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J M Dumonceau

Publications and source records attributed to J M Dumonceau.

At least 19 recordsLinked to original sources
PubMed2006

In vivo microscopic examination of the esophagus for the detection of cancer before liver transplantation in patients with alcoholic cirrhosis.

Esophageal squamous-cell carcinoma is relatively common in alcohol and tobacco abusers, and it can develop rapidly after liver transplantation. We report the early detection of an esophageal squamous-cell carcinoma in a patient with alcoholic cirrhosis, diagnosed during the pre-enlistment work-up that he was undergoing before liver transplantation. This lesion had not been detected at standard endoscopy, but was well characterized using in vivo staining and microscopic examination with an "endocytoscopy" system.

Carcinoma, Squamous Cell↗
PubMed2006

Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory?

BACKGROUND: We aimed to determine before Roux-en-Y gastric bypass (RYGBP) in asymptomatic morbidly obese patients: 1) the prevalence of abnormal findings at upper gastrointestinal (UGI) endoscopy; 2) Helicobacter pylori (HP) status; 3) clinical consequences of these findings; and 4) associated costs. METHODS: We retrospectively reviewed 468 consecutive patients, excluded those with UGI symptoms, drug intake or previous UGI endoscopy/surgery, and analyzed findings in the 319 remaining patients (68%). RESULTS: There were abnormal findings in 147 patients (46%), including 54 hiatal hernias and 146 parietal (i.e. mucosal or submucosal) lesions. The most significant were 7 ulcers and 2 gastric polyposis. HP was detected (using CLO-test) in 124 patients (39%). Histopathological examination of biopsies was abnormal in 109/161 patients (68%), and disclosed mainly chronic gastritis (n=98). Abnormal findings were more frequent in HP-positive compared to HP-negative patients (94 vs 51%, P<0.001). Findings had clinical implications in only 4% of patients: delayed surgery (7 ulcers), prophylactic gastrectomy (2 gastric polyposis), unnecessary work-up (3 irrelevant/false-positive diagnoses), and inclusion in a screening program (1 Barrett's esophagus). Mean cost of complete UGI work-up was 389 euro/patient. CONCLUSION: Asymptomatic morbidly obese patients frequently harbour UGI lesions warranting UGI work-up before RYGBP. However, routine endoscopy presents drawbacks. We propose a less invasive strategy which reduces costs and limits false-positive results and the subsequent investigations that they require. In our series, it would have missed two gastric polyposis only, for which no formal recommendation has yet been issued. This strategy could be a valuable alternative to routine UGI endoscopy before RYGBP in asymptomatic patients.

Adult↗
PubMed2005

[Barrett's esophagus: epidemiology diagnosis and treatment in 2005].

Barrett's oesophagus is a complication of gastro-oesophageal reflux disease and should be considered as a major risk factor for the development of adenocarcinoma of the oesophagus. Each and every patient with Barrett's oesophagus should be enrolled in a endoscopic surveillance program. During the last years, the endoscopic treatment of high grade dysplasia or intramucosal adenocarcinoma (by mucosectomy) has been reported to be successful in relatively large series of patients. This therapeutic option is particularly useful for patients with a high operative risk. It can be applied for lesions detected at an early stage only (i.e., usually detected in the setting of a surveillance program). Therefore, non-operability is not considered as an exclusion criteria of such programs anymore.

Barrett Esophagus↗
PubMed2001

Diamond stents for palliation of malignant bile duct obstruction: a prospective multicenter evaluation.

BACKGROUND AND STUDY AIMS: Various types of self-expandable metal stents have been introduced for biliary drainage in patients with malignant jaundice, showing prolonged patency compared with plastic endoprostheses. However, there has only been prolonged experience with a meaningful number of patients using the Wallstent. We evaluated the Diamond stent, a self-expanding uncoated biliary metal stent, in a prospective uncontrolled multicenter setting. PATIENTS AND METHODS: The eligibility criterion was obstructive jaundice due to inoperable malignant disease. Between August 1995 and January 2000, 126 patients, who received a total of 134 Diamond stents in four European centers, were followed prospectively. RESULTS: Technical and clinical success rates were 96 % and 98 %, respectively. No major procedure-related complications occurred. The 30-day mortality rate was 13 %. Stent occlusion occurred in 28 patients (22 %). Overall median stent patency was 477 days; overall median survival was 173 days. Stent occlusion, confirmed by endoscopic retrograde cholangiopancreatography, was successfully treated with plastic stents in all patients. Cost analysis revealed estimated costs of 3440 euros per patient for palliative treatment with the Diamond stent. CONCLUSIONS: The Diamond stent compares favorably with other biliary metal stents for patients requiring biliary drainage of malignant jaundice.

