The forceps-assisted technique is used to perform a difficult cannulation. ▶ Fig. 1 Endoscopic view showing the sphincterotome and a pediatric forceps emerging from the working channel. ▶ Fig. 2 Fluoroscopic view showing successful cannulation of common bile duct with the forceps-assisted technique.
Background Stenosis is the most common complication of Crohn's disease (CD). Imaging of the ileo-caecal junction is mainly based on endoscopy, ultrasound, CT-enteroclysis or entero-MRI. The aim was to evaluate the performance of digestive ultrasound in the monitoring of Crohn's disease.The purpose of this work is to show the performance of digestive ultrasound and fecal calprotectin in the monitoring of CD. We compared the results of digestive ultrasound, enteroscan or enteroIRM with endoscopy and biology Methods This is a prospective study including 42 patients, spanning between July 2021 and July 2022. Clinical, biological, radiological and endoscopic data were studied. Khi-2 test was used with a value of p<0.05 which was considered statistically significant. Results We included 42 patients in our study, divided into 18 men 24 women (sex ratio M/F is 0.75), mean age was 43.2 years, with a CD of L1 or L3 location, according to the Montreal classification were prospectively included. The main risk factor found was smoking in 61.9% of patients. The majority of patients (80.95%, n = 34) had koenig syndrome. All patients underwent digestive ultrasound, CT-enteroclysis and colonoscopy with an average delay of 15 days between the examinations. Digestive ultrasound showed intestinal thickening in 85.71% (n=36), of the small intestines in 57.14% of patients and localized at the terminal ileum (21.42%). Loss of stratification was found in 40.47% of patients, ileo-caecal stenosis in 57.14%, a directed fistula in 23.80% of patients, a deep collection in 28.57% (n=10). The CT-enteroclysis showed stenosing thickening of the ileo-caecal junction in 66.67% (n=28), a deep collection in 38.09%, a combed aspect of the mesentery in 33.33% and intestinal thickening associated with a fistulous path in 35.71%. Colonoscopy was performed with catheterisation of the last ileal loop in the majority of patients (73.80%, n=31). It showed ulcerations in 88.09% (70.5% deep and 17.6% superficial) and a stenosis that could not be crossed by the colonoscope in 40.47% (n=17). The mean level of faecal calprotectin was 532.5 with a standard deviation of 265.1 reflecting moderate to severe disease activity. There was a correlation between ultrasound and endoscopy in 71.4% of cases (n=30). There was significant correlation between endoscopic and ultrasound inflammatory activity (p=0.01) and between the location of intestinal thickening and ulcerations on endoscopy (p=0.01). Conclusion Ultrasound is non-radiating, reproducible and available, coupled with fecal calprotectin constitutes an accessible and easy monitoring tool. Our preliminary results are satisfactory and the study is still in progress to confirm the interest of ultrasound in the follow-up of patients with CD.
Background Crohn’s disease (CD) is associated with the emergence of complications, including intra-abdominal abscess. Management is multidisciplinary based on close medical-surgical collaboration. The aim of the study was to evaluate the clinical characteristics, the efficacy of different therapeutic options of intra-abdominal abscess in CD patients and to identify predictive factors of a favorable response. Methods Medical records of 56 CD patients who had intra-abdominal abscess were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and therapeutic data were retrospectively assessed. Treatment progression was appreciated.IBM SPSS software 21.0 was used for statistical analysis of our data. Results In total, 897 patients were identified as having CD in the study period, 56 of them developed intra-abdominal abscess. Means that the prevalence of intra-abdominal abscess in CD patients was 6,2%. Mean age was 35,24 ± 11,6 years old with a sex ratio M/F 0,64. 47,3% had penetrating CD. 50.9% of our patients were known to be carriers of Crohn’s disease, 45% of whom were on 5-ASA, while the remaining patients 49.1% (n = 26), the abscess was inaugural and revealing of the CD.The clinical signs were dominated by pain in 80%, the abscess was localised mainly at the right iliac fossa in 77.7% of cases. Median size of collection was 3,8 ± 2 cm. There were 47,3% patients who had fistula associated to abscess. The initial reactive C protein ranged from 14 to 320 (median 58.3) mg/L. All patients had first-line treatment based on broad-spectrum bi-antibiotic therapy, alone in 25.5%, combined with surgical resection in 45.5%, surgical abscess drainage without resection in 23,6% or guided by imaging in 5.5%, the initial success was 71.7%. 28.3% of patients underwent surgery for initial treatment failure, which was dominated by ileocecal resection in 53.1%. Overall success was 92.3%, only one death was noted following postoperative release with peritonitis. Predictive factor of favorable response was: fistula associated with intra-abdominal abscess (p =0.03) and surgical resection seems to be the best therapeutic option (p < 0,001). Conclusion Intra-abdominal abscess is a complication of Crohn’s disease (CD) mainly penetrating, in almost half of the cases, it can reveal CD. Our study showed that the presence of fistula appears to be significantly associated with therapeutic success and the best results are obtained in the case of surgical resection.
Review ArticleAchalasia or megaesophagus is a pathology predisposing to the occurrence of squamous cell carcinoma and adenocarcinoma of the esophagus. The diagnosis is often made late. The first-line paraclinical workup should include esogastroduodenal fibroscopy with biopsies to confirm the diagnosis. Materials and methods: Retrospective study over a period of 18 years collecting all the patients followed in our departement. The diagnosis of megaesophagus was made by esophageal manometry. Results: Among 104 patients followed for megaesophagus, only one patient developed an squamous cell carcinoma on achalasia, that is a prevalence of 0.96%. This is a 44-year-old patient who is non smoker, or who consumes alcohol and who has had functional dysphagia since the age of 5 and in whom esophageal manometry had demonstrated an aperistalsis of the esophageal body with hypertonia and lack of relaxation of the LES. This dysphagia became 39 years later marked with solids and semi-liquids, a constant progressive associated with odynophagia and weight loss of 07 kg in 2 months.The clinical examination was without particularities. Esogastroduodenal fibroscopy objectified ulcerative stenosing cauliflower mass of the lower esophagus. The anatomopathological study of the biopsies revealed a well differentiated, mature and infiltrating squamous cell carcinoma of the lower esophagus. A thoraco-abdomino-pelvic CT scan revealed a tumor of the lower stenosing esophagus classified T3N0M0. The patient received exclusive radiochemotherapy. Conclusion: The megaesophagus is a risk factor for the development of squamous cell carcinoma of the esophagus. The prevalence in our series is 0.6% of cases. The clinician must be aware of this association so that prevention programs and treatment are not delayed.
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