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Gilles Lesur

Publications and source records attributed to Gilles Lesur.

12 recordsLinked to original sources
PubMed2005

Management of bleeding peptic ulcer in France: a national inquiry.

AIMS OF THE STUDY: To evaluate and compare management practices in France for bleeding peptic ulcers using a national inquiry of university and non-university hospitals. METHOD: Responses to questionnaires sent to 812 gastroenterologists, 496 practicing in non-university hospitals and 316 in university hospitals, were compared. RESULTS: An analysis was possible in 279 (34% response rate) of the questionnaires. Forrest classification was used more frequently in university hospitals (83% vs 60%, P<0.01). Endoscopic hemostatic therapy was used more frequently in university hospitals for Forrest Ib (92% vs 81%, P=0.02), IIa (93% vs 73%, P<0.001), and IIb (58% vs 29%, P<0.001) ulcers. Injection therapy, mainly epinephrine, was the first-intention treatment for 99% of the responding gastroenterologists. Proportions of clinicians employing hemoclips (27%) or argon plasma coagulation (21%) were similar in both types of practice. Anti-secretory treatment included mainly omeprazole (82%), given intravenously (76%), sometimes as bolus i.v. doses followed by i.v. high-dose continuous infusion (15%) with some variations according to the type of hospital. In the event of recurrent or persistent bleeding, surgery was more frequent in non-university hospitals. When rebleeding occurred, a second endoscopic treatment was performed in about one quarter of patients. CONCLUSION: In France, management practices for bleeding peptic ulcer vary between university and non-university hospitals.

Endoscopy, Gastrointestinal↗
PubMed2004

Pancreatic metastases: a multicentric study of 22 patients.

AIMS OF THE STUDY: To evaluate the diagnosis, treatment and outcome of patients with pancreatic metastases. PATIENTS AND METHODS: We retrospectively reviewed the records of patients with pancreatic metastasis managed in the Paris area between 1990 and 2000. RESULTS: The series analyzed included 22 patients, 10 men and 12 women, mean age 61 years (range: 35-76). The primary tumors were renal-cell carcinoma (N=10), colorectal cancer (N=4), lung cancer (N=4), breast cancer (N=2), cutaneous melanoma (N=1) and ileal carcinoid (N=1). The mean interval between primary treatment and presentation was 73.5 months (range: 2-151). Diagnosis was established because of clinical symptoms (N=15) or during surveillance (N=7). Computed tomography (N=19) and endoscopic ultrasound (EUS) (N=18) mainly showed solitary and hypodense/or hypoechoic masses. Histological diagnosis was obtained before surgery by EUS-guided fine needle aspiration (N=6), ultrasound-guided biopsy (N=3) or duodenoscopy (N=3). Among 10 patients with primary renal-cell carcinoma, 7 were treated by surgery. Median global survival was 33 months. Median survival was 61 months in the event of surgical treatment and 20 months in the other patients (ns). Mean survival depended on the type of primary tumor, 61 months for renal-cell carcinoma and 33 for colorectal cancer (P=0.06). CONCLUSIONS: Most pancreatic metastases develop from renal-cell carcinoma and can occur several years after nephrectomy. Histological diagnosis is often obtained before surgery. Surgical resection must be discussed as it can allow long-term survival.

Adult↗
PubMed2003

[The aims of endoscopy in upper gastrointestinal hemorrhage].

FOR DIAGNOSIS AND FOR TREATMENT: Endoscopy for upper gastrointestinal haemorrhage has a double objective. It is difficult and to be optimal, it must be conducted at the right time and in the best technical conditions as possible. Depending on the etiology, identification of the cause of bleeding precedes the choice of the haemostatic method to be used, preferentially injections of adrenaline in the case of bleeding ulcers and elastic ligature in the case of ruptured oesophageal varicose veins. In general the aim of endoscopic treatment is to stop the haemorrhage and to reduce as far as possible the risk of recurrent haemorrhage, which represents a factor of high deathrate.

Endoscopy↗
PubMed2003

[The place of endoscopic treatment in hemorrhagic ulcers].

INJECTIONS OF ADRENALINE: More than one third of upper gastrointestinal haemorrhages are still of ulcerous origin. In the case of active bleeding ulcers or ulcers with non-haemorrhagic visible vessels, endoscopy should be performed to stop bleeding. Injections of adrenaline, which combine efficacy, simplicity and absence of morbidity represent the treatment of choice for many. THE USE OF THERMAL METHODS: Spurting haemorrhages are probably the only haemorrhages that would benefit from injections of adrenaline combined with another haemostatic method, notably thermal. THE NEED FOR ASSOCIATED MEDICAL TREATMENT: Whatever the haemostatic method used, a powerful anti-secretory treatment administered intravenously must be associated since it will enhance the effects of endoscopic treatment.

Clinical Trials as Topic↗
PubMed2003

[The place of endoscopic treatment in portal hypertension].

A POTENTIALLY SEVERE EVENT: Upper gastrointestinal haemorrhage in a cirrhotic patient is always extremely serious, particularly in the case of rupture of the oesophageal varices, which is the most frequent cause. THE TWO POLES OF TREATMENT: Early vasoactive treatment permits elastic ligature in optimal conditions using an endoscope. The prevention of other complications of cirrhosis is an essential element in the management of these patients.

Acute Disease↗
PubMed2003

[The place of endoscopic treatment in other causes of upper gastrointestinal haemorrhage].

IN MALLORY-WEISS SYNDROME: With fissuring of the cardial area, probably subsequent to a rapid increase in intra-gastric pressure, hemorrhagic Mallory-Weiss syndrome may justify haemostatic endoscopic treatment. However, one should not forget that the majority of these syndromes usually regress spontaneously. IN DIEULAFOY'S ULCERS: Loss of substance destroying the muscle mucosa, Dieulafoy's ulcer would be at the origin of around 2% of upper gastrointestinal haemorrhages. Initial haemostasis can be obtained using endoscopic treatment in 85% of cases. The mechanical methods (clips, elastic ligature) are probably more effective than injections, but they are still under assessment.

Acute Disease↗