Although anal cancer remains rare in the general population, it is becoming more prevalent, particularly in high-income countries such as France, where the incidence rate is among the highest in the world. Over 90 % of anal cancers are caused by high-risk human papillomavirus (HR-HPV), particularly HPV16. Although two-thirds of cases occur in women, certain groups are at a higher risk, including men who have sex with men (MSM) living with HIV, women living with HIV, women with a history of high-grade vulvar lesions and patients who have received a solid organ transplant more than ten years ago. The ANCHOR randomised trial demonstrated for the first time that treating high-grade squamous intraepithelial lesion (HSIL) significantly reduces the risk of progression to anal cancer in people living with HIV, justifying the implementation of targeted screening strategies. Screening is primarily based on anal cytology and HR-HPV detection, with algorithms varying according to national and international recommendations. In France, a novel approach focusing on HPV16 detection aims to enhance specificity and reduce the reliance on high-resolution anoscopy (HRA), which is considered the gold standard but is not widely accessible. Anal self-sampling appears to be a significant factor in facilitating the implementation of screening, with analytical performance comparable to samples taken by clinicians. Despite ongoing debates about the risk-benefit ratio and cost-effectiveness of anal cancer screening, recent data support its value in high-risk populations. Improvements in triage algorithms, particularly through the use of methylation biomarkers, could optimise the referral of patients requiring HRA in the future and enhance the effectiveness of anal cancer screening by reassuring patients at lower risk of developing cancer. This article aims to provide an overview of the knowledge on which the various anal cancer screening recommendations are based, the means available for implementing this screening, and the obstacles to its implementation.

