Publications by authors named "Napoleon B"
Ampullary composite gangliocytoma/neuroma and neuroendocrine tumor (CoGNET), previously called ampullary gangliocytic paragangliomas, is a rare entity, with only few reported cases in the literature. This is a multicentric retrospective cohort study of patients treated with endoscopy or surgery for ampullary CoGNET. A literature review of ampullary CoGNET was also performed.
View Article and Find Full Text PDFObjective: Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA.
Design: Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded.
Article Synopsis
- Stent misdeployment (SMD) is a significant challenge in EUS-guided choledochoduodenostomy (EUS-CDS) for treating malignant distal biliary obstruction, with the study aiming to define its rate and outcomes, and propose a classification system.
- In a review of data from two randomized controlled trials involving 152 patients, SMD was found in 7.2% of cases, with most types being misdeployments of the distal flange (type I) and a small number causing minor adverse events.
- The analysis revealed that a smaller extrahepatic bile duct diameter (≤ 15 mm) increases the likelihood of SMD or technical failures, but most misdeployments can be successfully managed
Article Synopsis
- The study utilized endoscopic ultrasound-guided fine needle aspiration biopsy to diagnose and analyze genetic material from primary pancreatic tumors in 397 patients with pancreatic adenocarcinoma.
- Key findings revealed significant differences in molecular profiles between metastatic and non-metastatic tumors, including varying mutation rates of KRAS and TP53.
- The researchers suggested that genomic and transcriptomic profiling could help predict survival outcomes for patients undergoing specific chemotherapy treatments, informing future therapeutic strategies.
Article Synopsis
- Management of ampullary tumors (AT), which include adenomas (AA) and carcinomas (AC), is tough because there's not a lot of solid research on it.
- The French medical community worked together to create guidelines based on recent studies and expert advice, which categorize recommendations by how strong the evidence is.
- Accurate diagnosis requires special tests, and every patient should have their case reviewed by a team of different doctors before deciding on treatment, with a recommended follow-up period of 5 years.
Background: We assessed efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) vs. endoscopic retrograde cholangiopancreatography (ERCP) as first-line intervention in malignant distal biliary obstruction (MDBO).
Methods: PubMed/Medline, Embase, and Cochrane databases were searched until 01 /12 /2023 for randomized controlled trials of EUS-BD vs.
In this 14th document in a series of papers entitled "" we discuss various aspects of EUS-guided biliary drainage that are debated in the literature and in practice. Endoscopic retrograde cholangiography is still the reference technique for therapeutic biliary access, but EUS-guided techniques for biliary access and drainage have developed into safe and highly effective alternative options. However, EUS-guided biliary drainage techniques are technically demanding procedures for which few training models are currently available.
View Article and Find Full Text PDFTo assess the outcomes of urgent endoscopic retrograde cholangiopancreatography (ERCP) performed with a single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis. Between 2021 and 2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled to undergo urgent ERCP with SUD. Technical success was defined as the completion of the planned procedure with SUD.
View Article and Find Full Text PDFEUS-guided interventions have become widely accepted therapeutic management options for drainage of peripancreatic fluid collections. Apart from endosonographic skills, EUS interventions require knowledge of the endoscopic stenting techniques and familiarity with the available stents and deployment systems. Although generally safe and effective, technical failure of correct stent positioning or serious adverse events can occur, even in experts' hands.
View Article and Find Full Text PDFThe costs of reusable endoscope reprocessing have been evaluated, yet external validity of the findings remains challenging. The aim of this study was to assess the costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope per endoscopic retrograde cholangiopancreatography (ERCP) in France. Study findings exclude the costs of infection, downtime due to breakdown, reprocessing single-use material disposal, and device disposal, all of which should also be considered.
View Article and Find Full Text PDFDespite the increasing rate of detection of incidental pancreatic cystic lesions (PCLs), current standard-of-care methods for their diagnosis and risk stratification remain inadequate. Intraductal papillary mucinous neoplasms (IPMNs) are the most prevalent PCLs. The existing modalities, including endoscopic ultrasound and cyst fluid analysis, only achieve accuracy rates of 65-75% in identifying carcinoma or high-grade dysplasia in IPMNs.
View Article and Find Full Text PDFObjective: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been constantly increasing, particularly in the treatment of pancreatic neuroendocrine neoplasms (pNENs). While emerging data in this field are accumulating, we aimed to assess the pooled efficacy and safety of EUS-RFA for pNENs.
Methods: The PubMed/Medline, Embase, and Cochrane Library databases search was conducted to identify studies reporting EUS-RFA of pNENs with outcomes of interest (efficacy and safety).
Background And Aims: Data on how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs) are limited. Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs.
Methods: Twenty-one early-career nCLE-naïve endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs.
Article Synopsis
- - Insulinoma is a common type of pancreatic tumor that causes symptoms due to excess insulin, and while surgery is the traditional treatment, it often leads to high rates of adverse events (AEs).
- - The study aims to compare the safety and effectiveness of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) to surgical options, focusing on various health outcomes like AEs, quality of life, and hospital stay length.
- - An ongoing international trial named ERASIN-RCT will involve 60 patients to evaluate these treatments, hoping to determine if EUS-RFA could be a preferred first-line option for treating small insulinomas.
Introduction: Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management.
Methods: From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included.
Background: Ethical debates as an active learning strategy encourage students to think critically through complex ethical issues while using evidence-based literature to compare views and support decision-making actions that affect patient outcomes.
Problem: The current complexity of health care implies that nurses will continue to encounter ethical dilemmas that demand essential knowledge of ethical principles, critical thinking strategies, and practical communication skills.
Approach: Student groups were assigned a health care-related ethical issue and collaborated to present their pro or con position.
EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial).
Gastroenterology
August 2023
Background & Aims: Several studies have compared primary endoscopic ultrasound (EUS)-guided biliary drainage to endoscopic retrograde cholangiopancreatography (ERCP) with insertion of metal stents in unresectable malignant distal biliary obstruction (MDBO) and the results were conflicting. The aim of the current study was to compare the outcomes of the procedures in a large-scale study.
Methods: This was a multicenter international randomized controlled study.
Background: It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).
Methods: Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed.
Article Synopsis
- EUS-guided radiofrequency ablation (EUS-RFA) is being evaluated as a safe and effective treatment for solid and cystic pancreatic tumors in a large study with 100 patients in France.
- The study found that while there were no deaths from the procedure, 22 adverse events occurred, primarily linked to how close the tumors were to the main pancreatic duct.
- Overall, the treatment showed promising results with 60.2% of patients achieving complete tumor response, particularly effective for smaller neuroendocrine neoplasms.