In this early experience, the feasibility of ESD appeared to be good but R0 resection and complication rates did not match those reported by Japanese authors and must be improved by an extended practice.

While hemorrhagic complications of portal cavernoma are frequent, compression of the bile ducts by portal cavernoma is uncommon and treatment is still a matter for debate. We report here six new cases in order to describe: (a) the clinical, biological, and morphological features of this condition, and (b) the long-term results of a combined endoscopic and surgical treatment. The median age of patients at the time of diagnosis was 36.5 years. The circumstances of diagnosis were acute cholangitis (n=3), asymptomatic biological cholestasis (n=1), pruritus, jaundice and asthenia (n=1) and jaundice alone (n=1). Portal cavernoma and bile duct dilatation were confirmed by abdominal ultrasonography with pulsed color doppler and endoscopic retrograde cholangiography (ERC). Gallstones were found in four patients. Following stenting of the bile duct, there was a good outcome in two patients. In four patients, after failure of prolonged endoscopic treatment, second-line surgical portal-systemic shunting allowed removal of the biliary stent, and no recurrence of disease. In conclusion, biliary involvement in portal cavernoma is now a well-recognized entity, and our results suggest that combined endoscopic and surgical treatment could be required.

In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.

Background and study aims: The SARS-CoV-2 pandemic has strongly affected medical activity around the world. We sought to measure the impact of the COVID-19 pandemic on the gastrointestinal endoscopic activity in France. Methods: We performed a web-based survey, including 35 questions on the responders and their endoscopic practice, from March 23rd to March 27th 2020, sent to the 3300 French gastroenterologists practicing endoscopy. Results: 694 (21%) gastrointestinal endoscopists provided analyzable data. 29.4% (204/694) were involved in the management of COVID-19 patients outside the endoscopy departments, and 98.7% (685/694) of the endoscopic procedures were canceled. 12.8% (89/694) of the gastroenterologists reported symptoms compatible with COVID-19 infection, and a positive PCR was recorded in 12/197 (6.1%) vs. 3/497 (0.6%) patients in the high vs. low prevalence areas, p<0.0001. Conclusions: The COVID-19 pandemic led to a major reduction in the volume of gastrointestinal endoscopies performed in France in March 2020. The prolonged limited access to gastrointestinal endoscopy could lead to a delay in the management of patients with gastrointestinal cancers.

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