Adult↗
PubMed2000

A comparison of Ultraflex Diamond stents and Wallstents for palliation of distal malignant biliary strictures.

OBJECTIVE: The objective of this study was to compare the effectiveness of the Ultraflex Diamond stent and the Wallstent for the drainage of distal malignant biliary strictures. METHODS: The results obtained in 23 consecutive patients in whom the insertion of a Ultraflex Diamond stent had been attempted were compared with those obtained in 23 patients matched for age, gender, serum bilirubin, and diagnosis who had been treated with Wallstents. RESULTS: Biliary drainage was obtained in 100% of cases. More than one stent was required in 4% and 12% of patients treated with Ultraflex Diamond stents and Wallstents, respectively (p > 0.05). The first stent inserted did not provide adequate biliary drainage in four patients, because of the impaction of the proximal end of Wallstents into the bile duct wall (n = 2) and obstruction of the stent lumen by tumor tissue (one in each group). Procedure-related morbidity and mortality were 4%. Patients were followed-up for a mean of 228 days (range, 1 to 1262 days). During follow-up, bile duct obstruction relapsed in 5/22 and 6/21 patients treated with Ultraflex Diamond stents and Wallstents, respectively. Life table analysis of bile duct patency was similar with both stent models. CONCLUSIONS: Ultraflex Diamond stents are easy to insert and provide a high success rate of biliary drainage with minimal complication. Although long-term patency rates obtained with this stent were similar to those observed with Wallstents, no firm conclusion can be drawn in this regard due to the relatively small number of patients studied.

Adult↗
PubMed2000

[Treatment of pain in chronic calcifying pancreatitis with endoscopy and extracorporeal shock wave lithotripsy. A case report].

Abdominal pain is the most frequent symptom of chronic pancreatitis and may, on occasions, lead to great treatment problems. The case of a 56-years-old patient with idiopathic chronic pancreatitis calcifying who showed intracanalicular lithiasis is reported. Treatment with endoscopy and extracorporal shock wave lithotripsy (ESWL) was successful.

Abdominal Pain↗
PubMed1999

Esophageal fistula sealing: choice of stent, practical management, and cost.

BACKGROUND: Three models of covered metal stents are available to seal esophageal fistulas. METHODS: Stainless steel covered stents were inserted in 5 patients (group I); nitinol covered stents were inserted in 12 patients (group II) with malignant (n = 14) or benign (n = 3) esophageal fistulas. RESULTS: Stent positioning was satisfactory in all cases. Fistula sealing was complete in 1 of 5 (20%) and 12 of 12 (100%) patients of groups I and II, respectively (p < 0.005). Continued esophageal leakage was initially related to the passage of fluids alongside the stent covering (n = 3) and to early stent migration (n = 1). Complications related to stent placement were observed in 2 of 17 (12%) patients and were fatal. During follow-up (mean 153 +/- 143 days), esophageal fistulas relapsed after initial sealing in 5 of 13 (38%) patients. Further treatment (glue or fibrin sealant injection, additional stent insertion) was attempted in 7 cases of persistent or relapsing esophageal fistula, with sealing obtained in 5 of them. The costs per patient and per day free from symptoms due to the esophageal fistula were $106 and $57 in groups I and II, respectively. CONCLUSION: Nitinol covered stents more frequently provided complete esophageal fistula sealing, as compared with stainless steel covered stents. Further treatments tailored to the mechanisms of fistula persistence or relapse often provided sealing.

Adolescent↗
PubMed1999

Self-expandable metal stents.

