Les perforations duodénales sont rares et associées à une mortalité élevée qui augmente jusqu’à 30 -50 % en cas de péritonite associée. Les étiologies les plus fréquentes sont l’ulcère, les fistules postopératoires, les perforations endoscopiques ou encore les traumatismes. La difficulté de prise en charge de cette pathologie réside dans le fait qu’une résection-anastomose n’est souvent pas réalisable et que la mise en stomie n’est pas possible. La prise en charge, adaptée au cas par cas, doit être toujours médicale, souvent endoscopique et parfois chirurgicale. En effet, cette dernière option est possible chez les patients sélectionnés, diagnostiqués précocement et sans complications. Les gestes chirurgicaux sont classés en 2 catégories : les procédés de reconstruction, lorsque la résection de la perforation et le rétablissement de la continuité digestive sont possibles, sont à privilégier et nécessitent des conditions locales et hémodynamiques favorables ; les procédés de dérivation duodénojéjunales lorsque la perforation est laissée en place et les sécrétions dérivées, sont à privilégier lorsque ces conditions ne sont pas favorables. En cas de conditions locales défavorables ou d’instabilité hémodynamique, la duodénostomie par drainage duodénal est à privilégier. Cette technique consiste à diriger les sécrétions duodénales vers la peau en créant des remaniements fibreux puis un trajet fistuleux et enfin une cicatrisation. La prise en charge de ces perforations est longue et difficile.

Duodenal perforation is a rare occurrence and is associated with high mortality, which rises to 30-50% in cases that involve associated peritonitis. The most frequent etiologies include peptic ulcer, post-operative fistula, endoscopic perforation, and trauma. The challenge in managing this pathology lies in the fact that resection with anastomosis is often unfeasible, and the creation of a stoma is not possible. Management must be tailored on a case-by-case basis that always involves medical measures, often endoscopic interventions, and sometimes surgery. Indeed, the surgical option is feasible in selected patients who are diagnosed early and present without complications. Surgical procedures are classified into two categories: preferably, reconstructive procedures-where resection of the perforation and restoration of digestive continuity is possible, provided that local and hemodynamic conditions are favorable; conversely, a duodenojejunal diversion procedure-in which the perforation is left in situ while enteric secretions are diverted-is the preferred approach when conditions are unfavorable. When local conditions are unfavorable, or there is hemodynamic instability, duodenostomy drainage is the preferred option. This technique involves directing duodenal secretions toward the skin, thereby inducing the formation of a fibrotic fistulous tract with eventual wound healing. The management of duodenal perforation is a lengthy and challenging process.

Abstract Background The STRIDE II guidelines recognize endoscopic mucosal healing (MH), defined by a UCEIS score ≤1 or a Mayo endoscopic subscore = 0 (MES), as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved. Methods We conducted a prospective study including all consecutive UC patients in clinical remission and endoscopic MH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading). Results A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5-19.0]) and 66 (82%) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy. Mayo=0 and HH were observed in 49 (65%) and 55 (79%) patients, respectively. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17%) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no significant difference in the risk of relapse between MES 1 and MES 0 patients (13.6% vs. 30.7% respectively p = 0.27). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7% versus 20.1% respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0% versus 27.4% respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, only absence of HH was associated with disease relapse (HR = 6.1, 95% CI = [1.6 - 23.1], p = 0.01). The degree of correlation between rectal biopsies and whole-colon biopsies was almost perfect (к 0.84 (%-agree 93.1, p < 0.001)) for HH assessment. Conclusion In this prospective study, histological healing was associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing. Rectal biopsies were effective in identifying HH.

