Introduction Accurate descriptions of the extent of disease in intrahepatic bile ducts are essential for managing patients with perihilar cholangiocarcinoma (pCCA). This study describes and assesses a new, automated Computed Tomography (CT)-scan-based 3D reconstruction process (3DR) of biliary tree in these patients compared with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Methods We studied consecutive patients with histologically proven hilar cholangiocarcinoma, who were referred for biliary drainage by ERCP in our center between 2015 and 2023. Automated reconstruction of bile ducts from CT images was performed using an artificial intelligence software (Synapse 3D 6.7, Fujifilm, Tokyo, Japan). We compared the Bismuth-Corlette classification assessed by ERCP (gold-standard), MRCP, CT-scan, and 3DR by computing exact percentage and weighted Kappa agreements. Results We included 62 patients. As compared with ERCP, CT-scan without 3DR had an exact agreement of 48% and had a moderate weighted Kappa agreement (weighted Kappa 0.47; 95%CI: 0.27-0.67). The MRCP had an exact agreement of 52% and a moderate weighted Kappa agreement (weighted Kappa 0.57; 95%CI: 0.39-0.76). The 3DR had an exact agreement of 60%, and a strong weighted Kappa agreement (weighted Kappa 0.72; 95%CI: 0.60-0.85). Conclusion 3DR is highly concordant with ERCP in assessing the extent of pCCA.

BACKGROUND Mixed pancreatic cystic lesions (PCLs) could be a sign of malignant transformation from PCLs. The proper diagnosis of these lesions are crucial for management and avoiding unnecessary treatment. Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) may improve diagnostic yield by providing histologic core tissue as well as liquid fraction samples; however, data on its safety and diagnostic performance in cystic and mixed lesions remain limited. AIM To evaluate the safety and diagnostic performance of EUS-FNB using a 22G needle in mixed PCLs. METHODS This retrospective observational cohort study was conducted at a tertiary referral center between January 2019 and December 2024. Consecutive patients undergoing EUS-FNB (22G) for pancreatic cystic or mixed lesions were included. Solid lesions and pancreatic pseudocysts were excluded. Primary outcome was procedure-related safety. Secondary outcomes included technical success, adequacy, diagnostic yield, pathological spectrum, and concordance with surgical histopathology when available. Follow-up data were collected to assess subsequent management and outcomes. RESULTS Among 640 EUS-guided biopsies performed during the study period, 60 patients (mean age 65.0 ± 12.1 years; 36.6% female) underwent EUS-FNB for pancreatic cystic (31.7%) or mixed lesions (68.3%). Technical success was achieved in all cases. Adequate tissue, cytology, or fluid for analysis was obtained in 57 patients (95.0%). No EUS-FNB-related adverse events were observed after review of the medical records. The most frequent diagnosis was pancreatic adenocarcinoma (40.0%), followed by serous cystadenoma (10.0%) and intraductal papillary mucinous neoplasm (10.0%). Overall diagnostic yield was 85.0%. Ten patients underwent surgical resection, with complete concordance between EUS-FNB and surgical histopathology in this selected subgroup. Over a mean follow-up of 17.0 ± 14.3 months, management included chemotherapy, surgery, surveillance, repeat EUS, or drainage according to diagnosis and multidisciplinary assessment. CONCLUSION EUS-FNB using a 22G needle could be a feasible approach for tissue acquisition in pancreatic cystic and mixed lesions, with high technical success and specimen adequacy in this retrospective cohort. Higher quality studies are needed to further define its clinical role and safety profile.

Immune checkpoint inhibitors (ICI) have improved the prognosis of several cancers. ICI enhance T-cell activation, and therefore stimulate anti-cancer immunity, but also cause immune related adverse effects (irAE), including those affecting the gastrointestinal (GI) tract. GI-irAE are observed in 7 to 30 % of patients treated with ICI. With extending indications of ICI, oncologists, gastroenterologists and primary-care physicians face an increasing number of patients with ICI-induced GI-irAE. This paper summarizes incidence, risk factors, clinical manifestations and management of GI-irAE. Current management of patients with GI IrAE should include refutation of differential diagnoses, assessment of severity, corticosteroids and rapid introduction of infliximab in non-responders.