Self-expandable metal stents are indicated for the palliation of oesophageal and biliary malignant strictures. In these indications, the main advantages of metal over plastic stents are a lower incidence of complications associated with the placement procedure (oesophageal stents) and a longer stent patency duration (biliary stents). This article describes the different models of metal stent currently available and their insertion techniques. Clinical results reported with every stent model are reviewed, particular emphasis being placed on 'global success', defined as the proportion of patients who require no endoscopic (or percutaneous) intervention after stent insertion, up to death. Recommendations for choosing between the numerous models available are inferred from this literature review and from our clinical experience.

Cholestasis↗
PubMed1999

The ultraflex diamond stent for malignant biliary obstruction.

The Ultraflex Diamond stent presents three features that might be of interest when treating biliary strictures: ease of insertion, high flexibility, and presentation of relatively large meshes. Limited clinical studies have shown its efficacy in relieving duct obstruction (in contrast with some other stent models, correct positioning of the Ultraflex Diamond stent provides adequate biliary drainage in almost all cases), and satisfactory long-term patency rates. The main improvement awaited is an efficient means to prevent late stent obstruction. The addition of coverage to this stent is feasible and could be the first step toward this goal.

Alloys↗
PubMed1999

The ultraflex diamond stent for benign biliary obstruction.

The most frequent type of benign bile duct stricture (BBDS) that complicates surgery, is not an indication for placement of any current model of metal stent because of poor long-term results. This statement could not apply to less frequent types of BBDSs, in particular those complicating chronic pancreatitis (CP) and radiotherapy. The authors report their preliminary results observed in 10 patients whose CP-related BBDS was treated with an Ultraflex Diamond stent. No stent dysfunction was detected in the observed patients during a mean follow-up of 17 months. Studies involving larger numbers of patients followed for longer periods of time are necessary to know whether endoscopy using this material may replace surgery in this indication.

Bile Duct Diseases↗
PubMed1998

A guiding catheter to facilitate accurate stent length determination.

BACKGROUND: Endoscopic stenting is widely used for drainage in benign and malignant strictures of the bile and pancreatic ducts. Accurate fitting of the stent to the anatomic ductal features is essential, although this is often done by visual assessment alone. METHODS: A new guiding catheter, the measuring-mounting catheter, with radiopaque bands at 1 cm intervals from its distal end, was used in 10 patients. Visual estimates, based on fluoroscopic images, of the length of the duct segments considered for stenting were compared with measurements obtained with the catheter. RESULTS: There was a significant difference between duct length estimations based on visual assessment and lengths determined objectively using the catheter (mean +/- SD, 17 +/- 11 mm; p < 0.0005). In one half of the cases, the operator rejected the stent he chose before using the catheter. CONCLUSIONS: The measuring-mounting catheter improves the precision of plastic stent implantation without loss of time during the procedure. It is particularly useful in technically difficult situations such as hilar or main pancreatic duct strictures.

Bile Ducts↗
PubMed1998

Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst.

BACKGROUND: Endoscopic treatment of postoperative benign bile duct strictures (BBDS) is technically challenging, and the long-term outcome after stricture dilation remains poorly defined. METHODS: Forty-eight cases of postoperative BBDS with attempted endoscopic treatment (either transient plastic stenting or definitive metal stent insertion) were reviewed. RESULTS: Endoscopic stricture dilation succeeded in 47 of 48 cases (98%). No procedure-related mortality was observed; 16 (33%) procedure-related or stent-associated complications were observed during treatment. Endoscopic treatment was interrupted in five patients. Stricture relapse occurred in 6 of 6 (100%) and 7 of 36 (19%) patients after metal stent insertion and plastic stent removal, respectively (p < 0.001) (mean follow-up periods 50+/-12 and 44+/-34 months, respectively). After plastic stent removal, stricture relapses were more frequent among patients with strictures related to liver transplantation as opposed to other surgical procedures (p < 0.05); these recurrent strictures were successfully treated by repeated insertion of plastic stents on a temporary basis. At the end of follow-up, all but one patient treated with plastic stents had normal serum alkaline phosphatase values. CONCLUSION: Metal stents proved to be inadequate for treating postoperative BBDS. Temporary insertion of a plastic stent (possibly repeated) provided long-term results equal or superior to those reported for surgical biliary drainage. Repeated insertion of plastic stents was more frequently indicated for strictures related to liver transplantation compared with other surgical procedures.

Adult↗