[Multidisciplinary management of a giant hepatic hydatidosis]. / Prise en charge multidisciplinaire d'une volumineuse hydatidose hépatique.

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the most commonly affected organ. In this paper, the authors describe the multidisciplinary management of this pathology based on the clinical case of a patient suffering from a 28 cm cystic echinococcosis treated by combination of albendazole and liver resection. Several treatment options are described in the literature although there is currently no clear consensus on the management of this condition.

L'échinococcose cystique, appelée aussi hydatidose, est une zoonose causée par le développement chez l'homme de la larve d'un ténia échinocoque de type Echinococcus granulosus. Il s'agit d'une pathologie cosmopolite qui peut être rencontrée en Belgique chez des patients originaires de pays endémiques et qui atteint, le plus souvent, le foie. Dans cet article, les auteurs discutent la prise en charge multidisciplinaire de cette pathologie en partant du cas d'un patient souffrant d'un kyste échinococcique hépatique de 28 cm traité par albendazole et résection hépatique. Plusieurs options de traitement de l'échinococcose cystique sont décrites dans la littérature bien qu'il n'existe pas, à l'heure actuelle, de consensus clair concernant la prise en charge de cette pathologie.

[Non alcoholic fatty liver disease assessment]. / Mise au point d'une stéatopathie non alcoolique.

Non alcoholic Fatty Liver Disease (NAFLD) is the leading cause of consultation in hepatology department. It is a manifestation of the metabolic syndrome. If the simple steatosis is considered as benign, Non Alcoholic Steato Hepatitis (NASH) is associated with increased mortality linked to cardiovascular, metabolic and liver diseases. The diagnosis of NAFLD is based on simple clinical and biological data often corroborated by a liver imaging. The main issues in the assessment of these diseases are firstly to exclude secondary causes of steatosis and secondly to establish the severity of the disease. The assessment of the severity of NAFLD implies the determination of the degree of fibrosis. Combination of biological tests and elastography allows to determine indirectly fibrosis, reserving liver biopsy for doubtful cases. Comorbidities associated with metabolic syndrome (insulin resistance and cardiovascular diseases) must be researched and screening measures for colon and breast cancers should be considered. Eventually, NASH monitoring should include, like for others chronic hepatitis, the screening for the complications of end-stage liver diseases, including portal hypertension and hepatocarcinoma.

A novel system for the improvement of colonic cleansing during colonoscopy.

Suboptimal bowel cleansing prior to colonoscopy impairs the efficacy and safety of the procedure. A new system for intracolonic cleansing has been developed, which includes a disposable catheter device that is inserted through the working channel of a standard colonoscope and an irrigation unit with predefined pressure and flow rate. The aim of the current study was to assess the safety and efficacy of this novel system for the improvement of bowel cleansing during colonoscopy. A total of 42 patients with suboptimal bowel preparation were systematically allocated, in a 1:1 ratio, to either the study group (JetPrep system, n = 21) or the control group (syringe irrigation, n = 21). The cleansing efficacy was evaluated using a segmental scoring scale to rate the bowel preparation level before and after irrigation. One patient from the study group was excluded from the efficacy analysis due to treatment with both techniques. The JetPrep system was significantly superior to syringe irrigation (P = 0.0001). No adverse events were reported. This study suggests that the safety profile of the JetPrep system is comparable to standard irrigation and shows that the device significantly improves suboptimal bowel preparation.