Isolated perianal Crohn’s Disease (CD) represent a diagnostic and therapeutic challenge. Evidence on the efficacy of anti-TNF agents in this context remains limited (1). The aim of this study was to evaluate the long-term effectiveness of anti-TNF among patients with perianal fistula without luminal CD. All consecutive patients (i) with recurrent perianal fistulas, (ii) without evidence of luminal CD after upper endoscopy and ileocolonoscopy, and (iii) treated with anti-TNF (infliximab or adalimumab) in 10 French centers between January 2006 and December 2024 were included in this retrospective cohort. The TOPCLASS classification was used to characterize the type of perianal involvement (1). Clinical remission (disappearance of discharge and fistula openings), clinical response (decrease in fistula discharge according to the clinician), and MRI response/remission were evaluated. Discontinuation of anti-TNF therapy for reasons other than clinical remission, the need of antibiotic therapy, or for further anoperineal surgery were considered treatment failures. Sixty-five patients were included (median age 37 years [IQR]: 28-44), 37 (57%) men and 20 (33%) active smokers). All had undergone at least one perianal surgery prior to anti-TNF treatment (median number of procedures: 3 [2-4]). Almost all fistula tracts were complex (97%). According to the TOPCLASS consensus criteria (1), 26 patients (39%) met the definition of isolated anal CD. The median follow-up was 28 months [12-60] and the median duration of exposure to anti-TNF agent was 19 [12-36] months. At 12 and 36 months, clinical response was achieved in 32/63 (51%) and 10/35 (29%) patients, respectively, while clinical remission was achieved in 16/63 (25%) and 7/34 (21%) patients (Figure 1). At 12 months, MRI response was observed in 29/55 (52,3%) patients and remission in 6/55 (11%) patients. At 36 months, MRI response rate was 7/21 (21%) and the remission rate was 1/21 (5%). In univariate analysis, transsphincteric tracts and rectovaginal fistulae were the only caracteristics associated with clinical remission at 12 months (respective odds radios : 3.6 (1.1 – 11.8); p = 0.03 and 11.5 (1.5-151.2); p = 0.04). During follow-up, 21 of the 53 patients who had a seton in place at baseline (83% of the cohort, 53/65) underwent seton removal (39.3%). In addition, luminal CD were diagnosed in 10 patients (15%), including 4 who had met the TOPCLASS criteria for isolated anal CD at induction. In this cohort of patients with anoperineal fistulas and no evidence of luminal CD, anti-TNF treatment resulted in clinical remission in a quarter of patients within one year. Over a median follow-up of two years, one-sixth of patient were diagnosed with luminal CD. Reference: 1. Hanna LN, Munster LJ, Joshi S, Wendelien van der Bilt JD, Buskens CJ, Hart A, et al. Isolated perianal Crohn’s disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice. Lancet Gastroenterol Hepatol. 2025;10(8):75768. Conflict of interest: Idrissi, Abla: No conflict of interest Fathallah, Nadia: Grant: A. Legrand AbbVie Amgen Biolitec Brothier FCare Systems Janssen Sandoz Takeda THD Lab Tillotts Pharma Altwegg, Romain: Advisory boards from Abbvie, Takeda, Johnson and Johnson, Lilly, Alphasigma, Celltrion, Pfizer, Amgen, Biogen, Sandoz, Ferring Savoye, Guillaume: No conflict of interest De Parades, Vincent: - Clinical research: Brothier, Sandoz, Takeda - Advisory boards: Abbvie - Courses, training, conferences: Abbvie, Amgen, Biolitec, FCare Systems, Janssen, Takeda, THD lab, Tillots Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Amiot, Aurelien: Personal Fees: Abbvie, Fresenius-Kabi, Adacyte, Tillotts pharma, Janssen, Pfizer, Biogen, AMgen, Sandoz, Takeda, Galapagos, Eli Lilly Abramowitz, Laurent: No conflict of interest Caillo, Ludovic: Abbvie, Amgen, Celltrion, Ferring, Fresenius, Lilly, Jonhson&Jonhson, MSD, Pfizer, Takeda, Sandoz Rouillon, Clea: Abbvie\Takeda\Galapagos\Biogen\Amgen\Lilly Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, MSD, Pfizer, Sandoz and Takeda Fumery, Mathurin: Grant: Pfizer Personal Fees: Abbvie, Janssen, Takeda, MSD, Biogen, Amgen, Sandoz, Fresenius, Gilead, Celgene, Galapagos, Mylan, Tillots, Ferring, Pfizer, Hospira, CTMA, Boehringer, Lilly, Arena Non-financial Support: Abbvie, Janssen, Takeda, MSD, Galapagos, Ferring, Pfizer Dr. Richard, Nicolas: Lecture/consultant fees from AbbVie, Amgen, Celltrion, Ferring, Janssen, Lilly, Sandoz and Takeda.

Background and purpose.The optimal radiotherapy delivery strategy for anal canal cancer remains debated. We compared outcomes between simultaneous integrated boost (SIB) and sequential boost approaches in patients treated with chemoradiotherapy. Materials and methods:This single-centre retrospective study included consecutive patients with localised or locally advanced anal canal squamous cell carcinoma treated with volumetric modulated arc therapy between June 2019 and July 2024. All patients received 60 Gy to the primary tumour and involved lymph nodes. Prophylactic nodal irradiation was delivered either sequentially (44 Gy in 22 fractions) or with SIB (45 Gy in 30 fractions). The primary endpoint was disease-free survival (DFS). Secondary endpoints included overall survival (OS) and treatment-related adverse events (CTCAE v5.0). Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Cox models were used for multivariable analysis. Results:Eighty-four patients were included: 50 treated with SIB and 34 with a sequential approach.Median follow-up from the end of radiotherapy was 21 and 48 months in the SIB and sequential groups, respectively. The 24-month DFS rate was 96% in the SIB group versus 70% in the sequential group. SIB was independently associated with improved DFS (HR 0.12, 95% CI 0.03-0.53; p = 0.006). OS at 24 months was 98% with SIB and 85% with sequential treatment, without statistical significance after adjustment. Acute grade ≥ 2 adverse events tended to be lower with SIB, without significant differences. No grade > 3 adverse event was observed. Post-treatment lymphocyte counts were higher in the SIB group (p = 0.029). Conclusion:SIB-based radiotherapy was associated with improved DFS without increasing the rate of treatment-related adverse events. This benefit may be partly related to shorter overall treatment time and potential immune-sparing effects. Longer follow-up and prospective studies are warranted.

