Publications by authors named "Stephane Koch"
Background And Study Aims: Pancreatic metastases from renal cell carcinoma (RCC) are usually managed surgically but with significant morbidity. As an alternative, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has shown promising results in treatment of pancreatic neuroendocrine tumors. The aim of our study was to assess technical success, effectiveness, and safety of EUS-RFA in patients with pancreatic metastases of RCC.
View Article and Find Full Text PDFBackground And Aims: New techniques for endoscopic resection, including endoscopic submucosal dissection (ESD), have been developed to allow for en-bloc resection with very low recurrence rates and organ sparing in patients without inflammatory bowel disease (IBD). Data on ESD for the management of colorectal dysplasia in IBD patients are scarce. We aimed to evaluate the efficacy and safety of ESD for the treatment of IBD.
View Article and Find Full Text PDFExpansion of interventional endoscopy and day-case procedures: A nationwide longitudinal study of gastrointestinal endoscopy in France.
Hervé-Pierre Toudic
,
Marie Morvan
,
Noémi Reboux
,
Stanislas Chaussade
,
Olivier Gronier
,
Stéphane Koch
Clin Res Hepatol Gastroenterol
January 2025
Background: An accurate assessment of the evolution of GI endoscopy volumes is warranted to identify long-term trends and to help anticipate training, infrastructure and human resource needs. The main objective of this longitudinal study was to evaluate the evolution of GI endoscopy in France.
Methods: This retrospective study consisted of a cross-sectional analysis repeated each year from 2008 to 2018 using data from a national health database related to hospital admissions.
Article Synopsis
- A multicenter study assessed the feasibility and safety of EUS-guided fiducial marker placement in patients with esophageal or rectal cancer referred for radiation therapy, focusing on success rates and outcomes.
- The study involved 33 patients, achieving a 93.9% success rate in marker placement, with an average procedure time of 12.5 minutes and no reported adverse events.
- Results showed that all fiducial markers remained visible throughout radiation therapy, emphasizing the approach's safety and effectiveness for these cancer types.
Ampullary tumors: French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, UNICANCER, GERCOR, SFCD, SFED, ACHBT, AFC, SFRO, RENAPE, SNFCP, AFEF, SFP, SFR).
Vincent Hautefeuille
,
Nicolas Williet
,
Anthony Turpin
,
Bertrand Napoleon
,
Aurélien Dupré
,
Stéphane Koch
Dig Liver Dis
September 2024
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.
Article Synopsis
- Missed lesions during colonoscopy can lead to post-procedure colorectal cancer, prompting the development of contrast-enhanced technologies like linked color imaging (LCI) for better polyp detection.
- A national, randomized trial compared polyp detection rates between standard white-light imaging (WLI) and LCI in the right colon, involving 764 patients across 10 endoscopy units.
- Results showed no significant difference in the proximal adenoma miss rate or miss rates for other types of lesions between the WLI-first and LCI-first groups, challenging the idea that LCI improves detection in routine colonoscopy.
Long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction.
Abdellah Hedjoudje
,
Johanna Pokossy Epée
,
Enrique Perez-Cuadrado-Robles
,
Hadrien Alric
,
Paul Rivallin
,
Stephane Koch
United European Gastroenterol J
October 2024
Article Synopsis
- Hepaticogastrostomy drainage via endoscopic ultrasound (EUS-HGS) has gained recognition since the 2010s as a reliable alternative for patients who experience failure of traditional endoscopic techniques in managing malignant biliary obstruction (MBO).
- A study involving 211 patients found that while many experienced adverse events and some faced recurrent biliary obstruction (RBO), the primary cause of mortality was due to the progression of their underlying cancer, not complications from the stenting procedure.
- The analysis indicated that using partially covered self-expandable metal stents significantly reduced the risk of RBO, and patients with distal blockages had better outcomes in terms of stent function.
Article Synopsis
- A study was conducted to compare the rates of postoperative recurrence (POR) of Crohn's disease (CD) after two surgical techniques: Kono-S anastomosis and standard ileocolic anastomosis.
- 85 patients underwent surgery with 30 using Kono-S and 55 using the conventional method, and their endoscopic POR rates were evaluated after 6 to 12 months.
- The results showed no significant difference in POR rates between the Kono-S group (56.7%) and the control group (49.1%), suggesting that Kono-S does not lead to lower rates of recurrence, although anti-TNF treatment was beneficial.
Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study.
Clara Yzet
,
Yann Le Baleur
,
Jérémie Albouys
,
Jérémie Jacques
,
Paul Doumbe-Mandengue
,
Stéphane Koch
Endoscopy
November 2023
INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions.
View Article and Find Full Text PDFArticle Synopsis
- - The study investigated the safety and effectiveness of endoscopic resection for early esophageal tumors in patients with liver cirrhosis or portal hypertension, given their shared risk factors like alcohol use and obesity.
- - It analyzed data from 112 patients who underwent this procedure between 2005 and 2021, finding that a majority had liver cirrhosis, and various methods were employed to reduce bleeding risks during the surgery.
- - Results showed high rates of complete and curative resection but also identified some adverse events, such as delayed bleeding and infections; the findings suggest that expert centers should perform these procedures following established guidelines to ensure patient safety and treatment effectiveness.
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.
The PRSS3P2 and TRY7 deletion copy number variant modifies risk for chronic pancreatitis.
Pancreatology
January 2023
Article Synopsis
- Variants in the PRSS1 and PRSS2 genes are linked to chronic pancreatitis (CP), prompting research into whether a deletion variant affecting two trypsinogen pseudogenes (PRSS3P2 and TRY7) might influence CP risk.
- A study analyzed this deletion in over 4,000 participants from different countries and found that it is associated with a protective effect against CP, especially in French, German, and Japanese populations.