INTRODUCTION:The STRIDE II guidelines recognize endoscopic healing (EH), defined by an SES-CD score ≤ 2, as one of the main therapeutic targets in Crohn's disease (CD). Nevertheless, complete EH could further reduce the risk of long-term complications in CD. We aimed to assess the risk of long-term complications in CD according to the degree of EH achieved. METHOD:We conducted a prospective multicenter study including all patients with EH assessment (2019-2022) in 3 centers and compared the outcomes of patients with complete EH (CDEIS = 0) vs partial EH (CDEIS > 0 but < 4). The primary endpoint was therapeutic failure (need for drug intensification and/or corticosteroid initiation and/or CD-related hospitalization and/or intestinal resection and/or development of a luminal stricture/fistula and/or perianal CD). RESULTS:In total, 128 patients were included. Patients had been on treatment for a median of 12 months (8.3-24.3) before colonoscopy. After a median follow-up of 22 months (interquartile range, 19-23), 40 (31%) patients experienced therapeutic failure. The risk of therapeutic failure was significantly higher among patients with partial EH (25% vs 43%, P = .036). The risk of CD-related hospitalization was significantly higher for patients with partial EH (2.5% vs 17%, P = .005; hazard ratio = 6.89, Interval confidence 95% (IC95%) = [1.46-32.4], P = .015). The risk of intestinal resection, steroid initiation, and drug intensification among patients with complete and partial EH, were 0% vs 4.3% (P = .13), 2.5% vs 11% (P = .1); and 22% vs 36% (P = .088), respectively. CONCLUSION:Although higher-powered studies are needed to confirm these findings, current results suggest that complete EH may be associated with more favorable long-term outcomes than partial EH in patients with CD.

Background and study aims:Musculoskeletal disorders (MSDs) are prevalent among endoscopists. The aim of this study was to evaluate biomechanical risk factors for MSDs in gastroenterologists performing ESD. Methods:An observational study was performed among interventional endoscopists performing ESD in three French centers. Physical constraints were assessed using an analog scale of perceived physical effort intensity and physiological sensors to measure joint angulation kinematics and muscle activity levels (flexor and extensor carpi radialis muscles) during diagnostic colonoscopy and ESD. High muscle strain was defined as any muscle activation exceeding 10% of maximum voluntary contraction (MVC). Two distinct sub-tasks of ESD were identified: lesion marking and circumferential incision phase (ESD-1) and dissection phase (ESD-2). Results:Six interventional gastroenterologists participated in the study. Perceived physical effort was significantly greater for ESD compared with colonoscopy ( P = 0.03). Time spent at more than 10% MVC for the right extensor carpi radialis was significantly higher during ESD-1 than during colonoscopy (+15%, P = 0.04). The greatest strain was observed in the left extensor carpi radialis. This muscle was particularly exposed because more than 50% of the time was spent at more than 10% of MVC during colonoscopy and up to more than 80% during ESD-1 and -2. Time spent in the neck flexion risk zone was significantly higher during ESD-2 than during colonoscopy (+42%, P = 0.046). Conclusions:ESD increased the risk of musculoskeletal strain. It is crucial to develop prevention programs to reduce risk of MSD in the population of gastroenterologists.

The development of endoscopy and interventional radiology has reduced the need for repeat surgery to manage postoperative complications, thereby reducing morbidity and mortality. Surgical set-ups modify the anatomy and are sometimes difficult for gastroenterologists and radiologists to understand. To improve multidisciplinary management, certain surgical techniques can be adapted to facilitate morphological identification and endoscopic access to the various anastomoses that are a source of complications, particularly at the supra-mesocolic level. The aim of this update is to provide a non-exhaustive list of surgical procedures that can be used to anticipate the endoscopic and radiological management of possible postoperative complications.

BACKGROUND:The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved. METHODS:We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading). RESULTS:A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5-19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively p = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], p = 0.0118). CONCLUSION:In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.

BACKGROUND:STRIDE II guidelines recognise endoscopic healing as a main therapeutic target in Crohn's disease (CD). Nevertheless, transmural healing (TH) could reduce the risk of long-term complications. AIM:To assess the impact of intestinal ultrasound (IUS) TH on CD long-term among patients with endoscopic healing. METHOD:We conducted a prospective study of consecutive patients with CD who underwent colonoscopy with endoscopic healing (CDEIS < 4) and IUS. IUS TH was defined by a bowel wall thickness < 3 mm without colour Doppler signal. The primary endpoint was CD relapse (drug intensification, initiation of steroid, CD-related hospitalization or surgery, luminal stricture/fistula or perianal CD). RESULTS:We included 93 patients. IUS TH was observed in 73%. No difference in median IBD-risk score was observed among patients with and without IUS TH (22 (IQR 7-41) vs. 30 (IQR 13-55); p = 0.15). After a median follow-up of 22.5 months (IQR 19.3-23.7), the cumulative risk of relapse was significantly lower among patients with IUS healing (17% vs. 48%; p = 0.007). The benefit of TH remained when considering only patients with complete endoscopic healing (CDEIS = 0) (12-month relapse rate, 2% vs. 33%; p = 0.03). The risk of CD-related hospitalization (3% vs. 16%; p = 0.04) and perianal CD (3% vs. 16%; p = 0.04) were significantly lower among patients with IUS healing. In multivariate analysis, the absence of TH remained the only independent factor associated with CD relapse (hazard ratio 2.6 (1.1-6.2); p = 0.03). CONCLUSION:IUS TH was associated with improved long-term outcomes with lower risks of CD relapse, hospitalization, and perianal CD.