INTRODUCTION:Intravenous infliximab (IFX) is the cornerstone for treating patients with perianal Crohn's disease (pCD). Data on the recently launched subcutaneous (SC) IFX for pCD are limited. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. METHODS:We conducted a multicenter retrospective cohort study from the GETAID, including patients with either active (group 1) or inactive (group 2) pCD when they started SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months before initiation of SC IFX; for group 2: inactive pCD for >6 months at the time of IV to SC switch. The primary end points were clinical remission at 6 months in group 1 and pCD relapse in group 2. RESULTS:Of the 183 patients included in 24 centers, 66 were in group 1 and 117 in group 2. The median follow-up was 50.4 (27.0-64.6) and 53.4 (40.6-67) weeks, respectively. In group 1 at 6 months, clinical remission was observed in 44.6% of patients and clinical response in 87.7%. Clinical remission including seton removal occurred in 35.5% of patients. In multivariable analysis, high body mass index was the only independent predictor of remission (odds ratio 0.88, 95% confidence interval 0.77-0.99). In group 2, rates of relapse-free survival were 94.3% and 87.9% at 6 and 12 months, respectively. Sixteen cases (8.3%) of adverse events related to SC injection were observed. DISCUSSION:SC IFX was effective and safe for the treatment of active pCD and for maintaining remission after switching in this large multicenter cohort, thus supporting its use in routine practice in this indication.

Sexually transmitted infections (STI) are a prominent health issue in Africa, especially in key populations such as men who have sex with men (MSM). Here, we present the baseline results of a 2-year longitudinal cohort in Togo. A total of 200 MSM in Lomé, Togo, were included in the ANRS I MIE 12400/DepIST-H cohort, half living with HIV. High-risk HPV (hrHPV) detection was performed on anal smears. Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) were tested from urine, pharyngeal and anal swabs. Overall, median age was 23 years, hrHPV prevalence was 75.9

BACKGROUND:French and International anal cancer screening recommendations for at-risk populations, published in 2024, are based on cytology and/or high-risk human papillomavirus (HPV) detection on anal smears. Biological markers to triage the patients most at-risk for anal cancer are crucial in prioritising patients needing high-resolution anoscopy consultations, which are frequently overwhelmed. METHODS:The AIN3 cohort is a French national multicenter study including patients with a history of high-grade anal lesions (AIN3). Patients were followed-up for at least 3 years, with anal smears and clinical examinations performed yearly. Levels of ZNF582 and ASCL1 gene methylation were quantified using real-time PCR on anal smears collected at the time of inclusion. FINDINGS:Overall, 514 anal smears were contributive for host-cell DNA methylation analysis. Patients' mean age was 50.8 years and 40% were women. Among the 41% who were living with HIV, 91% were men. Median follow-up duration was 48 months, and 22 patients (4%) developed anal cancer during follow-up. Higher methylation levels of ZNF582 and ASCL1 were significantly associated with high-grade squamous cell intraepithelial lesion (HSIL) cytology, p16-Ki67 dual-staining positivity, and high-risk HPV and HPV16 positivity on the same anal smear. Both methylation markers showed an AUC of 0.72 for discrimination between HSIL and non-HSIL cytology on the same anal smear. Higher methylation levels of both markers were significantly associated with evolution to anal cancer in univariate and multivariable analyses adjusted for age and HIV status (p < 0.001). When assessing the AUC over 1 and 3 years of follow-up, methylation markers demonstrated superior predictive value for anal cancer compared to other markers. INTERPRETATION:We have demonstrated the predictive value of host-cell DNA methylation marker levels in anal smears with regard to evolution to anal cancer in a very high-risk population. FUNDING:This study was funded by the Agence Nationale de Recherche sur le Sida et les hépatites virales (ANRS) I Maladies Infectieuses Emergentes.

