Endoscopic submucosal dissection (ESD) is the method of choice for “en-bloc” resection of superficial tumors. European countries are late in implementing this method, and current guidelines recommend training on animal models. The objective of our study was to prospectively evaluate the efficiency of an ESD training course using live anaesthetized pigs.

Narrow-Band Imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect oesophageal squamous cell carcinoma (SCC) and appears more specific than Lugol chromoendoscopy in expert centres but its specificity in current practice is not known. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy to detect oesophageal SCC and high-grade dysplasia (HGD) in current practice (including tertiary care centres, local hospitals and private clinics).

Le Narrow-Band Imaging (NBI) est aussi sensible que le Lugol pour la détection du cancer épidermoïde de l'oesophage (CEO). Le NBI apparaît néanmoins plus spécifique que le Lugol dans les centres experts mais des données dans les centres de gastro-entérologie (incluant des centres non experts) sont manquantes. Nous avons mené une étude multicentrique, randomisée, prospective comparant la spécificité du Lugol et du NBI dans la détection des CEO et des dysplasies de haut grade (DHG) en pratique quotidienne (centres experts et non experts).

La dissection sous muqueuse (DSM), développée et maitrisée depuis longtemps dans les pays asiatiques, est la méthode de choix pour la résection monobloc de lésions tumorales superficielles. Les pays européens rattrapent petit à petit leur retard dans la maîtrise de cette technique. Les recommandations actuelles préconisent un apprentissage multi-étapes de la technique, dont une partie sur modèle animal. L'objectif de notre étude était d'évaluer prospectivement l'efficacité de sessions d'entrainement à la DSM gastrique sur un modèle de cochon vivant anesthésié.

The role of human papillomavirus (HPV) in Barrett's esophagus (BE) has been examined but remains unclear. The purpose of the study is to dispute the connection between HPV and BE in a prospective case-control study. Biopsies were performed above and inside the Barrett's segment for BE patients and in the distal third of the esophagus for control patients for histological interpretation and for virological analysis. Biopsies for virological analysis were placed in a virus transport medium and immediately frozen in liquid nitrogen. Virological analysis involved real-time PCR using the SyBr® green protocol with modified SPF10 general primers. A total of 180 patients (119 control and 61 BE, respectively) were included. In BE patients, 31, 18, and 12 patients had, respectively, no dysplasia, low-grade dysplasia, and high grade dysplasia. Overall, nine were found to be HPV positive: five were control patients and four BE patients. HPV positive status was not associated with BE. No factors were associated with HPV, in particular the degree of BE dysplasia. HPV infection appears unlikely to be significant in the etiology of BE compared with control patients. (ClinicalTrials.gov, Number NCT02549053).

legend N2D N1D 2LPEG N2D vs. 2LPEG N1D vs. 2LPEG EFFICACY Primary analysis set, n1⁄4 275 Primary analysis set, n1⁄4 275 Primary analysis set, n1⁄4 272 Primary endpoint: Patients with successful overall bowel cleansing efficacy (HCS) [n] 253 (92.0%) 245 (89.1%) 238 (87.5%) -4.00%* [0.055] -6.91%* [0.328] Supportive secondary endpoint: Patients with successful overall bowel cleansing efficacy (BBPS) [n] 249 (90.5%) 243 (88.4%) 232 (85.3%) n.a. n.a. Primary endpoint: Excellent plus Good cleansing rate in colon ascendens (primary analysis set) [n] 87 (31.6%) 93 (33.8%) 41 (15.1%) 8.11%* [50.001] 10.32%* [50.001] Key secondary endpoint: Adenoma detection rate, colon ascendens 11.6% 11.6% 8.1% -4.80%; 12.00%** [0.106] -4.80%; 12.00%** [0.106] Key secondary endpoint: Adenoma detection rate, overall colon 26.6% 27.6% 26.8% -8.47%; 8.02%** [0.569] -7.65%; 9.11%** [0.455] Key secondary endpoint: Polyp detection rate, colon ascendens 23.3% 18.6% 16.2% -1.41%; 15.47%** [0.024] -6.12%; 10.82%** [0.268] Key secondary endpoint: Polyp detection rate, overall colon 44.0% 45.1% 44.5% -8.85%; 8.00%** [0.579] –7.78%; 9.09%** [0.478] Compliance rates (min 75% of both doses taken) [n] 235 (85.5%) 233 (84.7%) 245 (90.1%) n.a. n.a. SAFETY Safety set, n1⁄4 262 Safety set, n1⁄4 269 Safety set, n1⁄4 263 All treatment-emergent adverse events [n] 77 89 53 n.a. n.a. Patients with any related treatment-emergent adverse event [n] 30 (11.5%) 40 (14.9%) 20 (7.6%) n.a. n.a. *1⁄4 97.5% 1-sided CI; **1⁄4 95% 2-sided CI; n.a.1⁄4 not applicable. United European Gastroenterology Journal 4(5S) A219