Background The diagnosis of cholangiocarcinoma in patients with a biliary stricture without mass syndrome can be obtained by biliary brushing with a sensitivity of ~50 %. We performed a multicenter randomized crossover trial comparing the aggressive Infinity brush with the standard RX Cytology Brush. The aims were to compare sensitivity for cholangiocarcinoma diagnosis and cellularity obtained. Methods Biliary brushing was performed consecutively with each brush, in a randomized order. Cytological material was studied with blinding to the brush type used and order. The primary end point was sensitivity for cholangiocarcinoma diagnosis; the secondary end point was the abundance of cellularity obtained with each brush, with cellularity quantified in order to determine if one brush strongly outperformed the other. Results 51 patients were included. Final diagnoses were cholangiocarcinoma (n = 43; 84 %), benign (n = 7; 14 %), and indeterminate (n = 1; 2 %). Sensitivity for cholangiocarcinoma was 79 % (34 /43) for the Infinity brush versus 67 % (29/43) for the RX Cytology Brush (P = 0.10). Cellularity was rich in 31/51 cases (61 %) with the Infinity brush and in 10/51 cases (20 %) with the RX Cytology Brush (P < 0.001). In terms of quantification of cellularity, the Infinity brush strongly outperformed the RX Cytology Brush in 28/51 cases (55 %), while the RX Cytology Brush strongly outperformed the Infinity brush in 4/51 cases (8 %; P < 0.001). Conclusions This randomized crossover trial showed that the Infinity brush is not significantly more effective than the RX Cytology Brush for biliary stenosis without mass syndrome in terms of sensitivity for cholangiocarcinoma diagnosis, but does offer a significantly higher abundance of cellularity.

The WallFlex® and Evolution® stents are the most widely used duodenal stents, but no study has compared them. We aimed to compare the efficacy and safety of WallFlex® and Evolution® stents for malignant gastric outlet obstruction. We included all consecutive patients who were treated for malignant gastric outlet obstruction with WallFlex® or Evolution® self-expandable metal uncovered duodenal stents between 2013 and 2020. Multivariable Cox models were performed to assess duodenal stent failure, as defined by gastric outlet obstruction necessitating another duodenal stent. We included 129 patients: 74 received a WallFlex® stent and 55 received an Evolution® stent. The non-failure rate was of 68

Les indications d’endoscopie digestive en réanimation ou en soins intensifs en dehors des hémorragies digestives sont nombreuses. La problématique interventionnelle concerne principalement le bilio-pancréatique : drainage des angiocholites et des collections post pancréatite aiguë, ou après transplantation hépatique. L’essor des drainages extra-anatomiques échoguidés par écho-endoscopie et des prothèses d’apposition luminale permet de s’affranchir de techniques plus invasives radiologiques ou chirurgicales et constitue, en cas de succès technique et clinique, en un réel service rendu au patient. Des situations plus courantes comme la mise en place d’une sonde de nutrition, l’évaluation de la gravité endoscopique d’une ischémie mésentérique, la prise en charge d’un volvulus colique ou d’un syndrome d’Olgivie compliqués sont également rencontrées.

Objectives: Primary prophylaxis of bleeding is debated in children with gastroesophageal varices; one of the reasons is the limited number of studies concerning its efficacy and safety. We report our experience with endoscopic primary prophylaxis. Methods: From 2006 to 2019, 145 children (median age, 3.5 years; cirrhosis, n = 116) with high-risk gastroesophageal varices underwent primary prophylaxis (banding, n = 114; sclerotherapy n = 31, primarily in smaller children). Results: We observed the eradication of varices in 93% of children after a mean of 6 months, at least one recurrence of varices in 45% after eradication, and gastrointestinal bleeding in 17% of children. Irrespective of the cause of portal hypertension, grade 3 esophageal varices, presence of gastric varices along the cardia and a lower composite score of endoscopic severity were associated with a worse probability of eradication, a longer time to eradication and a lower risk of a first recurrence and of bleeding following the procedure, respectively. Ten-year probabilities of overall survival and of bleeding-free survival were 95% and 75%, respectively. Conclusions: Endoscopic primary prophylaxis of variceal bleeding is reasonably effective and safe in children with high-risk gastroesophageal varices. Worse results are observed in children with more advanced endoscopic features. This pleads for endoscopic screening in children with portal hypertension and early detection of varices warranting primary prophylaxis.