– L'incidence des cancers anaux est en augmentation dans les pays à haut niveau de revenu tels que la France. – Deux tiers des cancers anaux sont diagnostiqués chez des femmes. – Les cancers anaux sont liés dans plus de 90 % des cas à une infection par l'HPV16. – Depuis 2023, des recommandations de dépistage systématique de certains groupes à risque de cancer anal ont été émises par Société Nationale Française de Colo-Proctologie : • Hommes ayant des relations sexuelles avec des hommes de plus de 30 ans vivant avec le VIH • Femmes avec antécédent de lésion pré-cancéreuse ou cancer de la vulve • Femmes transplantées d'organe solide depuis plus de 10 ans – Anal cancer incidence is increasing in high-income countries such as France. – Two third of anal cancer cases occur in women. – HPV16 is responsible for more than 90% of anal cancer cases. – Since 2023, new anal cancer screening recommendations have been proposed for asymptomatic patients in at-risk groups by the Société Nationale Française de Colo-Proctologie: • Male having sex with men living with HIV older than 30 years-old. • Women with previous vulvar lesion or vulvar cancer. • Women who have been solid organ transplant recipient for more than 10 years.

In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.

Abstract Background Infliximab (IFX) demonstrated its effectiveness in perianal CD (pCD) and represents the first-line medical treatment. A subcutaneous (SC) formulation has recently been developed, however so far it has not been specifically investigated in pCD. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. Methods We conducted a multicentre retrospective cohort study in the French GETAID, in patients with either active (group 1) or inactive (group 2) pCD who received SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months prior to initiation of SC IFX; and for group 2: inactive pCD for > 6 months at the time of IV to SC switch, but with a history of seton drainage. The primary endpoint in group 1 was clinical remission at 6 months (absence of anal ulcers, and absence of draining fistula). Univariate and multivariable logistic regression analyses were performed to identify predictors of clinical remission. In group 2, the primary endpoint was perianal clinical recurrence during follow-up. Results A total of 192 patients were included in 24 centres. Mean age was 38.9 years, 43.2% were women, 25.1% were smokers. 66 patients were included in group 1, 117 in group 2. In 9 patients, pCD had a > 6 months persistent activity on IV IFX when switched to SC. In group 1, median follow-up was 46 (26.6-64.6) weeks, 51/66(77.3%) patients received combination therapy, surgical drainage was performed in 40(60.6%) patients. One(1.5%), 1(1.5%), 32(48.5%), 20(30.3%) and 12(18.2%) patients received 0, 1, 2, 3 and ≥ 4 IV perfusions respectively before SC switch. At M6, 27/61(44.3%) patients were in clinical remission and 53/61(86.9%) in clinical response. MRI remission or response was achieved in 19/28(68%) patients. In univariate analysis, factors inversely associated with remission were BMI, previous pCD surgery, initial seton drainage, and SC dose optimization. In multivariable analysis, prior exposure to ≥1 biologic (OR 0.248;CI95% [0.071-0.861]p= 0.0243) was predictive of clinical remission. In group 2, median follow-up was 53.6(36.7-67) weeks. The pCD recurrence rate at 6 months was 3.1%. The recurrence-free survival curve is shown in Figure1. Overall, SC IFX was discontinued in 20(10.4%) patients, 8 switched back to IV. Two cases of immunization were observed. Median IFX serum concentration was > 20(17.1- > 20) µg/l. There were 16(8.3%) cases of adverse events related to pain/injection-site reaction: 4 switched back to IV, 1 stopped IFX. There were 5 cases of infection, no case of cancer. Conclusion Our results are in line with those reported in the literature on the effectiveness of IV IFX in pCD. The SC formulation appears to be effective and safe for active pCD, and for maintaining remission in inactive pCD