La radiofréquence de l’œsophage (RFO) est un traitement endoscopique disponible dans la palette des méthodes de traitement endoscopique de l’œsophage de Barrett (OB). Son efficacité et faible morbidité de gravité modérée ont été démontrées dans des études prospectives et/ou randomisées.

Objective Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training. Design Nationwide multicentre trial. Setting Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case. Patients The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset. Interventions Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results. Main outcome measures Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection. Results Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥6 mm in the training set was the only remaining significant predictive factor for subsequent performance. Conclusions Radiologist sensitivity CTC for detection of polyps ≥6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.

Introduction: L'endomicroscopie confocale utilise une excitation en lumière bleue et collecte une lumière en fluorescence produite par des fluophores captés par un détecteur à balayage permettant de générer des images microscopiques de muqueuse digestive. But: tester une nouvelle technique d'endomicroscopie confocale par minisonde (Cellvizio®-GI) chez des patients sélectionnés présentant un EBO.

Connaître les techniques actuelles d’exploration du côlon. Connaître les différentes pathologies coliques explorables en imagerie. Comprendre les apports diagnostiques de chaque type d’examen. L’approche radiologique des pathologies coliques s’est considérablement modifiée ces dernières années et la tomodensitométrie est devenue l’examen de prédilection pour l’étude du côlon. Le lavement baryté n’a pratiquement plus d’indication. Les pathologies coliques infectieuses, inflammatoires ou vasculaires peuvent avoir un aspect peu spécifique en imagerie. La pathologie tumorale est correctement explorée en TDM. La tomodensitométrie permet une exploration de la totalité de la paroi colique mais également de son environnement mésentérique et des organes de la cavité péritonéale. Une distension de la lumière colique par de l’eau, du gaz ou un produit de contraste hydrosoluble permet une exploration spécifique des anomalies coliques. L’étude de la paroi colique permet d’orienter le diagnostic des pathologies infectieuses, inflammatoires ou vasculaires, le plus souvent explorées en situation aiguë. La coloscopie virtuelle ou le coloscanner à l’eau permettent une étude adaptée des tumeurs coliques.

Rationnel: La mucosectomie endoscopique est efficace pour des lésions <2cm – une résection en monobloc est possible permettant une analyse histologique complète. La résection des lésions >2cm est possible par la technique de fragmentation ou la dissection de la sous muqueuse (ESD). La technique par fragmentation reste controversée car elle expose aux risques de laisser en place des fragments pathologiques et l'analyse histologique des marges latérales des pièces/fragments est non interprétable.

Introduction: l'alternative à l'oesophagectomie pour le traitement de l'EBO avec DHG et/ou cancer superficiel est le traitement endoscopique à condition de pouvoir obtenir l'éradication complète de l'EBO; en cas d'EBO long et circulaire, le protocole thérapeutique idéal reste à préciser. Le but de cette étude est de présenter notre expérience d'une bi et trithérapie séquentielle.

