Ammar Oudjit

CT antegrade colonography to assess proctectomy and temporary diverting ileostomy complications before early ileostomy takedown in patients with low rectal endometriosis.

OBJECTIVE The purpose of this study is to describe an imaging method based on a CT technique, CT antegrade colonography, for the evaluation of low anastomosis and to evaluate the value of CT antegrade colonography before early ileostomy closure after proctectomy in low rectal endometriosis. MATERIALS AND METHODS One hundred ninety-five patients referred for low rectal endometriosis underwent proctectomy and were eligible for early ileostomy closure. All patients underwent standard antegrade fluoroscopy (n=77) or CT antegrade colonography (n=118) 8 days after surgery. The negative predictive values, positive predictive values, sensitivity, specificity, and likelihood ratio of standard antegrade fluoroscopy and CT antegrade colonography in detecting anastomotic leakage and abscesses were assessed. The reference standard for positive and negative examinations was based on clinical follow-up, imaging, surgical, or interventional procedure findings. RESULTS Negative and positive predictive values for detecting anastomotic leakage were 100% (95% CI, 96.8-100%) and 100% (95% CI, 39.8-100%), respectively, for CT antegrade colonography and 98.6% (95% CI, 92.4-100%) and 100% (95% CI, 54.1-100%), respectively, for standard antegrade fluoroscopy. The negative and positive predictive values for detecting abscess were 100% (95% CI, 96.8-100%) and 100% (95% CI, 47.8-100%), respectively, for CT antegrade colonography and 97.3% (95% CI, 90.8-99.7%) and 100% (95% CI, 2.5-100%), respectively, for standard antegrade fluoroscopy. CONCLUSION CT antegrade colonography may play a major role in the evaluation of low anastomosis protected by an ileostomy after proctectomy in low rectal endometriosis, leading to the development of a new strategy with early restoration of the intestinal continuity.

Gastric emptying evaluation by ultrasound prior colonoscopy: An easy tool following bowel preparation

AIM To investigate the gastric emptying after bowel preparation to allow general anaesthesia. METHODS A prospective, non-comparative, and non-randomized trial was performed and registered on Eudra CT database (2011-002953-80) and on www.trial.gov (NCT01398098). All patients had a validated indication for colonoscopy and a preparation using sodium phosphate (NaP) tablets. The day of the procedure, patients took 4 tablets with 250 mL of water every 15 min, three times. The gastric volume was estimated every 15 min from computed antral surfaces and weight according to the formula of Perlas et al (Anesthesiology, 2009). Colonoscopy was performed within the 6 h following the last intake. RESULTS Thirty patients were prospectively included in the study from November 2011 to May 2012. The maximum volume of the antrum was 212 mL, achieved 15 min after the last intake. 24%, 67% and 92% of subjects had an antral volume below 20 mL at 60, 120 and 150 min, respectively. 81% of patients had a Boston score equal to 2 or 3 in each colonic segment. No adverse events leading to treatment discontinuation were reported. CONCLUSION Gastric volume evaluation appeared to be a simple and reliable method for the assessment of gastric emptying. Data allow considering the NaP tablets bowel preparation in the morning of the procedure and confirming that gastric emptying is achieved after two hours, allowing general anaesthesia.

A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer

Case report A 59 year-old man was admitted in our department for abdominal pain, vomiting and general condition deterioration. He had no stool since two days and his abdomen was clinically distended. The patient had an advanced gallbladder cancer with synchronous peritoneal and hepatic metastases, and was treated since 12 months with a gemcitabine-based chemotherapy with partial response according to the RECIST criteria. We suspected an occlusive syndrome due to progression of the peritoneal carcinomatosis and also performed a computed tomography (CT) scan. The CT scan confirmed the occlusive syndrome with a colon dilatation and failed to identify a disease progression. Meanwhile, abdominal imaging found the migration of a large gallstone from the gallbladder to the colon due to

Tumour growth increased following antiangiogenic interruption: the challenge of tumour evaluation

Vascular endothelial growth factor inhibitors, led by bevacizumab, are considered the cornerstone of the therapy in metastatic colorectal carcinoma. We present the case of a patient with metastatic colorectal cancer who experienced rapid tumour growth with liver broad invasion after the withdrawal of an antivascular endothelial growth factor therapy, aflibercept. The rebound effect caused by the residual tumour inducing a regrowth after an initial controlled disease has already been stressed in mice and metastatic colorectal cancer patients following bevacizumab interruption. The use of liver volume evaluation was consistent with the Response Evaluation Criteria in Solid Tumours 1.1 criteria evaluation and might be a useful tool in patients with more than a half liver invasion. We describe for the first time the case of a major liver disease progression, confirmed by Response Evaluation Criteria in Solid Tumours 1.1 criteria and liver volume evaluation, after an antiangiogenic interruption in second line.

Alternatives à la coloscopie, état des lieux en 2009

La coloscopie optique standard est l’examen de reference pour l’exploration du colon. Sa morbidite et son acceptabilite mediocre ont entraine le developpement de techniques alternatives. L’imagerie du colon, en particulier le coloscanner, a beneficie d’un nombre considerable de travaux. La sensibilite et la specificite pour la detection de polypes superieurs a 9 mm sont respectivement de 85 et de 97 % selon la meta-analyse de Mulhall et al. Le caractere irradiant de cette technique ferait preferer la colo-IRM, technique apparue plus recemment, pour laquelle les travaux sont moins nombreux. Par ailleurs, la technologie de la videocapsule du grele a ete adaptee a l’etude du colon. Les resultats de la videocapsule colique sont prometteurs : une etude multicentrique europeenne portant sur 320 patients retrouvait des valeurs de sensibilite, specificite, VPP et VPN respectivement de 64, 84, 60 et 86 % pour la detection de polypes superieurs a 6 mm. Aucune complication severe n’avait ete observee. Enfin, des ameliorations du coloscope classique ont ete recherchees : Aer-O-Scope™, Invendoscope™, coloscope CathCam™, systeme endoscopique NeoGuide™, etc. Ces coloscopes « alternatifs » n’en sont qu’a leurs balbutiements. Les caracteristiques de ces methodes d’exploration du colon sont tres differentes d’une technique a l’autre, et leur place et leurs indications respectives restent a definir.