[Does Barrett esophagus regress after total duodenal diversion?]. / L'endobrachyoesophage régresse-t-il après diversion duodénale totale?

The outcome of Barrett's esophagus was evaluated in 21 patients who prospectively underwent total duodenal diversion and followed from 13 to 86 months. The total duodenal diversion procedure included troncular vagotomy, antrectomy and Roux-en-Y reconstruction incorporating a 70 cm loop. The diagnosis of Barrett's esophagus was made on endoscopy when a circular zone of columnar epithelium more than 3 cm long was found and was always corroborated by biopsies. All patients had esophagitis on endoscopy or acid reflux on pH-monitoring. During follow-up, for all cases, no esophagitis and no bile were detected in the stomach by successive endoscopies; none of the 16 pH-studies showed any aggressive reflux. The length of Barrett's esophagus was measured before and after Roux-en-Y duodenal diversion. In spite of the suppression of gastroesophageal reflux, regression of Barrett's esophagus was observed in one case only beginning 24 months after the diversion. No cases of adenocarcinoma or dysplasia were detected. In conclusion, regression of Barrett's esophagus is exceptional even after duodenal diversion.

[Granular cell tumors of the esophagus. 5 cases]. / Tumeurs à cellules granuleuses de l'oesophage. Cinq observations.

The authors report 5 new cases (3 women, 2 men) of granular cell tumours of the oesophagus. Two patients were treated by endoscopic resection with a diathermy loop, two patients underwent surgical ablation and the other tumour was discovered at autopsy. There were no complications related to treatment and there have been no recurrences to date. Endoscopic resection of these tumours would seem to be the treatment of choice when their size is less than 30 mm.

[Adenomatous lesions of the papilla in familial adenomatous rectocolic polyposis. Value of duodenoscopy]. / Les lésions adénomateuses de la papille dans les polyposes adénomateuses recto-coliques familiales. Intérêt de la duodénoscopie.

When compared to the general population, individuals with Gardner's syndrome may have a 100- to 200-fold increased risk of developing periampullary carcinoma. This prospective work was undertaken in order to study the endoscopic aspects and to perform biopsies of the papilla in 9 patients (7 males, 2 females, aged 18-65 years) with familial polyposis coli or Gardner syndrome. In 4 cases the papilla was endoscopically grossly polypoid and biopsies showed adenomatous lesions. In 5 cases, the papilla appeared endoscopically normal; in 2 cases, the papilla appeared endoscopically normal; in 2 of these cases biopsies showed adenomatous proliferation; in the 3 other cases, the biopsies were normal. In 5 cases, there were adenomatous duodenal lesions outside the papilla. These results suggest that: a) adenomatous lesions of the papilla are frequent in familial polyposis coli and Gardner's syndrome; b) the endoscopic gross aspect of the papilla may be normal even when there are adenomatous lesions; c) adenomatous lesions of the papilla may be associated or not with adenomatous lesions of the 2nd duodenum; d) as the natural history of these lesions is not known and because of the risk of cancer of Vater's ampulla, it seems reasonable to perform routine duodenoscopies with biopsies in order to ensure early diagnosis of cancer.

[Tumoral extension by inversion of the lymphatic flow in colonic cancer]. / Extension tumorale par inversion du courant lymphatique au cours d'un cancer colique

In a patient with an adenocarcinoma of the ascending colon, the jejunal central villous lymphatics were dilated and contained tumour cells. This case, apparently the only one of its type, demonstrates the proof of a phenomenon sometimes described in connection with malignant diseases, but rarely proven; that of the dissemination of tumour cells by reversal of lymphatic flow.

[Encapsulating peri-hepatitis. Apropos of 4 cases]. / La périhépatite encapsulante. A propos de quatre observations

The authors report 4 cases of encapsulating peri-hepatitis, including an angiographic study. Selective arteriography of the coeliac trunk showed extremely sinuous intra-hepatic arteries in 3 of these cases, and obstruction of the portal vein, in one case. Catheterisation of the hepatic veins showed a pressure gradient between the obstructed hepatic vein and the free supra-hepatic pressure, showing a post-sinusoidal block. In 2 of the 4 cases, ascites was chylous. Lymphography carried out via lymphatics in the foot was negative in 3 cases where it was carried out. One case showed, on two successive laparoscopies, that micro-nodular cirrhosis was present before the development of encapsulating peri-hepatitis.