Aim Monkeypox virus (MPXV) has been spreading in many European countries, the USA and Canada since May 2022. General symptoms, skin and anoperineal lesions have been reported. Anal pain is often reported, but anal canal lesions have yet to be described in these patients. The aim of this study was to describe anoperineal lesions in patients infected with MPXV undergoing systematic margin and anal canal examination at a tertiary care centre in France.Method In this prospective descriptive study, systematic anal examination was performed in 20 patients diagnosed with MPXV infection at Bichat Hospital, Paris, France between 6 and 11 July 2022. Anal swabs were also obtained from all these patients for polymerase chain reaction testing for MPXV.Results All the patients were men that have sex with men (MSM). Sixteen patients had anal symptoms: 13 reported anal pain, and the other anal symptoms described were anal bleeding (n = 12), pruritus (n = 11), dyschezia (n = 10), tenesmus (n = 13), burning (n = 3), swelling (n = 9) and discharge of mucus (n = 9). Proctological examination detected: (i) anal margin lesions in 14 patients (vesicles, n = 8; pustules, n = 6; ulceration, n = 6); (ii) anal canal lesions in 16 patients (ulceration, n = 13; ulcers, n = 4; pustules, n = 1), seven of whom presented anal hypertonia; and (iii) rectal lesions in 12 patients (congested rectum, n = 6; erythema, n = 10; ulcers, n = 2; not seen in one case). the presence of mucus was noted in 10 patients and the presence of blood in six patients.Conclusion This is the first study to describe anal canal lesions in patients infected with MPXV. Most of the observed lesions were ulceration, accounting for the pain reported.

Postpartum anal incontinence is common. After a first delivery (D1) with perineal trauma, follow-up is advised to reduce the risk of anal incontinence. Endoanal sonography (EAS) may be considered to evaluate the sphincter and in case of sphincter lesions to discuss cesarean section for the second delivery (D2). Our objective was to study the risk factors for anal continence impairment following D2. Women with a history of traumatic D1 were followed before and 6 months after D2. Continence was measured using the Vaizey score. An increase ≥2 points after D2 defined a significant deterioration. A total of 312 women were followed and 67 (21%) had worse anal continence after D2. The main risk factors for this deterioration were the presence of urinary incontinence and the combined use of instruments and episiotomy during D2 (OR 5.12, 95% CI 1.22–21.5). After D1, 192 women (61.5%) had a sphincter rupture revealed by EAS, whereas it was diagnosed clinically in only 48 (15.7%). However, neither clinically undiagnosed ruptures nor severe ruptures were associated with an increased risk of continence deterioration after D2, and cesarean section did not protect against it. One woman out of five in this population had anal continence impairment after D2. The main risk factor was instrumental delivery. Caesarean section was not protective. Although EAS enabled the diagnosis of clinically-missed sphincter ruptures, these were not associated with continence impairment. Anal incontinence should be systematically screened in patients presenting urinary incontinence after D2 as they are frequently associated.

