial immunodiffusion and the level was referred to lipase activity. The test was considered as positive when lactoferrin (microgram/ml) X 100/lipase (U/ml) greater than 0.1. No one control subject had a positive test, 2 pancreatic cancers out of 4, 1 acute pancreatitis out of 7, 12 CP out of 17 had a positive test. The sensitivity (0.71) and the specificity (0.92) of the test do not allow us to propose this test as unequivocal in the diagnosis of CP.