Abstract Background The STRIDE II guidelines recognize endoscopic healing as one of the main therapeutic targets in Crohn’s disease (CD). Nevertheless, transmural healing could reduce the risk of long-term complications. The aim of this study was to assess the risk of long-term complications in CD according to the degree of endoscopic and ultrasound healing. Methods We conducted a prospective study that included all patients with CD in clinical remission who underwent colonoscopy with endoscopic healing (CDEIS <4) and intestinal ultrasound (IUS) within 4 weeks between September 2019 and September 2022. IUS transmural healing was defined by a parietal thickness < 3 mm on all digestive segments (colonic and ileal) without colour doppler signal. The primary endpoint was CD relapse, defined as the need for drug intensification, initiation of corticosteroid therapy, CD-related hospitalization, development of a perianal and luminal fistula or abscess, or the need CD-related bowel surgery. Patients were followed up at least every 6 months for two years. Results A total of 93 patients were included, the majority of whom were women (53%) with ileocolic location (43%). The median disease duration was 12 years (IQR, 4-19) and 71% patients were treated with anti-TNF. Ultrasound transmural healing was observed in 73% (68/93) of patients. After a median follow-up of 22.5 months [IQR, 19.3-23.7], relapse was significantly higher among patients without IUS transmural healing (48% vs. 18% p = 0.007). Relapse rate at 6 and 12 months were significantly higher among patients without IUS transmural healing (22% vs. 9% and 22% vs. 13%; p = 0.019). In multivariate analysis, the risk of relapse was 5 times higher without IUS transmural healing (HR 5.5 (2.1-14.2) p < 0.001). Conclusion IUS transmural healing was associated with a lower risk of relapse among patients with endoscopic healing and could be considered as a non-invasive therapeutic target in CD.

La rémission endoscopique est l’objectif actuel à atteindre dans les MICI.Les scores endoscopiques d’activité permettent d’uniformiser les pratiques.Le traitement endoscopique des manifestations sténosantes est efficace et sûr.La surveillance endoscopique est primordiale pour le dépistage des lésions dysplasique dans les MICI.Le traitement endoscopique des lésions dysplasiques visibles est possible même pour des lésions de grandes tailles.

BACKGROUND AND AIMS:Despite increasing interest in endoscopic and histological remission as a treatment target in ulcerative colitis (UC), the accuracy of endoscopic and histological findings in the left colon and/or rectum to detect pancolonic remission is poorly known. We aimed to compare the diagnostic accuracy of rectosigmoidoscopy (RS) and rectoscopy for detecting endoscopic and histological healing elsewhere in the colon. METHODS:Consecutive UC patients who underwent colonoscopy were prospectively included. Endoscopic healing was defined by a Mayo endoscopic score (MES) = 0 on all explored segments and histological healing was defined by a Nancy index ≤ 1 (2 biopsies/segments). The agreement between colonoscopy, RS, and rectoscopy for endoscopic and histological healing was assessed using Cohen's kappa coefficient. RESULTS:Eighty patients were included. Thirty-four had an MES = 0 by RS and colonoscopy. The agreement between colonoscopy and RS was almost perfect, with a к index of 0.95 (%-agree 97.5) for Mayo 0, and к of 0.95 for Mayo 0-1 (%-agree 97.5, P < .0001). The agreement between RS and colonoscopy was also almost perfect (к = 0.877, (%-agree 91.7, P < .001) for the assessment of histological healing. The agreement between rectoscopy and colonoscopy for the evaluation of endoscopic (Mayo 0) and histological healing was almost perfect as well (к = 0.83 (%-agree 91.2, P < .001) and к = 0.80 (%-agree 91.7, P < .001)). CONCLUSION:For UC patients undergoing treat-to-target interventions, endoscopic and histological findings in the rectum alone provide good accuracy for determining pancolonic endoscopic and histological remission. Rectal examination could be an alternative to RS for monitoring UC patients.

