BACKGROUND AND AIMS:Barrett's esophagus (BE) is a common precancerous condition requiring surveillance or treatment at various stages. Low-grade dysplasia (LGD) increases the risk of progression to high-grade dysplasia or esophageal adenocarcinoma, but histopathological assessment is challenging, and progression is unpredictable. Endoscopic resection, through mucosal or submucosal techniques, offers high efficacy, low adverse event rates, and shorter treatment duration. This study evaluated the effectiveness and safety of endoscopic eradication therapy in patients with LGD BE. METHODS:This retrospective study included 119 patients with LGD BE treated at 3 tertiary centers. Patients underwent endoscopic mucosal resection (EMR) or, for nodular or retractile lesions, endoscopic submucosal dissection (ESD). The primary outcome was complete LGD eradication (CE-D), confirmed endoscopically and histologically. Secondary outcomes included adverse events, histopathology of resected specimens, treatment duration, and recurrence rates. RESULTS:Of the 119 patients (75% men; mean age 62 years), EMR was performed in 97% and ESD in 97.5% cases. LGD was confirmed by 2 different pathologists in 87% and by repeat biopsy in 70% before treatment. CE-D was achieved in 95% of patients. Histopathology revealed LGD in 50%, high-grade dysplasia in 9%, adenocarcinoma in 3%, and nondysplastic findings in others. Early adverse events occurred in 2.5%, and late adverse events in 12%, all managed conservatively or endoscopically. LGD recurred in 10% of patients over a median follow-up of 905 days. CONCLUSIONS:Endoscopic therapy with EMR or ESD appears effective and safe for selected patients with LGD in BE, with low recurrence rates. In addition to lesion eradication, it provides histological assessment, allowing detection of more advanced pathology in some cases. These findings suggest that resection may represent a valuable adjunct or alternative within current treatment strategies.
The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS). This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and 2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS. There were 101 patients with CPR after chemotherapy (n = 58, 57.4
Pancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE. Retrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity. 27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33
BACKGROUND & AIMS:Whether the dynamics of non-invasive tests (NITs) correlate with hepatocellular carcinoma (HCC) risk in patients with cirrhosis following sustained virological response (SVR) remains unknown. Thus, we aimed to describe NIT dynamics and assess their correlation with HCC risk. METHODS:The dynamics of NITs (fibrosis-4 index [FIB-4], aspartate aminotransferase-to-platelet ratio index [APRI] and liver stiffness measurement) were described in patients with cirrhosis after SVR included in two prospective French multicenter cohorts (ANRS CO22 Hepather and CO12 CirVir) between 2006 and 2015. To assess their relationship with the risk of HCC, a joint modeling approach was employed using both standard and flexible models adjusted for age and sex. The impacts of NIT current value and slope during follow-up on HCC risk were assessed, considering competing risks of death. RESULTS:A total of 3,067 patients with cirrhosis who achieved SVR were analyzed, among whom 228 (7.4%) developed HCC and 210 (6.9%) died during a 26-month follow-up. All NITs were increased at baseline in patients who ultimately developed HCC, whereas platelet counts were lower. All NITs improved in patients who did not develop HCC. More varied changes were observed during the follow-up of patients who ultimately developed HCC. Joint model analyses showed that current values of FIB-4, APRI and platelet count at any time impacted HCC risk. Only FIB-4 and APRI slopes influenced the same outcome. When considering NIT current value and slope simultaneously, only the current value of NITs impacted HCC risk while the slopes were not informative. CONCLUSIONS:The dynamics of NITs following SVR do not identify patients with cirrhosis who could be safely excluded from surveillance programs. NIT current value is more informative than slope, which will necessitate regularly re-assessment of HCC risk to design individualized surveillance strategies. IMPACT AND IMPLICATIONS:It has been postulated that monitoring non-invasive test (NIT) dynamics following HCV cure may provide information on the residual risk of hepatocellular carcinoma (HCC) in patients with cirrhosis and may allow for the discontinuation of surveillance in certain patient subsets. We analyzed data from over 3,000 patients and found that while all NITs improved in patients with cirrhosis who did not develop HCC, those who eventually developed liver cancer showed more varied changes in these tests. Specifically, the current values of tests like FIB-4 (fibrosis-4 index) and APRI (aspartate aminotransferase-to-platelet ratio index) were linked to an increased risk of HCC, while their slopes did not provide additional useful information, suggesting that dedicated prospective studies are warranted to define how repeated measurement of NITs could be combined with other variables into HCC risk stratification algorithms. Until then, HCC surveillance should be maintained in all patients with cirrhosis following HCV eradication, even in case of decreased NIT values.