OBJECTIVE:There are over 145 million births worldwide, with over 30 million cesarean deliveries yearly. There are limited data comparing the perinatal and maternal outcomes between planned cesarean delivery and planned vaginal delivery. This study aimed to evaluate perinatal and maternal morbidity and mortality by meta-analysis of randomized controlled trials that randomly assigned patients to either planned cesarean delivery or planned vaginal delivery. DATA SOURCES:Scopus, PubMed, CINAHL, Cochrane Library, and the World Health Organization clinical trial databases were searched from inception through August 2022. STUDY ELIGIBILITY CRITERIA:Randomized controlled trials that compared planned cesarean delivery with planned vaginal delivery at any gestational age and for any delivery indication were included. METHODS:Two authors independently extracted data. PRISMA guidelines were used for data extraction and quality assessment. The primary outcome was perinatal mortality. The summary measures were reported as relative risks or as mean differences with 95% confidence intervals. Pooled odds ratios and 95% confidence intervals were calculated using Mantel-Haenszel random-effects models for outcomes. RESULTS:In 15 primary randomized controlled trials, 3265 patients were randomized to planned cesarean delivery and 3353 to planned vaginal delivery. The incidence of perinatal deaths was not different (1.3% vs 1.3%; relative risk, 0.71; 95% confidence interval, 0.33-1.52). Planned cesarean delivery was associated with lower neonatal incidences of low umbilical artery pH (0.3% vs 2.4%; relative risk, 0.18; 95% confidence interval, 0.05-0.67), birth trauma (0.3% vs 0.7%; relative risk, 0.46; 95% confidence interval, 0.22-0.96), tube feeding requirement (2.5% vs 7.1%; relative risk, 0.36; 95% confidence interval, 0.19-0.66), and hypotonia (0.4% vs 3.5%; relative risk, 0.11; 95% confidence interval, 0.03-0.47), compared to planned vaginal delivery. Chorioamnionitis was less frequent in the planned cesarean delivery group (0.3% vs 1.0%; relative risk, 0.27; 95% confidence interval, 0.08-0.98). Wound infection was more common in the planned cesarean delivery group (1.9% vs 1.1%; relative risk, 1.61; 95% confidence interval, 1.04-2.52). Lower rates were observed in the planned cesarean delivery group for urinary incontinence at both ≤3 months (8.7% vs 12.2%; relative risk, 0.71; 95% confidence interval, 0.59-0.85) and 1 to 2 years (16.9% vs 22%; relative risk, 0.77; 95% confidence interval, 0.67-0.88) and for a painful perineum at 2 years (4% vs 6.2%; relative risk, 0.64; 95% confidence interval, 0.47-0.87) compared to planned vaginal delivery. Among singleton pregnancies, planned cesarean delivery was associated with a lower rate of perinatal death (0.69% vs 1.81%; relative risk, 0.45; 95% confident interval, 0.21-0.93). CONCLUSION:Planned cesarean delivery and planned vaginal delivery were associated with similar rates of perinatal and maternal mortality in this meta-analysis of randomized controlled trials. Planned cesarean delivery was associated with significant decreases in adverse neonatal outcomes such as low umbilical artery pH, birth trauma, tube feeding requirement, and hypotonia, and significant decreases in chorioamnionitis, urinary incontinence, and painful perineum. Planned vaginal delivery was associated with significant decreases in need for general anesthesia and wound infection. Further randomized trials are needed to assess the risks and benefits of planned cesarean delivery vs planned vaginal delivery in lower-risk patients and in the general population.

The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year’s follow-up. This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II–III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. A total of 129 patients (69

Background The most effective treatment for anal fistula is fistulotomy, but it involves a risk of anal incontinence. To reduce this morbidity, sphincter-sparing treatments have been developed, but their success in real life is often less than 50%. The aim is to determine the clinical healing rate 6 months after radiofrequency treatment. Methods We planned to evaluate 50 patients from three French proctology centres. Treatment efficacy was evaluated at 6 and 12 months by means of clinical and magnetic resonance imaging examination. We evaluated morbidity and healing prognostic factors. Results Fifty patients with a mean age of 51 years (22-82) were included. Eleven patients had a low trans-sphincteric fistula (LTS), 21 patients had a high trans-sphincteric fistula (HTS), eight had a complex fistula and nine had Crohn's disease fistula. After 6 months, 17 patients (34.7%) had a clinically healed fistula, including five (45.5%) with LTS fistula, seven (33.3%) with HTS fistula, one (12.5%) with complex fistula, four (44.4%) with Crohn's disease, with no significant difference between these fistula types (p: 0.142). At 12 months, the healing rate was identical. MRI in 15 out of 17 clinically healed patients showed a deep remission of 73.3% at 12 months. Energy power was associated with the success of the treatment. There was an 8.2% incidence of post-surgical complications with 4.1% being abscesses (one required surgical management). Postoperative pain was minor. No new cases or deterioration of continence have been shown. Conclusion Radiofrequency is effective in 34.7% of the cases as an anal fistula treatment in this first prospective study, with low morbidity and no effect on continence. Clinical healing was deep (MRI) in three-quarters at 1 year. The increase in energy power during the procedure seems to be a key point to be analysed to optimise results.