Background We aimed to evaluate the diagnostic accuracy of fecal calprotectin (FC) and intestinal ultrasound (IUS), independently and in combination, as screening tools for adults with suspected IBD to reduce the number of unnecessary endoscopic procedures. Methods We conducted a retrospective monocentric study that included consecutive adult patients with (i) ileocolonoscopy for suspected IBD between January 2021 and June 2023 who had either (ii) IUS and/or (iii) a FC test within 6 weeks. Bowel wall thickness (BWT) and the color Doppler signal (CDS) were evaluated for all segments. The presence of lymphadenopathy, loss of stratification, stricture, and fistula were also recorded. Results In total, 119 patients with a median age of 32 years (IQR, 24.0-41.0) were included. The most common symptoms were abdominal pain (n=88, 75%) and chronic diarrhea (n=89, 75%). Among the 119 patients, 74 (62%) had IUS, 101 (82%) had a FC test, and 56 (47%) had both. Forty patients (34%) had a diagnosis of IBD, including 31 (26%) with CD and 9 (8%) with UC. By ROC curve analysis, the best threshold of FC to diagnose IBD was 117 ug/g (Se 97%, Sp 73%, PPV 67%, NPV 98%, AUC 0.88, 95%CI [0.81; 0.94], p=0.006). Using this threshold, only 3% of patients were misclassified as non-IBD. Screening by measuring FC levels would result in a 48% reduction in the number of adults requiring endoscopy. Abnomal IUS was significantly associated with a diagnosis of IBD (OR 5.6, 95%IC [2.1;16.2], P=0.0008). The association of a BWT>3 mm and a positive CDS was associated with a Se, Sp, PPV, and NPV of 48%, 100%, 100%, and 75%, respectively, but 52% of patients were misclassified as non-IBD. The combination of a BWT>3 mm, CDS, and FC>117 ug/g had a Se, Sp, PPV, and NPV of 44%, 100%, 100%, and 69%, respectively. For patients with a normal IUS and FC<117 ug/g, 4% were misclassified as non-IBD. Conclusions The combination of FC and IUS is a useful screening strategy to identify patients who truly require endoscopy for suspected IBD. Calprotectin is a highly effective test for ruling out IBD. Conversely, relying solely on IUS lacks the discriminative power to safely rule out IBD. However, it shows a high PPV and is a potent tool for diagnosing IBD.

Abstract Background Intestinal ultrasound is a powerful tool for diagnosing and monitoring inflammatory bowel disease (IBD). Although access to training is improving, the detection and interpretation of ultrasound images in IBD remains complex. The aim of this study was to develop and validate an artificial intelligence module to automatically detect the intestinal tract and active IBD in order to simplify the use of ultrasound in IBD. Methods Vision Transformers (ViTs), recently introduced as a competitive alternative to Convolutional Neural Networks (CNNs), were used to automate the real time detection and segmentation of the normal and inflamed intestinal tract. ViTs were chosen for their ability to better capture global relationships in images, which is particularly useful for recognizing complex patterns in medical images. The ViT model was trained on a dataset consisting of 17,488 intestinal ultrasound images from 46 patients, including 11,396 images of active IBD and 6,092 inactive IBD evaluated by two gastroenterologists. Results The sensitivity, specificity and accuracy for the detection of inactive and active IBD calculated from two intestinal ultrasound loop containing a total of 617 images of inactive IBD and 339 images of active IBD were 95%, 94% and 95% respectively. Some limitations were identified, notably a decrease in sensitivity in the detection of minor anomalies, in areas of low contrast and during variations in scale. These points suggest that the model could benefit from further refinement of its spatial processing capabilities, particularly in complex clinical situations. Conclusion We have developed a model based on the pre-trained Vision Transformer (ViT) architecture that is able to detect the active and inactive IBD. This approach could eventually make it easier for inexperienced operators to use intestinal ultrasound to detect and monitor IBD. Further in-depth tests on a larger set of images and videos are under way to validate the model’s performance.