La litiasis biliar es una patología frecuente que se produce con más frecuencia como resultado de la precipitación de cristales de colesterol en la vesícula biliar. La migración espontánea de un cálculo en la vía biliar principal puede producir una sintomatología variable que puede ir desde la ausencia de sintomatología a cuadros más floridos del tipo cólico hepático, pancreatitis aguda, ictericia o colangitis. Los principales signos clínicos que se observan son dolor, fiebre e ictericia, asociados a la aparición de una colestasis ictérica en los exámenes biológicos. La colangiografía por resonancia magnética (RM) muestra una dilatación del conducto biliar principal con presencia de una imagen de defecto en la vía biliar principal. La ecoendoscopia sólo se realiza cuando se puede llevar a cabo un tratamiento mediante colangiopancreatografía retrógrada endoscópica (CPRE) con extracción de cálculos en el mismo tiempo. Posteriormente, estaría indicada una colecistectomía laparoscópica diferida para prevenir la aparición de complicaciones biliares. Gracias a los progresos recientes del tratamiento endoscópico, la CPRE ha sustituido al tratamiento quirúrgico en la mayoría de los centros. La cirugía de la litiasis de la vía biliar principal (LVBP) sigue siendo posible a condición de tener suficiente experiencia quirúrgica y en condiciones locales favorables (vía biliar amplia) o tras fracaso del enfoque endoscópico (cálculo impactado, barro biliar, asa en Y). Por último, el tratamiento combinado (CPRE y colecistectomía laparoscópica) en el mismo tiempo permite disminuir la duración de la hospitalización y facilitar el cateterismo de la papila.

La litiasi biliare è una malattia frequente che, il più delle volte, deriva dalla precipitazione di cristalli di colesterolo nella cistifellea. La migrazione spontanea di un calcolo nella via biliare principale può portare a una sintomatologia variabile, che va dall’assenza di sintomi a quadri più clamorosi, tipo colica epatica, pancreatite acuta, ittero o colangite. I principali segni clinici riscontrati sono dolore, febbre e ittero, associati alla comparsa, sul piano laboratoristico, di una colestasi itterica. La colangiorisonanza magnetica (RM) evidenzia una dilatazione della via biliare principale con presenza di un’immagine di difetto nella via biliare principale. L’ecografia endoscopica viene eseguita solo quando è possibile realizzare contemporaneamente un trattamento mediante colangiopancreatografia retrograda endoscopica (ERCP) con estrazione dei calcoli. La colecistectomia laparoscopica è indicata nel decorso, per prevenire la comparsa di complicanze biliari. Grazie ai recenti progressi nel trattamento endoscopico, la ERCP ha sostituito il trattamento chirurgico, nella maggior parte dei centri. La chirurgia della litiasi della via biliare principale (LVBP) resta possibile a condizione di avere una sufficiente esperienza chirurgica e condizioni locali favorevoli (via biliare ampia) o dopo insuccesso dell’approccio endoscopico (calcoli impattati, calcoli multipli, ansa a Y). Infine, il trattamento combinato (ERCP e colecistectomia laparoscopica) nello stesso tempo consente di ridurre la durata della degenza e di facilitare la cateterizzazione della papilla.

Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 – 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 – 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

