Rémi Dumas

Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique ☆

BACKGROUND The aim of this study was to identify factors that facilitate bilateral insertion of metal stents in malignant hilar stenoses, for which plastic stents often result in incomplete drainage and subsequent cholangitis. METHODS Between January 1994 and April 1998, we collected 45 cases of advanced (Bismuth stage II or higher) hilar malignant stenoses. The insertion technique was progressively modified and the success rate in the early period (1994 to 1995) was compared with that of a later period (1996) and the most recent period (1997 to 1998). RESULTS Overall success rate was 73.3% (33 of 45). The success rates for the three periods were 50%, 67%, and 88% (p = 0.008), respectively. Cholangitis occurred in 3 of the patients with unilateral stents compared with 1 with bilateral stents. CONCLUSION We have described a technique for endoscopic insertion of bilateral metallic stents for malignant hilar stenoses that results in high (>88%) and reproducible success rates.

A prospective national study on colonoscopy and sigmoidoscopy in 2000 in France.

AIM The aim of this study was to evaluate the practice of colonoscopy and sigmoidoscopy in France in 2000. METHODS A prospective study was conducted in November 2000 using questionnaires sent to all gastroenterologists practicing in France (N=2858) who were asked to reply to items concerning colonoscopies and sigmoidoscopies performed on two workdays chosen in advance. The response rate was 32.8%. Data were extrapolated to establish estimates for the entire year. RESULTS An estimated 894000 colonoscopies and 115320 sigmoidoscopies were performed in 2000. Single-use material was used in 22.1% of the procedures. Indications for endoscopy were mainly hematochezia (21.6%), gastrointestinal symptoms (35%) and surveillance of patients with a history of previous polypectomy (15%). Colorectal cancer screening was the indication for 20% of colonoscopies. Abnormal findings were reported for 54.8% of the endoscopies (polyps for 287218 procedures and cancer for 32799). Failure was noted in 4.9% of colonoscopies. The complication rate was 0.48%. Most polyps were adenomas (64.4%) or hyperplasic polyps (28.1%). The overall estimated number of colonoscopies with polypectomy was 224133. CONCLUSION In 2000 there was an increased rate of colonoscopy for colorectal cancer screening (20%) but an overall decrease (2.5%) in the total number of colonoscopies compared to 1999. Abnormal findings were disclosed by 54.8% of the procedures. Extrapolation from these data indicates that colonoscopic screening enabled the diagnosis of 32799 colorectal cancers.

Prevalence of Cholelithiasis (Results of an Epidemiologic Investigation in Vidauban, Southeast France)

Cholelithiasis leads to 80,000 cholecystectomiesbeing performed every year in France, but its prevalenceis still unknown. The aim of this study was to assessthe prevalence and risk factors of cholelithiasis in a random population of 1027 women and 727men over the age of 30 in a small town in the southeastof France. Detailed clinical history, dietaryinvestigation, and gallbladder ultrasound were collected for each subject and assessed by univariateanalysis. A regression model was used in themultivariate analysis to detect the relative risk ofcholelithiasis. Cholelithiasis was found in 130individuals (global prevalence 13.9%). The relative riskfor lithiasis was higher in women compared to men(1.89). Age (P < 0.0001) and body mass index (BMI)>25 (P = 0.013) were also significant risk factors. Neither pregnancy nor oral contraceptive useproved to be risk factors. Typical biliary colic painwas the only symptom significantly associated withcholelithiasis (P < 0.0001). These results show that the prevalence of gallstones in France issimilar to that in Denmark and Italy.

Totally robotic combined right hemicolectomy and nephrectomy

Combined minimally invasive procedures for the treatment of colorectal and urologic tumours are not common. The adoption of robotic-assisted laparoscopy in urology especially for prostatectomy has permitted the performance of concurrent robotic procedures with a minimal increase in morbidity. Simultaneously, there is increased interest in robotic techniques for colo-rectal resection. Previous cases of robotic-assisted laparoscopic prostatectomy combined with robotic nephrectomy [1] or with a laparoscopic hemicolectomy [2] have been reported. We present the first totally robotic combined hemicolectomy and nephrectomy. Case report

⁎4642 Plastic or metallic stents for inoperable malignant strictures of the common bile duct? results of a randomised prospective study.

The systematic use of metallic stents (MS) is hampered by their price compared to plastic stents (PS) in biliary obstruction. Aims. 1- to compare cost and efficacy of plastic stents (PS) and metallic stents (MS) in the treatment of inoperable malignant strictures of the common bile duct, 2- to define predictive factors of survival of patients with inoperable malignant biliary stricture. Patients. 118 patients (mean age 75 yrs) with an inoperable malignant stricture of the common bile duct were randomized to receive PS or MS. The characteristics of the 2 groups were comparable. Comparisons were made with chi-2 tests and survival rates compared with a Cox model. Results. There was no significant difference of survival between the 2 groups. Time for first obstruction was longer in patients with PS (median not reached vs 5 months, p=0.007). Number of additional days of hospitalization (173), of days with antibiotics (237), of ERCPs (20) and of abdominal ultrasonographies (18) were significantly higher in the group treated with PS. By multivariate analysis, 2 variables were independent prognostic factors of survival: the ASA classification (p=0.03 ; RR=1.5) and the number of liver metastases (p