To date, Lugol chromo-endoscopy is the reference technique to detect an esophageal neoplasia in patients with prior esophageal squamous-cell carcinoma (ESCC), but is not easy to perform without general anesthesia, which can limit its use in routine practice. The objective of this study were to compare the accuracy of white light, narrow band imaging (NBI), and Lugol to detect esophageal neoplasia in patients with a history of cured ESCC, in a prospective study. Thirty patients were prospectively included between June 2006 and June 2009. They all had a history of cured ESCC. Esophageal mucosa was examined first using white light, second NBI, and third after Lugol staining. Histology was obtained in all abnormalities detected by white light, NBI, and/or Lugol. Five neoplastic lesions in five different patients were identified at histology, four cancers, and one high-grade dysplasia. NBI and Lugol both detected all esophageal neoplastic lesions, whereas white light detected the four cancers but missed the high-grade dysplasia. In this feasibility study, NBI and Lugol both detected all identified esophageal neoplasia in very high-risk patients of ESCC. This result suggests that NBI could be used instead of Lugol to detect an esophageal neoplasia in patients with high risk of ESCC, but needs to be confirmed in a larger study.

Desmoplastic small round cell tumor (DSRCT) is a very rare but aggressive malignancy. It is usually observed in males during adolescent and early adulthood. The tumor primarily affects the intra-abdominal serosal and is characterized by distinctive histological and immunophenotypic features and by the specific reciprocal translocation EWS-WT1. Prognosis is mainly poor with a mean survival approximately of 2.5 years. However, long-term survivals have been reported using aggressive multimodal therapy based on complete surgical excision, systemic chemotherapy and radiotherapy. The addition of hyperthermic intraperitoneal chemotherapy in the multimodal approach has been reported in very few cases but no effect on survival has been clearly demonstrated. We report a case of a 51-year old adult patient presenting with a DSRCT treated with aggressive therapy based on systemic chemotherapy, complete cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy, resulting in a long term survival of 4 years.

Introduction: Les polypes sessiles de moins de 6mm de diamètre ne sont détectés par le colo-scanner que dans 59% des cas (1). Or, l'American Society of Cancer (ASC) recommande une surveillance précoce par coloscopie (avant 3 ans) après la résection d'un adénome colique ou rectal lorsqu'au moins un des critères suivants est présent: diamètre >1cm, multiplicité (3 adénomes ou plus), présence d'une dysplasie de haut grade ou d'un contingent villeux (2).

Les polypes sessiles de moins de 6 mm de diamètre ne sont détectés par le colo-scanner que dans 59 % des cas [1]. Or, l'American Society of Cancer (ASC) recommande une surveillance précoce par coloscopie (avant 3 ans) après la résection d'un adénome colique ou rectal lorsqu'au moins un des critères suivants est présent : diamètre > 1 cm, multiplicité (3 adénomes ou plus), présence d'une dysplasie de haut grade ou d'un contingent villeux [2]. Le but de l'étude était d'analyser la fréquence avec laquelle ces critères étaient retrouvés chez des malades ayant bénéficié de la résection d'un adénome de diamètre inférieur à 6 mm. Entre janvier 2005 et septembre 2008, 649 polypes coliques ou rectaux ont été réséqués chez 512 malades consécutifs. Parmi ces 649 polypes, 370 (57 %) étaient des adénomes. Le diamètre de ces adénomes était inférieur à 6 mm dans 177 cas (groupe 1) chez 111 malades et supérieur ou égal à 6 mm pour les 193 adénomes restants (groupe 2) chez 170 malades. La présence d'adénomes multiples (3 ou plus) chez le même malade, la présence d'une dysplasie de haut grade ou la présence à l'histologie d'un contingent villeux ont été recherchées et comparées entre les deux groupes. Pour le comptage des adénomes multiples, lorsqu'un malade présentait au moins un adénome supérieur ou égal à 6 mm de diamètre, il était classé dans le groupe 2. L'un au moins des trois critères impliquant selon l'ASC une surveillance endoscopique anticipée avant trois ans était présent chez 25 % des malades ayant un adénome < à 6 mm de diamètre (28/111 malades). Un contingent villeux était significativement plus fréquent dans le groupe 2 (p < 0,001), il existait cependant dans 16,4 % des cas dans le groupe 1. Une dysplasie de haut grade, plus fréquente dans le groupe 2 (p = 0,007), existait également dans 4 % des cas dans le groupe 1. La présence d'au moins 3 adénomes était similaire dans les deux groupes de malades (13,5 % vs 10 % ; p = 0,3). Un cancer était retrouvé chez 13 malades du groupe 2 contre aucun dans le groupe 1 (0 % vs 7,6 % ; p = 0,002). Une dysplasie de bas grade était retrouvée avec une fréquence non différente dans les 2 groupes (51,4 vs 56,5 %, p = 0,4). Un quart des patients ayant un adénome colique ou rectal de moins de 6 mm de diamètre ont au moins un des critères définis par l'ASC pour proposer un contrôle endoscopique à moins de 3 ans. La non détection dans près d'un cas sur deux de ces adénomes < 6 mm par le colo-scanner (1) suggère que cette technique sous-estime la population nécessitant une surveillance endoscopique rapprchée.