INTRODUCTION:Intravenous (IV) lidocaine has both analgesic and anti-inflammatory effects. Its use has never been evaluated for analgesia for patients with acute pancreatitis (AP). We aimed to evaluate the effectiveness and safety of IV lidocaine in the management of AP resistant to weak opioids. MATERIALS AND METHODS:We conducted a retrospective, monocentric study between January 2015 and December 2021 that included consecutive patients with (i) AP and (ii) pain resistant to non-opioid and weak-opioid analgesia (tramadol) (iii) treated with IV lidocaine. The effectiveness of the treatment was defined as a decrease in the numerical pain scale (NPS) of at least one point from the initiation of lidocaine and the absence of a need for opioid analgesia (morphine or oxycodone). RESULTS:In total, 154 patients were included. The patients were predominantly male (69 %), with a median age of 48.5 years [37.0; 58.0]. The main etiology of AP was alcoholic (36 %), and necrotizing AP was observed for 69 % of patients. Lidocaine was continuously administered at a dose of 2 g/24 h. Lidocaine treatment was effective for 88.3 % of patients (136/154). The median score on the NPS before the administration of lidocaine was 8.0 [7.0; 9.0] and significantly decreased to 5.8 [4.5; 7.0] by day 1 (p < 0.001). No factors were associated with lidocaine failure. Two (1.3 %) patients experienced lidocaine-related adverse events, including skin rash and dysgeusia, and no severe adverse events were observed. CONCLUSION:IV lidocaine administration appears to be effective and safe for patients with AP with pain resistant to weak-opioid analgesia. Further prospective studies are needed to confirm these results.

L’essor de l’endoscopie et de la radiologie interventionnelle a permis de limiter le nombre de réinterventions chirurgicales dans la prise en charge des complications postopératoires diminuant ainsi la morbidité et la mortalité. Les montages chirurgicaux modifient l’anatomie et sont parfois difficiles à comprendre pour les gastro-entérologues et les radiologues. Pour améliorer cette prise en charge multidisciplinaire, certaines adaptations techniques chirurgicales permettent de faciliter le repérage morphologique et l’accès endoscopique aux différentes anastomoses sources de complications notamment à l’étage sus-mésocolique. Cette mise au point a pour but de faire une liste non exhaustive des gestes chirurgicaux qui permettent d’anticiper la prise en charge endoscopique et radiologique d’éventuelles complications postopératoires.

Abstract Background Ulcerative colitis (UC) is a major cause of disability, affecting physical, emotional and social well-being. The recent STRIDE II international guidelines consider disability-free and normal quality of life as therapeutic targets. Today, the degree of mucosal healing required to reduce disability, incontinence and bowel urgencies is poorly known. Methods We conducted a single-center cross-sectional study between January 2021 and June 2023. All consecutive patients with UC and endoscopic healing (Mayo ≤ 1) underwent IBD-disk disability assessment the day of the colonoscopy. Histological healing was defined as Nancy score 0 or 1 (2 biopsies per segment from rectum to right colon). Moderate to severe disability was defined as an overall score ≥ 40. Incontinence was defined by a Wexner score >5 and bowel urgency by an NRS urgency score > 1). Results A total of 57 patients were included, with 34 (59.6%) women. Median age and disease duration were 47.4 (interquartile range [IQR] [43.5; 51.2]) and 13.0 years (IQR, 13.1-18.4), respectively. 37/57 (65%) patients had complete endoscopic healing Mayo 0 and 43/54 (80%) histological healing. The median overall IBD-Disk score was 29 [25.5; 37.5] and 27 (47%) had moderate to severe disability. There were no differences in terms of age, gender, body mass index, smoking status, disease extension and treatment for the 3 groups Mayo 1, Mayo 0 and histological healing. The rate of moderate to severe disability was not different among patients with Mayo 0 (7/20, 35%) vs. Mayo 1 (20/37, 54%) patients (p=0.26), or in patients with (22/43, 51%) or without histological healing (4/11,36%) (p =0.51). Of the 35 patients assessed, bowel urgency were reported in 11 (31.4%), with no difference between the two definitions of endoscopic healing (p=0.72) or histological healing (p=0.37). Among the 35 patients with a Wexner score evaluation, incontinence was observed in 19% (4/21) and 14% (2/14) of Mayo 0 and Mayo 1 patients respectively (p=0.99), and 24% (6/25) vs. 0% (0/7) of patients with or without histological healing (p=0.3). Conclusion Half of patients with UC who achieved endoscopic healing reported a moderate to severe disability. Mayo 0 (vs. 1) endoscopic healing and histological healing do not appear to provide any short-term benefit in terms of disability, fecal incontinence or bowel urgency.