Editor—Precapillary pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (mPAP) ≥25 mm Hg at rest coupled with a pulmonary capillary wedge pressure (PCWP) ≤15 mm Hg and an elevated pulmonary vascular resistance (PVR) >3 Wood units (WU).1Hoeper M.M. Bogaard H.J. Condliffe R. et al.Definitions and diagnosis of pulmonary hypertension.J Am Coll Cardiol. 2013; 62: D42-D50Crossref PubMed Scopus (1120) Google Scholar A high risk of perioperative morbidity and mortality is observed after noncardiac and non-obstetric surgery. Retrospective studies including small samples have reported a complication rate of 6–42%,2Kaw R. Pasupuleti V. Deshpande A. Hamieh T. Walker E. Minai O.A. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery.Respir Med. 2011; 105: 619-624Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar, 3Minai O.A. Yared J.-P. Kaw R. Subramaniam K. Hill N.S. Perioperative risk and management in patients with pulmonary hypertension.Chest. 2013; 144: 329-340Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 4Ramakrishna G. Sprung J. Ravi B.S. Chandrasekaran K. McGoon M.D. Impact of pulmonary hypertension on the outcomes of noncardiac surgery.J Am Coll Cardiol. 2005; 45: 1691-1699Crossref PubMed Scopus (249) Google Scholar, 5Price L.C. Montani D. Jais X. et al.Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension.Eur Respir J. 2010; 35: 1294-1302Crossref PubMed Scopus (80) Google Scholar, 6Lai H.-C. Lai H.-C. Wang K.-Y. Lee W.-L. Ting C.-T. Liu T.-J. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery.Br J Anaesth. 2007; 99: 184-190Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar, 7Meyer S. McLaughlin V.V. Seyfarth H.-J. et al.Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey.Eur Respir J. 2013; 41: 1302-1307Crossref PubMed Scopus (82) Google Scholar and a mortality rate up to 18%.3Minai O.A. Yared J.-P. Kaw R. Subramaniam K. Hill N.S. Perioperative risk and management in patients with pulmonary hypertension.Chest. 2013; 144: 329-340Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar Gastrointestinal (GI) endoscopy procedures are very commonly performed procedures and general anaesthesia or sedation is very often needed. However, no studies have evaluated the safety of GI endoscopy in patients with PH. The aim of our study was to describe a cohort of patients with precapillary PH undergoing GI endoscopy requiring sedation or general anaesthesia and to report on complications and outcomes of these procedures. This was a retrospective cohort study (with systematic sampling) of consecutive patients with precapillary PH undergoing GI endoscopy, between March 1, 2012 and November 30, 2017, at the French National Reference Centre for Pulmonary Hypertension (Paris-South University, Bicêtre University Hospital, Le Kremlin-Bicêtre, France). Multiple procedures in the same year for one patient were excluded. Skilled gastroenterologists (>10 yr of practice) performed all procedures. Anaesthetists assisted by nurse anaesthetists provided all sedation or anaesthesia procedures. Major complications were recorded perioperatively and within 28 days after each procedure, and defined as hypotension requiring the use of a continuous catecholamine support (norepinephrine or phenylephrine), haemodynamically significant arrhythmia, right heart failure, or death. The most severe complication was reported. Patients with right heart catheterisation performed again in the following year had their data compared with preprocedural measurements. Data are presented as mean (standard deviation [sd]), and univariate analysis was performed to compare patients with and without complications. Of 74 eligible GI endoscopy procedures performed in patients with precapillary PH during the study period (11 procedures were excluded because of repeated endoscopy within 1 yr), 37 procedures in 26 patients were performed with sedation or general anaesthesia (Supplementary Fig. S1). At the most recent clinical evaluation before endoscopy, patients had moderate-to-severe functional impairment, New York Heart Association (NYHA) functional class III or IV, in 24/37 (65%) of cases. The 6 min walking distance was <440 m in 19 of 26 patients (73%), with a mean of 349 (111) m. The last haemodynamic assessments with right heart catheterisation before endoscopy (median interval, 2 months; inter-quartile range, 0–7 months) are shown in Table 1. Most patients had specific medications for PH (n=23/26, 88%), including various combinations of drugs (n=15/26, 58%).Table 1Patient and procedure characteristics and univariate analysis of risk factors for major postoperative complications. 