INTRODUCTION:We assessed the impact of a nationwide screening programme to reduce the risk of anal cancer in a large cohort of high-risk patients with HIV. METHODS:From a large database from one referral centre, all high-risk patients with HIV (men who have sex with men, history of anal or genital warts, or previous cervix human papillomavirus-related lesions) who were eligible to enter the French anal cancer screening programme (2011-2020) were retrospectively included. Adherence to the screening programme was defined as no interval >18 months between two visits. Standardized management included perianal visualization and standard anoscopy with biopsies of macroscopic abnormalities. RESULTS:Overall, 700 patients with HIV were included (median follow-up 8.4 years [interquartile range 4.3-9.2] and 1491.6 patient-years), and 336 had one or more proctology visit. A total of 13 patients were diagnosed with anal squamous cell carcinomas. The risk of anal cancer was higher with anal intra-epithelial neoplasia grade 3 (AIN3; hazard ratio [HR] 44.5 [95% confidence interval {CI} 11.2-176.6], p < 0.001), AIN2 (HR 11.9 [95% CI 2.1-66.9], p = 0.005), or high-grade dysplasia (HR 23.4 [95% CI 7.9-69.1], p < 0.001) than with low-grade dysplasia or no lesion. Among the patients who were strictly adherent to the screening programme (4.6% [32/700]), we did not report any AIN or anal cancer, but we also did not observe any significant reduction in the risk of anal cancer (p = 0.51), AIN3 (p = 0.28), high-grade dysplasia (p = 0.19), or any AIN lesions (p = 0.10) compared with non-adherent patients. In contrast, screened patients were more likely to be diagnosed with anal warts (HR 3.71 [95% CI 2.14-6.42], p < 0.001). CONCLUSION:Macroscopic high-grade dysplasia lesions are associated with a higher risk of developing anal cancer. Despite finding no cases of cancer during the screening programme, we also did not demonstrate a clear benefit from our screening programme for the prevention of anal cancer in high-risk patients with HIV.

Chez la primipare, l’incidence de l’incontinence fécale est évaluée à 10 % en post partum. Un à deux pour cent des primipares rapportent une incontinence aux selles. Dans la majorité des cas, l’incontinence fécale disparaît dans les 6 mois du post partum plus ou moins corrigée par la rééducation du périnée.

The most effective treatment for anal fistula is fistulotomy, but it involves a risk of anal incontinence. To reduce this morbidity, sphincter-sparing treatments have been developed, but their success in real life is often less than 50%. The aim is to determine the clinical healing rate 6 months after radiofrequency treatment. We planned to evaluate 50 patients from three French proctology centres. Treatment efficacy was evaluated at 6 and 12 months by means of clinical and magnetic resonance imaging examination. We evaluated morbidity and healing prognostic factors. Fifty patients with a mean age of 51 years (22–82) were included. Eleven patients had a low trans-sphincteric fistula (LTS), 21 patients had a high trans-sphincteric fistula (HTS), eight had a complex fistula and nine had Crohn's disease fistula. After 6 months, 17 patients (34.7%) had a clinically healed fistula, including five (45.5%) with LTS fistula, seven (33.3%) with HTS fistula, one (12.5%) with complex fistula, four (44.4%) with Crohn's disease, with no significant difference between these fistula types ( p : 0.142). At 12 months, the healing rate was identical. MRI in 15 out of 17 clinically healed patients showed a deep remission of 73.3% at 12 months. Energy power was associated with the success of the treatment. There was an 8.2% incidence of post-surgical complications with 4.1% being abscesses (one required surgical management). Postoperative pain was minor. No new cases or deterioration of continence have been shown. Radiofrequency is effective in 34.7% of the cases as an anal fistula treatment in this first prospective study, with low morbidity and no effect on continence. Clinical healing was deep (MRI) in three-quarters at 1 year. The increase in energy power during the procedure seems to be a key point to be analysed to optimise results.