- The research suggests that the deletion enhances the function of remaining genes, leading to regulated PRSS2 expression, which could be crucial in understanding CP susceptibility.
Article Synopsis
- Budesonide is the main treatment for microscopic colitis (MC), but frequent relapses and some patients being intolerant lead to the exploration of anti-TNF therapy in those who do not respond to budesonide.
- In a study of 14 budesonide-refractory MC patients treated with anti-TNF agents, 35.7% achieved clinical remission and 64.3% showed improvement in stool frequency after 12 weeks.
- The study concludes that anti-TNF therapy can be effective for about half of patients with MC who fail budesonide, marking a significant finding in the treatment of this condition.
Liver spontaneous hypoattenuation on CT is an imaging biomarker of the severity of acute pancreatitis.
Diagn Interv Imaging
September 2022
Article Synopsis
- - This study aimed to explore how liver spontaneous attenuation (LSA) measured by CT can indicate the severity of acute pancreatitis (AP).
- - It analyzed data from 467 patients admitted for AP, finding that lower LSA was significantly linked to more severe cases, particularly in individuals with alcoholic pancreatitis.
- - The results suggest that LSA could serve as an additional indicator to assess the clinical severity of AP, enhancing diagnosis and treatment strategies.
Article Synopsis
- The study evaluates a high-fidelity simulated live animal model (HiFi SAM) for teaching therapeutic endoscopic ultrasound (TEUS) to improve training for endoscopists.
- Twenty-seven trainees completed a comprehensive 3-day program, performing 616 TEUS procedures under expert guidance, with a high success rate and positive feedback on the training quality.
- Trainees expressed a desire for more specific skills practice and reported improvements in their procedural capabilities after training with HiFi SAM, indicating its effectiveness in skill development.
Article Synopsis
- The study investigates TRPV6 as a gene linked to chronic pancreatitis (CP) and finds it associated with calcium (Ca) dysregulation.
- Researchers analyzed TRPV6 in various CP patient groups, identifying 25 rare TRPV6 variants, with 18 being newly reported.
- The analysis indicates that functionally deficient TRPV6 variants are more common in hereditary and familial CP, often co-occurring with other known risk genes, and highlight their significant role in the disease.
Article Synopsis
- The study investigates the importance of abdominal CT scans in diagnosing acute biliary pancreatitis (ABP) and determining its biliary origin, which is key for effective treatment and recurrence prevention.
- Researchers analyzed data from 271 patients over a span of several years and found several CT and clinical features, such as the presence of gallstones and specific signs like choledochal ring, that were strongly associated with ABP.
- The results led to the creation of a predictive nomogram that effectively combines clinical and CT data, achieving high accuracy in diagnosing ABP with an area under the curve of 0.94 in the study sample and 0.91 in a validation cohort.
Article Synopsis
- The study evaluated the long-term effectiveness of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for treating pancreatic neuroendocrine tumors (NETs) and certain pancreatic cystic neoplasms (PCNs) over a follow-up period of at least 3 years.
- Out of the participants, a high percentage (85.7%) of NETs showed complete tumor disappearance at both 1 year and the end of the follow-up, indicating that EUS-RFA can be a successful treatment option.
- The treatment response in PCNs was notable, with about 70.5% showing significant improvement at 1 year and 66.6% achieving a substantial response by the end of the study
Article Synopsis
- The study investigates the rare association between IgA vasculitis (IgAV) and inflammatory bowel disease (IBD), primarily in patients treated with anti-TNF-α therapy.
- Out of 43 cases analyzed, the majority showed that IBD, particularly Crohn's disease, preceded the onset of IgAV by an average of 9.2 years, with many patients experiencing purpura and joint issues.
- The findings suggest that discontinuing anti-TNF-α can lead to remission of IgAV, but also raises the risk of IBD flare-ups, while continuing treatment may help manage IBD but lead to recurring IgAV symptoms.
Article Synopsis
- Surgical resection and chemotherapy are the main treatments for localized pancreatic ductal adenocarcinoma (LPDAC), but most patients experience recurrence, highlighting the need for improved preoperative therapy assessments.
- A study at Besancon University Hospital analyzed factors from 146 LPDAC patients to predict relapse-free survival (RFS), focusing on immunological and nutritional elements.
- It found that preoperative lymphopenia (low lymphocyte count) and sarcopenia (low muscle mass) significantly impact RFS, allowing for the classification of patients into three risk groups with varied survival outcomes.
Introduction: The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers.
Methods: All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included.
Results: 271 children underwent 470 ERCP procedures.
Article Synopsis
- The SARS-CoV-2 pandemic significantly decreased gastrointestinal (GI) endoscopy activity in France, as shown by a comprehensive web-based survey conducted among French gastroenterologists.
- Out of 694 respondents, a staggering 98.7% reported having to cancel procedures due to the pandemic's impact, with a notable percentage involved in managing COVID-19 patients.
- The study reveals concerning health implications, including potential delays in treating gastroenterology patients, particularly those with GI cancers, due to the restricted access to necessary endoscopic procedures.
SFED recommendations for IBD endoscopy during COVID-19 pandemic: Italian and French experience.
Nat Rev Gastroenterol Hepatol
August 2020
Article Synopsis
- - The COVID-19 pandemic has significantly changed how patients with inflammatory bowel disease (IBD) are managed during endoscopic procedures due to the risk of SARS-CoV-2 transmission.
- - Key preventive measures include using personal protective equipment (PPE), improving hygiene in endoscopy rooms, and postponing non-urgent procedures to protect patients and healthcare workers.
- - This Perspective draws from experiences in Italy and France to offer guidelines on PPE use, as well as suggestions for when to reschedule endoscopies or use alternative biomarkers in managing IBD.