6MWD, 6 min walking distance; CI, confidence interval; ERCP, endoscopic retrograde cholangiopancreatography; mPAP, mean pulmonary artery pressure; NYHA, New York Heart Association; OR, odds ratio; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RAP, right atrial pressure; WU, Wood unit.Characteristics of patientsAll patients (n=37)No POC (n=32)POC (n=5)Univariate analysisOR95% CIPAge, yr (range)62 (40–82)60 (40–74)71 (63–82)1.32(1.03–1.69)0.030Female sex, n (%)18 (49)NYHA class I–II13 (35)11 (34)2 (40) III–IV24 (65)20 (66)3 (60)0.91(0.15–5.28)1.00 6MWD (m)349 (111)344 (117)371 (52)1.00(0.99–1.01)0.62Haemodynamic data mPAP (mm Hg)43 (12)43 (12)40 (6)0.97(0.88–1.07)0.555 RAP (mm Hg)8 (3)8 (3)7 (3)1.00(0.79–1.27)1.000 PCWP (mm Hg)10 (3)10 (3)10 (2)1.02(0.73–1.44)0.891 Cardiac index (L min−1 m2)3.0 (0.8)3.1 (0.9)2.5 (0.3)0.24(0.04–1.62)0.144 PVR (WU)6.1 (2.2)6.0 (2.5)7.1 (1.9)1.19(0.78–1.79)0.421Characteristics of endoscopic and anaesthetic proceduresAnaesthesia Sedation31 (84)28 (87)3 (60) General6 (16)4 (13)2 (40)4.67(0.70–31.30)0.182Emergency procedure, n (%)4 (11)2 (6)2 (40)10.00(1.26–79.47)0.022Duration procedure (min)36 (22)32 (16)58 (32)1.05(0.99–1.10)0.057ERCP, n (%)7 (19)4 (13)3 (60)10.50(1.57–70.44)0.037 Open table in a new tab Of 37 procedures performed with anaesthesia, eight were esophagogastroduodenoscopy (EGD), 10 were colonoscopy, 12 were combined EGD and colonoscopy, and seven were endoscopic retrograde cholangiopancreatography (ERCP) (Supplementary Fig. S1). In 4/37 cases (11%), an emergency procedure was performed, including ERCP (n=3) for acute cholangitis and one EGD for GI bleeding. Most GI endoscopic procedures were performed using sedation (n=31/37, 84%), whereas 16% were done using general anaesthesia. After the procedure, 28/37 patients (76%) were hospitalised on a general ward, and the others in an intensive care unit. Perioperative complications occurred in 21 (57%) out of 37 procedures. A major complication occurred in 5/37 procedures (14%), three during ERCP, one during EGD and one during colonoscopy. All these patients needed a continuous vasopressor infusion for hypotension during three endoscopic procedures (8%) and two (5%) patients for hypotension associated with arrhythmia. One patient developed an episode of acute right heart failure several hours after the procedure on day 0, an emergency ERCP in a patient with acute septic cholangitis. No patients died. Three of these major complications occurred during ERCP and two under general anaesthesia. The risk factors associated with major complications in univariate analysis were older age (odds ratio [OR], 1.32; P=0.030); emergency procedure (OR, 10.00; P=0.022) and ERCP (OR, 10.50; P=0.037; Table 1). There was no evidence of significant haemodynamic deterioration at follow-up (mean time interval, 5 [4–7] months). GI endoscopy without anaesthesia was performed in 29 patients, and among 37 procedures, no major complications were observed. Our study reports a rate of cardiopulmonary adverse events in patients with precapillary PH higher than in the general population undergoing GI endoscopy. The cardiopulmonary event rate in ASA physical status 3 patients has been reported to be 1.8% in a US database comprising 324 737 GI procedures.8Sharma V.K. Nguyen C.C. Crowell M.D. Lieberman D.A. de Garmo P. Fleischer D.E. A national study of cardiopulmonary unplanned events after GI endoscopy.Gastrointest Endosc. 2007; 66: 27-34Abstract Full Text Full Text PDF PubMed Scopus (282) Google Scholar Although no death was observed in our series, the incidence of major complications (14%) was in the lower range of what has been reported for surgical procedures in this population (6–42%).2Kaw R. Pasupuleti V. Deshpande A. Hamieh T. Walker E. Minai O.A. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery.Respir Med. 2011; 105: 619-624Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar, 3Minai O.A. Yared J.-P. Kaw R. Subramaniam K. Hill N.S. Perioperative risk and management in patients with pulmonary hypertension.Chest. 2013; 144: 329-340Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 4Ramakrishna G. Sprung J. Ravi B.S. Chandrasekaran K. McGoon M.D. Impact of pulmonary hypertension on the outcomes of noncardiac surgery.J Am Coll Cardiol. 