Objectives: Oesophageal pH monitoring is a useful test for the diagnosis of gastro-oesophageal reflux disease (GORD) but has some limitations related to the nasopharyngeal electrode. Recently, a telemetric catheter free system (CFS) (Bravo; Medtronic) was developed. The aim of this study was to determine the concordance of data between the conventional pH measurement system (CPHMS) and the CFS Bravo. Methods: Forty patients with symptoms suggestive of GORD underwent 24 hour oesophageal pH monitoring using the CPHMS with a nasopharyngeal electrode and the Bravo CFS simultaneously. The sensitive tips of both electrodes were positioned at the same level under fluoroscopy. In addition to automatic analysis, each reflux episode was checked visually and characterised.Results: There was a significant correlation (r = 0.87, p,0.0001) between the 24 hour oesophageal acid exposures recorded by the CPHMS and the CFS. Twenty four hour oesophageal acid exposure was significantly lower with the CFS than with the CPHMS (2.4 (0.4-8.7) v 3.6 (0.7-8.6); p, 0.0001). Consequently, with the CFS, the cut off level for the diagnosis of GORD, as calculated from the regression equation, was 2.9% (for the 4.2% cut off determined in controls with the CPHMS). After this adjustment, concordance of the diagnosis of GORD was 88% (kappa 0.760). Diagnosis of GORD was established in more patients with the CFS 48 hour results than with the 24 hour results. Conclusions: Despite strong correlations between oesophageal acid exposure recorded with the two devices, the Bravo CFS significantly under recorded acid exposure compared with the CPHMS. Provided some correcting factors are used, the Bravo CFS can improve the sensitivity of pHmetry for the diagnosis of GORD by allowing more prolonged recordings.

A screening program based on FIT 1-year appeared to be the most cost-effective approach for CRC screening in France. However, a substantial uncertainty over this choice is still present.

This large multicenter study confirms the safety and acceptable accuracy of ECE for the evaluation of esophageal varices. ECE might be proposed as an alternative to EGD for the screening of portal hypertension, especially in patients unable or unwilling to undergo EGD.

Tumors of the papilla of Vater, should be separated from periampullary tumors. They are not always malignant, and recent data from endoscopy series, and pathology studies, supports the adenoma-carcinoma sequence at this level. Adenomas are tubular or villous and are classified according to the degree of dysplasia. The endoscopic pattern separates exophytic tumors, sessile and easily detected, from intracanalar tumors usually detected after sphincterotomy. The malignancy of an exophytic tumor is suspected when it is ulcerated or large (over 3 cm), and is easily confirmed by biopsies. The typing of intracanalar tumors is more difficult. In a 5-year period, an ampullary tumor was detected by ERCP in 52 patients: the tumor was exophytic in 33 and intracanalar in 19. Adenocarcinoma was confirmed in 26 and adenoma in 26, resulting in a 50% ratio. Among the adenomas, 18 were fully benign and 8 had a superficial cancer focus. Therapeutic procedures included: laser photodestruction in 16, snare resection in 16, sphincterotomy in 47, stenting in 8, surgical bypass in 7, cephalic duodenopancreatectomy in 16. The 16 patients treated by laser (Nd:YAG mainly) included 8 adenomas: a complete tumor destruction was obtained in 7 (follow up from 14 to 53 months). Adenomatous recurrence was observed at 2 years in one patient. In 8 other patients the tumor was an adenocarcinoma; Laser photodestruction failed to completely destroy the tumor in 1 patient (operative control), in 7 others it was adopted as a complement to sphincteromy and stenting in palliation, but was not found very effective.(ABSTRACT TRUNCATED AT 250 WORDS)