Introduction: La mucosectomie endoscopique (ME) est le traitement le plus habituel des polypes plans ou des volumineux polypes sessiles rectaux ou coliques. But: évaluer la faisabilité, les caractéristiques techniques, les résultats et les complications de la ME dans une grande série de polypes rectaux ou coliques.

BACKGROUND AND STUDY AIMS:Celiac disease can manifest with nonspecific symptoms, including functional gastrointestinal disorders such as dyspepsia. The aim of our study was to assess the usefulness of duodenal endoscopic markers of villous atrophy for the selection of dyspeptic patients for histological assessment.PATIENTS AND METHODS:Esophagogastroduodenoscopy was performed in dyspeptic patients, in patients considered to be at risk of having celiac disease, and in healthy controls. At least three duodenal biopsies were performed for histological assessment of villous atrophy in all patients and controls. We looked for the following four duodenal endoscopic markers of celiac disease: reduction in the number of folds, scalloping of folds, mosaic-pattern mucosa, and nodular mucosa.RESULTS:A total of 175 people were enrolled (75 patients with dyspepsia; 75 patients who were "at risk" of having celiac disease; and 25 healthy volunteers, or "controls"). Of the dyspeptic patients, four had endoscopic markers of celiac disease with no histologically confirmed villous atrophy, while one patient without endoscopic markers was found to have Marsh type I villous atrophy. Of the patients at risk of having celiac disease, 16 had at least one endoscopic marker and 10/16 were found to have histological villous atrophy. In this group, the sensitivity and specificity of the endoscopic markers were 100 % and 90.8 % respectively. "At-risk" patients with two or more endoscopic markers all had histologically confirmed villous atrophy. Neither endoscopic markers nor villous atrophy were found in any of the control patients.CONCLUSIONS:Additional endoscopic markers are valuable for diagnosis in patients with clinical symptoms suggestive of celiac disease. In contrast, endoscopic markers of villous atrophy are not useful for selecting a subgroup of dyspeptic patients for screening for celiac disease by duodenal histological assessment. These patients should be screened using other protocols.

La microscopie confocale permet d'obtenir des images tissulaires/cellulaires in vivo. Cette technologie a été récemment appliquée à l'endoscopie digestive. Nous rapportons notre expérience préliminaire d'une étude ex vivo utilisant un prototype (Mauna Kea Technologies, Paris, France) en cours de développement.

Background: A prospective 1-year study was conducted to assess the frequency, clinical spectrum, histologic description, and follow-up of acute esophageal necrosis unrelated to ingestion of caustic or corrosive agents.Methods: The diagnosis of acute esophageal necrosis was based on a diffusely black esophagus at endoscopy and typical histologic features of diffuse mucosal and submucosal necrosis. Ingestion of caustic and corrosive agents was excluded in all patients. Medical history, associated diseases, and clinical symptoms were recorded for each patient. Nutritional status was evaluated based on clinical and biochemical parameters. Treatment included short-term parenteral nutrition and intravenous administration of a pump proton inhibitor. A second endoscopy was performed when possible at 2 weeks after presentation to assess regression of acute esophageal necrosis.Results: Among 3900 patients who underwent EGD, 1; (0.2%) with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. No esophageal strictures appeared during follow-up. Four patients died, but no death was directly related to acute esophageal necrosis.Conclusion: Acute esophageal necrosis is not as infrequent an endoscopic finding as has been reported. Acute esophageal necrosis appears to be associated with poor general health status and is not a purely local phenomenon.

Aim: We prospectively evaluated prevalence, clinical spectrum, and histological description of acute esophageal necrosis (AEN).Methods: The study was conducted from October 1999 to September 2000.Diagnosis of AEN was based on a black esophagus that always ending sharply at the Z-line on endoscopy.Patients who had history of caustic or corrosive agent's intake were excluded from the study.For each patient medical past, clinical symptoms, associated diseases, hemodynamic parameters, routine blood test were registered.Nutritional status was evaluated (weight of loss, plasmatic albumin rate).Multiple esophageal biopsy samples were taken if allowed by coagulation test.A clinical follow up was made and a second endoscopy was performed at 2 weeks.Results: Eight patients were included in the study.The prevalence of AEN was evaluated according to the number of upper GI endoscopy (n=3900)performed during this oneyear study in our university hospital.This prevalence was 0.2%.Mean age was 67,7 years (range 21 to 89).A male predominance was founded (M/F:7/1).Fast medical history of patients included cancer (n=4), diabetes mellitus (n=3), liver cirrhosis (n=2).Presenting symptoms were an upper gastrointestinal bleeding (n=6) or an epigastric pain (n=l).Only one patient was symptom free.At the time of diagnosis, hemodynamic failure was observed in 3 cases, acute renal failure in 5 and anemia in 4 cases.Nutritional status impairment was recorded in 6 patients.Biopsy samples from the esophagus were obtained in 5 patients.Histelogic examination showed mucosa and submucosa necrosis in all patients.Vascular thrombosis were observed in 3 patients and a partial destruction of muscular layer in one.Stains and culture were negative for viral inclusion, and one patient had a mycotic over infection.The mean follow-up was 14 weeks (range 1 to 25).Total regression of the symptoms without further recurrence were seen in 4 patients, associated with a complete resolution of AEN at the second endoscopy.No esophageal stricture appeared during the fonow-up.Four patients died but no death were related to/kEN.Conclusion: AEN is probably a more frequent endoscopic finding that usually supposed.Although its pathegenesis remains unclear, AEN seems to be a complication of a general illness with poor general status and malnutrition, and not only a local phenomenon.