Des marqueurs de méthylation de différents gènes sont utilisés sur des frottis cervicaux pour le triage des patientes à risque de cancer du col de l'utérus. Pour les marqueurs prédictifs ou pronostiques, des mesures de discrimination adaptées aux critères type survie ont été développés. L'objectif de cette étude était d'évaluer les performances diagnostiques de niveau de méthylation de marqueurs sur frottis anaux pour prédire le risque de cancer de l'anus chez des patients ayant une dysplasie anale de haut grade (AIN3 : « Anal Intraépithélial Neoplasia » grade 3). Il s'agit d'une étude ancillaire de la cohorte AIN3. Les patients inclus avaient soit des lésions AIN3 antérieures ou actuelles. Un frottis anal était réalisé à l'inclusion, puis un suivi prospectif. Les niveaux de méthylation de l'ADN des promoteurs 2 gènes, ASCL1 et ZNF582, ont été analysés par PCR en temps-réel et sont exprimés en log2(ΔΔddct). La survie sans cancer de l'anus était définie comme le délai entre la date du frottis d'inclusion et la date de cancer ou de fin de suivi. Les HR des marqueurs de méthylation ont été calculés avec des modèles de Cox ajustés. Des AUC temps dépendants cumulatif dynamiques (AUC C/D) ont été calculés selon la méthode « nearest neighbor estimator » : à un temps t donné, AUC C/D (t)=P (Xi >Xj ⁄(Ti≤t,Tj>t)), avec X le marqueur de méthylation et T date du diagnostic du cancer anal pour deux patients i et j. Les intervalles de confiance à 95% ont été calculés par bootstrap (2000 réplications). Les frottis d'inclusion ont été réalisés chez 657 patients de la cohorte AIN3 et 574 étaient disponibles ; 424 patients avaient un résultat de PCR analysable. Pour ces patients, la durée de suivi médiane était de 36 mois (IC 95% [32-40]) et 20 d'entre eux ont développés un cancer de l'anus. Des niveaux de méthylation plus élevés des deux marqueurs étaient associés à un risque siginificativement majoré d'évolution vers le cancer anal, ajusté sur l'âge et le statut VIH (HR=1,31 IC95% [1,10-1,57], p=0,003 pour ZNF582 et HR=1,26 IC95% [1,03-1,55], p=0,026 pour ASCL1). La figure 1 montre l'évolution de l'AUC C/D au cours du temps. A un an, l'AUC C/D estimée était de 82% (IC95% [82-95]) et 80% (IC95% [64-99]) pour respectivement ZNF582 et ASCL1. Cette première évaluation des niveaux de méthylation de gène de l'hôte sur frottis anal montre une discrimination satisfaisante pour l'évolution vers le cancer anal avec cependant des intervalles de confiance larges. Méthylation , Cancer , Pronostic , Dépistage Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Since our last publication of algorithms for the management of perianal fistulas in patients with Crohn’s disease, researchers have proposed a treat to target strategy systematic combotherapy for anal lesions, and indications for stem cell injection. In the absence robust publications, the Société Nationale Française de Coloproctologie (French National Society of Coloproctology [SNFCP]) wished to establish a group consensus using the Delphi method. From October 2020 to January 2021, a scientific committee and panel of gastroenterologists and surgeons established answers which were submitted to the members of the SNFCP during a national conference in November 2020. Three questions were clarified and reformulated, and then submitted during a third and final round of consultation of members of the SNFCP. The target was defined as being the response obtained in every domain (symptoms, physical and radiological evaluation) which could be considered satisfactory, without the need to intensify therapeutic management. By consensus, the time required for clinical evaluation of the efficacy of treatment was 6 months. A response on magnetic resonance imaging (MRI) should include the absence of a collection of 10 mm or more in size at 6 months, and a frank decrease or complete disappearance of hyperintensity in T1 and T2 sequences of the main tract at 12 months. Systematic association of an immunosuppressant with tumor necrosis factor inhibitors did not reach the consensus level for adalimumab (50%), but just did for infliximab (70%). The majority of the respondents considered failure of one, or even two lines of different biotherapies to be potential indications for injection of stem cells. These findings reinforce the importance of composite targets including MRI evaluation, and underscore the need for precise timing of evaluation. Combotherapy is only recommended with infliximab. Injection of stem cells is a second- or third-line option.