2005; 45: 1691-1699Crossref PubMed Scopus (249) Google Scholar, 5Price L.C. Montani D. Jais X. et al.Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension.Eur Respir J. 2010; 35: 1294-1302Crossref PubMed Scopus (80) Google Scholar, 6Lai H.-C. Lai H.-C. Wang K.-Y. Lee W.-L. Ting C.-T. Liu T.-J. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery.Br J Anaesth. 2007; 99: 184-190Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar, 7Meyer S. McLaughlin V.V. Seyfarth H.-J. et al.Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey.Eur Respir J. 2013; 41: 1302-1307Crossref PubMed Scopus (82) Google Scholar The small sample size limited the capacity to identify risk factors for major complications and did not allow multivariate analysis to be performed. There are also limitations associated with a retrospective and single-centre study, albeit performed in the national reference centre. However, this allowed us to examine consecutive cases with a standard anaesthetic protocol. A much larger patient population and a prospective study would be required to better assess outcomes and risk factors, but PH is a rare disease9Thenappan T. Shah S.J. Rich S. Gomberg-Maitland M. A USA-based registry for pulmonary arterial hypertension: 1982–2006.Eur Respir J. 2007; 30: 1103-1110Crossref PubMed Scopus (338) Google Scholar and the number of patients was already high because of the concentrating effect of the national reference centre. Finally, although our study population had well-established precapillary PH, mPAP was not very elevated, and right atrial pressure and cardiac index were not drastically changed, suggesting optimised treatment. Nevertheless, haemodynamic data are comparable with those in other surgical studies2Kaw R. Pasupuleti V. Deshpande A. Hamieh T. Walker E. Minai O.A. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery.Respir Med. 2011; 105: 619-624Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar, 3Minai O.A. Yared J.-P. Kaw R. Subramaniam K. Hill N.S. Perioperative risk and management in patients with pulmonary hypertension.Chest. 2013; 144: 329-340Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 4Ramakrishna G. Sprung J. Ravi B.S. Chandrasekaran K. McGoon M.D. Impact of pulmonary hypertension on the outcomes of noncardiac surgery.J Am Coll Cardiol. 2005; 45: 1691-1699Crossref PubMed Scopus (249) Google Scholar, 5Price L.C. Montani D. Jais X. et al.Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension.Eur Respir J. 2010; 35: 1294-1302Crossref PubMed Scopus (80) Google Scholar, 6Lai H.-C. Lai H.-C. Wang K.-Y. Lee W.-L. Ting C.-T. Liu T.-J. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery.Br J Anaesth. 2007; 99: 184-190Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar, 7Meyer S. McLaughlin V.V. Seyfarth H.-J. et al.Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey.Eur Respir J. 2013; 41: 1302-1307Crossref PubMed Scopus (82) Google Scholar. Still, the incidence of major complications is significant. We can only suspect that the risk of complications would be higher with more disturbed haemodynamic abnormalities and with less specialised care. The present study provides data on the occurrence of complications associated with GI endoscopy in patients with precapillary PH, which should not be underestimated. The incidence of major complications was in the lower range of what is seen in non-cardiothoracic non-obstetric surgery, but their occurrence was circumscribed to the day of the procedure and short- and long-term outcomes were not modified. A multidisciplinary approach and a careful perioperative planning are likely important factors. The authors declare that they have no conflict of interest. Institutional sources, departmental sources, or both.

Ibrutinib inhibits the Bruton tyrosine kinase (BTK), thus abrogating downstream activation of the BCR pathway and blocking cell growth, proliferation, and survival of malignant B cells. It has been...

La cholangiopancréatoscopie rétrograde utilisant le système Spyglass™ (Boston Scientific, USA), permet, au cours du cathétérisme bilio-pancréatique (CPRE) une étude visuelle des lésions et la réalisation de biopsies dirigées. Une étude française prospective, multicentrique, a étudié l'impact du Spyglass™ sur la prise en charge des atteintes bilio-pancréatiques indéterminées. Nous en présentons ici les résultats finaux.