Abstract Background The STRIDE II guidelines recognize endoscopic healing (EH), defined by an SES-CD score ≤2 or a CDEIS score <3, as one of the main therapeutic targets in Crohn's disease (CD). Nevertheless, complete endoscopic healing could reduce the risk of long-term complications in CD. The aim of this study was to assess the risk of long-term complications in CD according to the degree of endoscopic healing achieved. Methods We conducted a prospective multicenter study that included all patients with CD undergoing colonoscopy for EH assessment or dysplasia screening between September 2019 and September 2022 in one university hospital, one general hospital and one private center. Two groups were compared: patients with complete EH (CDEIS = 0) and those with partial EH (CDEIS <4). The primary endpoint was CD relapse, defined as the need for drug intensification and/or initiation of corticosteroid and/or CD-related hospitalization and/or development of a fistula (luminal or perianal) or abscess, and/or the need for bowel resection. Patients were followed up every 6 months for two years. Based on previously published data, 138 patients were expected to demonstrate a 13% difference with a two-sided alpha risk of 5% and a power of 80%. Results A total of 133 patients were included. The majority of patients were female (55%), non-smokers (63%), with a median disease duration of 10 (IQR, 4-19) years. Fifty-seven (43%) patients had ileocolonic location and 81 (61%) an inflammatory (B1) behavior. Patients had been on treatment for a median of 18.0 months (IQR 8.6-52) prior to colonoscopy, with no difference between the two groups. There was no significant difference between the two groups apart from BMI. Eighty-four (63%) patients had complete EH. After adjustment for BMI, the risk of relapse was significantly higher in the CDEIS>0 group (23% vs. 41%, HR = 2.05; IC95% = [1.09 - 3.87]; p=0.027). After a median follow-up of 23.3 months, the number of drug intensification, hospitalizations, use of corticosteroids, occurrence of abscess, fistula, or bowel resection in the CDEIS 0 and CDEIS > 0 and <4 groups were 20% and 35% (p=0.065), 2.4 and 16% (p=0.005), 2.4% and 10% (p=0.10), 3.6% and 18% (p=0.009), 7.1% and 18% (p=0.048), 7.1% and 18% (p=0.048) respectively. Conclusion This prospective multicenter study confirms that complete endoscopic healing is associated with better long-term outcomes than partial endoscopic healing in patients with CD, as well as fewer surgeries and hospitalizations and an overall decreased risk of treatment failure.

Choledocholithiasis is a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Mechanical lithotripsy is a frequently used technique for the extraction of complex common bile duct (CBD) stones; however, impaction of the Dormia basket around a large stone and fracture of Dormia basket wires have been described in up to 6% of procedures [1] [2] [3]. This complication is one of the most challenging to treat, often requiring endoscopic, percutaneous, or surgical intervention, with a risk of morbidity and mortality.

IntroductionEndoscopy is still the gold, standard for assessing disease activity in Crohn's disease (CD). Its invasiveness, poor acceptability, and cost limit its use in the era of tight control and treat-to-target management. Fecal calprotectin (FC) and intestinal ultrasound (IUS) are non-invasive alternatives to colonoscopy to assess disease activity. We aimed to evaluate the performance of IUS and FC to assess mucosal healing in CD.MethodsAll consecutive CD patients who underwent colonoscopy for mucosal healing assessment and IUS and/or FC within four weeks between September 2019 and April 2022 were included in a prospective cohort. The bowel-wall thickness (BWT) and color Doppler signal (CDS) were assessed for each segment. Endoscopic remission was defined by a CDEIS score < 3.ResultsIn total, 153 patients were included, of whom 122 showed endoscopic mucosal healing. Eighty-two (53.6%) were female, the median was age 36 years (IQR, 28-46), and the median disease duration was 10 years (IQR, 4-19). The sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of a BWT < 3 mm to predict endoscopic mucosal healing were 56%, 88%, 95%, and 36%, respectively (patients misclassified as mucosal healing, 2.5%). The best FC threshold (< 92.9 µg/g) provided similar results: 77%, 89%, 96%, and 67%, respectively (patients misclassified, 2.2%). The association of an FC < 250 µg/g with a BWT < 3 mm and the absence of CDS increased the Sp and PPV: Se 58%, Sp 95%, PPV 97%, VPN 43%; patients misclassified, 1.3%.ConclusionNoninvasive evaluation of mucosal healing by IUS or calprotectin efficiently identifies patients with CD who have achieved endoscopic mucosal healing.