Introduction: To correlate findings at high-resolution MR and endoscopic US (EUS) for preoperative loco-regional staging of rectal carcinoma.Patients and Methods: Fifty-two patients with rectal carcinoma underwent high-resolution MR imaging. Only 43 of these patients underwent EUS due to technical limitations and stenosing carcinomas. Morphological imaging features and TNM staging were evaluated for both imaging modalities. The degree of correlation and accuracy were calculated for both.Results: The correlation between MR and EUS was good for tumor length and thickness (r=0.7 and 0.61) for for nodal (N) staging (k =0.53). Correlation was good for T1 and T2 stages (k=0.51) and T3 stage (k=0.43) and very poor for stage 4 (k=-0.09), because no T4 lesion was detected at EUS. 81.8% of patients where T stage was over-estimated on MRI and 100% of patients where T stage was over-estimade on EUS had received preoperative radiation therapy. Therefore, results should be interpretated with caution. The predictive evaluation of tumor resectability (absence of perirectal fascia invasion) with a circumferential margin on MR >= 5 mm was 93%.Conclusion: Correlation between MR and EUS was moderate for T staging, because of limitations of EUS for large tumors. Results confirm that high-resolution MRI is useful for loco-regional staging of rectal carcinoma, especially for large tumors. EUS should be limited to the valuation of superficial tumors of the rectum.

INTRODUCTION:To correlate findings at high-resolution MR and endoscopic US (EUS) for preoperative loco-regional staging of rectal carcinoma.PATIENTS AND METHODS:Fifty-two patients with rectal carcinoma underwent high-resolution MR imaging. Only 43 of these patients underwent EUS due to technical limitations and stenosing carcinomas. Morphological imaging features and TNM staging were evaluated for both imaging modalities. The degree of correlation and accuracy were calculated for both.RESULTS:The correlation between MR and EUS was good for tumor length and thickness (r=0.7 and 0.61) for for nodal (N) staging (k=0.53). Correlation was good for T1 and T2 stages (k=0.51) and T3 stage (k=0.43) and very poor for stage 4 (k= -0.09), because no T4 lesion was detected at EUS. 81.8% of patients where T stage was over-estimated on MRI and 100% of patients where T stage was over-estimated on EUS had received preoperative radiation therapy. Therefore, results should be interpreted with caution. The predictive evaluation of tumor resectability (absence of perirectal fascia invasion) with a circumferential margin on MR> or =5 mm was 93%.CONCLUSION:Correlation between MR and EUS was moderate for T staging, because of limitations of EUS for large tumors. Results confirm that high-resolution MRI is useful for loco-regional staging of rectal carcinoma, especially for large tumors. EUS should be limited to the valuation of superficial tumors of the rectum.

12029 Background: Optimizing drug delivery based on pharmacokinetic data is an important research issue. Previous studies have demonstrated a pharmacological advantage for infusions of G with a fixed dose rate to maximize cellular accumulation of G active metabolite (GTP), despite high interindividual PK variability. Methods: To develop a PK-guided G dosing schedule, we conducted an intra-pt G DE trial to determine: (1) maximum tolerated dose level (MTD) and dose-limiting toxicity (DLT), (2) plasma G and peripheral mononuclear cell GTP post-infusion levels. G was administered over 150 min on day 1, 8 and 15, q4w. The initial dose level (DL) was 1000 mg/m2, escalated by 250 mg/m2 every cycle (cy) if no limiting toxicity occurred. Results: From 09/2003, 30 pts entered the study. Pts’ characteristics: 16 men/14 women; median age 66 years (49–81); tumor type: pancreas (10 pts), lung (7 pts), others (13 pts); prior chemotherapy (15 pts). A total of 109 cy were given (median: 3 cy/pt). Tolerance: Number of pts/DL: DL1 = 7 pts, DL2 = 5 pts, DL3 = 11 pts, DL4 = 5 pts, DL5 = 2 pts. Main reasons for stopping DE were: disease progression/early death (15 pts), DLT (4 pts), investigator’s decision (8 pts). DLT were: haematological (1 pt), asthenia (2 pts) and infection (1 pt). Most common grade (gr) 1–2/3–4 toxicities (% cy) included: nausea/vomiting (38%/2%), asthenia (56%/11%), neutropenia (29%/27%) and thrombocytopenia (42%/1%). Activity: 26 pts are evaluable (radiological assessment every 3 cycles) showing 5 partial response (2 unconfirmed), 7 stabilization and 14 progression. Conclusions: The main reason for DE failure was early progression, stressing the importance of an early individual dose adjustment. PK and PK/PD correlation analyses are ongoing to confirm our hypothesis. No significant financial relationships to disclose.