Aim: We prospectively evaluated prevalence, clinical spectrum, and histological description of acute esophageal necrosis (AEN).Methods: The study was conducted from October 1999 to September 2000.Diagnosis of AEN was based on a black esophagus that always ending sharply at the Z-line on endoscopy.Patients who had history of caustic or corrosive agent's intake were excluded from the study.For each patient medical past, clinical symptoms, associated diseases, hemodynamic parameters, routine blood test were registered.Nutritional status was evaluated (weight of loss, plasmatic albumin rate).Multiple esophageal biopsy samples were taken if allowed by coagulation test.A clinical follow up was made and a second endoscopy was performed at 2 weeks.Results: Eight patients were included in the study.The prevalence of AEN was evaluated according to the number of upper GI endoscopy (n=3900)performed during this oneyear study in our university hospital.This prevalence was 0.2%.Mean age was 67,7 years (range 21 to 89).A male predominance was founded (M/F:7/1).Fast medical history of patients included cancer (n=4), diabetes mellitus (n=3), liver cirrhosis (n=2).Presenting symptoms were an upper gastrointestinal bleeding (n=6) or an epigastric pain (n=l).Only one patient was symptom free.At the time of diagnosis, hemodynamic failure was observed in 3 cases, acute renal failure in 5 and anemia in 4 cases.Nutritional status impairment was recorded in 6 patients.Biopsy samples from the esophagus were obtained in 5 patients.Histelogic examination showed mucosa and submucosa necrosis in all patients.Vascular thrombosis were observed in 3 patients and a partial destruction of muscular layer in one.Stains and culture were negative for viral inclusion, and one patient had a mycotic over infection.The mean follow-up was 14 weeks (range 1 to 25).Total regression of the symptoms without further recurrence were seen in 4 patients, associated with a complete resolution of AEN at the second endoscopy.No esophageal stricture appeared during the fonow-up.Four patients died but no death were related to/kEN.Conclusion: AEN is probably a more frequent endoscopic finding that usually supposed.Although its pathegenesis remains unclear, AEN seems to be a complication of a general illness with poor general status and malnutrition, and not only a local phenomenon.

Aim: We prospectively evaluated prevalence, clinical spectrum, and histological description of acute esophageal necrosis (AEN).Methods: The study was conducted from October 1999 to September 2000.Diagnosis of AEN was based on a black esophagus that always ending sharply at the Z-line on endoscopy.Patients who had history of caustic or corrosive agent's intake were excluded from the study.For each patient medical past, clinical symptoms, associated diseases, hemodynamic parameters, routine blood test were registered.Nutritional status was evaluated (weight of loss, plasmatic albumin rate).Multiple esophageal biopsy samples were taken if allowed by coagulation test.A clinical follow up was made and a second endoscopy was performed at 2 weeks.Results: Eight patients were included in the study.The prevalence of AEN was evaluated according to the number of upper GI endoscopy (n=3900)performed during this oneyear study in our university hospital.This prevalence was 0.2%.Mean age was 67,7 years (range 21 to 89).A male predominance was founded (M/F:7/1).Fast medical history of patients included cancer (n=4), diabetes mellitus (n=3), liver cirrhosis (n=2).Presenting symptoms were an upper gastrointestinal bleeding (n=6) or an epigastric pain (n=l).Only one patient was symptom free.At the time of diagnosis, hemodynamic failure was observed in 3 cases, acute renal failure in 5 and anemia in 4 cases.Nutritional status impairment was recorded in 6 patients.Biopsy samples from the esophagus were obtained in 5 patients.Histelogic examination showed mucosa and submucosa necrosis in all patients.Vascular thrombosis were observed in 3 patients and a partial destruction of muscular layer in one.Stains and culture were negative for viral inclusion, and one patient had a mycotic over infection.The mean follow-up was 14 weeks (range 1 to 25).Total regression of the symptoms without further recurrence were seen in 4 patients, associated with a complete resolution of AEN at the second endoscopy.No esophageal stricture appeared during the fonow-up.Four patients died but no death were related to/kEN.Conclusion: AEN is probably a more frequent endoscopic finding that usually supposed.Although its pathegenesis remains unclear, AEN seems to be a complication of a general illness with poor general status and malnutrition, and not only a local phenomenon.