Publications by authors named "Michel Vix"

39 Publications

Somatostatin analogue pasireotide (SOM230) inhibits catecholamine secretion in human pheochromocytoma cells.

Cancer Lett 2021 Oct 9. Epub 2021 Oct 9.

Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France. Electronic address:

Increasingly common, neuroendocrine tumors (NETs) are regarded nowadays as neoplasms potentially causing debilitating symptoms and life-threatening medical conditions. Pheochromocytoma is a NET that develops from chromaffin cells of the adrenal medulla, and is responsible for an excessive secretion of catecholamines. Consequently, patients have an increased risk for clinical symptoms such as hypertension, elevated stroke risk and various cardiovascular complications. Somatostatin analogues are among the main anti-secretory medical drugs used in current clinical practice in patient with NETs. However, their impact on pheochromocytoma-associated catecholamine hypersecretion remains incompletely explored. This study investigated the potential efficacy of octreotide and pasireotide (SOM230) on human tumor cells directly cultured from freshly resected pheochromocytomas using an implemented catecholamine secretion measurement by carbon fiber amperometry. SOM230 treatment efficiently inhibited nicotine-induced catecholamine secretion both in bovine chromaffin cells and in human tumor cells whereas octreotide had no effect. Moreover, SOM230 specifically decreased the number of exocytic events by impairing the stimulation-evoked calcium influx as well as the nicotinic receptor-activated inward current in human pheochromocytoma cells. Altogether, our findings indicate that SOM230 acts as an inhibitor of catecholamine secretion through a mechanism involving the nicotinic receptor and might be considered as a potential anti-secretory treatment for patients with pheochromocytoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.canlet.2021.10.009DOI Listing
October 2021

State of the Art in Robot-Assisted Eye Surgery.

Klin Monbl Augenheilkd 2021 Sep 27. Epub 2021 Sep 27.

IRCAD, European Institute of Telesurgery, Strasbourg, France.

Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1562-2350DOI Listing
September 2021

Dual-Time-Point 18F-Fluorocholine PET/CT Improves Characterization of Thyroid Nodules in Patients Referred for Primary Hyperparathyroidism: A Proof of Concept Study.

Clin Nucl Med 2021 Sep 13. Epub 2021 Sep 13.

From the Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, Strasbourg University, Strasbourg Nuclear Medicine, Institut Godinot CReSTIC, EA3804, Reims Champagne-Ardenne University, Reims Digestive and Endocrine Surgery, University Hospital of Strasbourg Institute of Image-Guided Surgery, IHU/IRCAD, Strasbourg Thyroid Unit, Institut Godinot, Reims Nuclear Medicine, La Timone University Hospital, Aix-Marseille University European Center for Research in Medical Imaging, Aix-Marseille University, Marseille Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France.

Purpose: Thyroid nodules frequently coexist with primary hyperparathyroidism (pHPT). Because of the increasing use of 18F-fluorocholine (18F-FCH) PET/CT in patients with pHPT, evaluation of its clinical utility for thyroid nodules characterization in this population is of paramount importance. Herein, we investigate the value of dual-point 18F-FCH PET/CT in the diagnosis of thyroid cancer in patients referred for pHPT imaging who have thyroid nodules.

Patients And Methods: All pHPT patients who underwent a dual-time point 18F-FCH PET/CT (at 5 and 60 minutes postinjection) between July 2019 and December 2020 were analyzed. Only those with a thyroid nodule greater than 10-mm and pathological analysis (criterion standard) were included. Nodule-to-thyroid SUVmax ratio was calculated at the 2 study points, as well as the 18F-FCH washout index (WO%).

Results: Twenty-seven patients (32 nodules) were included in this study. The final diagnoses were as follows: 27 benign nodules including 2 NIFTPs (noninvasive follicular thyroid neoplasm with papillary-like nuclear features) and 5 cancers of follicular origin. Early uptake ratio was significantly higher in malignant lesions than in benign nodules (P = 0.0008). Thyroid cancers were also characterized by a marked 18F-FCH washout index (WO% benign vs cancer: 2.9% ± 4.1% vs 45.5% ± 13.4%, P = 0.0001). Using a WO% threshold of 22.1%, 25/27 benign nodules and 5/5 malignant lesions were accurately classified (sensitivity of 100%, specificity of 92.6%, positive predictive value of 71.4%, and negative predictive value of 100%). The false-positive findings were related to the 2 NIFTPs that share similarities with thyroid cancer.

Conclusions: Our preliminary results suggest to perform a dual-time-point PET/CT acquisition protocol in pHPT patients with uncharacterized centimeter thyroid nodules. However, the real impact of these promising results should be assessed by prospective studies on a larger cohort of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RLU.0000000000003904DOI Listing
September 2021

Indications and Long-Term Outcomes of Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass.

Obes Surg 2021 08 1;31(8):3410-3418. Epub 2021 May 1.

Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), 1 place de l'Hôpital, 67000, Strasbourg, France.

Purpose: Long-term results on sleeve gastrectomy (SG) with more than 10 years report patients needing sleeve revision for weight loss failure, de novo gastroesophageal reflux (GERD), or sleeve complications. The aim of this study was to analyze the results of laparoscopic conversion of failed SG to Roux-en-Y gastric bypass (RYGB).

Materials And Methods: Retrospective review of a prospectively institutional maintained database to identify patients who underwent conversion of SG to RYGB between 2012 and June 2020.

Results: Sixty patients(50 females) underwent conversion to RYGB. Average time to conversion was 5.6 years (2-11). Mean %WL and TWL after SG were respectively 26±8.8% and 33.2±14.1kg. Mean BMI at the time of RYGB was 38.1±7.1 kg/m. Mean follow-up was 30.4±16.8 months (6-84). Available patients at each time of follow-up: 1 year 59 (98.3%); 2 years 47 (78.3%); 3 years 39 (71.6%); and 5 years 33 (55%). Patients were divided according to indication for revision in weight regain/insufficient weight loss (30 patients) group 1 and GERD/complications (25 patients) group 2. Percentage of excess weight loss at 1, 3, and 5 years follow-up after bypass was for group 1 40.3±17.6, 34.3±19.5, and 23.2±19.4 and for group 2 90.4±37, 62.6±28.2, and 56±35.02. Total weight loss at last follow-up since sleeve was respectively 31kg in group 1 and 46.7kg in group 2 (p=0.002). No mortality was observed. Thirty-day complication rate was 3.3%.

Conclusion: RYGB after SG is a safe and effective revisional procedure to manage weight regain and de novo GERD, to address complications, and to improve comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-021-05444-4DOI Listing
August 2021

Endoscopic assessment of morphological and histopathological upper gastrointestinal changes after endoscopic sleeve gastroplasty.

Surg Obes Relat Dis 2021 Jul 2;17(7):1294-1301. Epub 2021 Apr 2.

IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute against Digestive Cancer, Strasbourg, France; Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.

Background: Endoscopic sleeve gastroplasty (ESG) is a promising bariatric endoluminal procedure. Restriction and shortening of the stomach are obtained by means of non-resorbable full-thickness sutures, thus inducing the formation of several endoluminal pouches in which food can stagnate. The effect of ESG on the upper gastrointestinal tract has never been investigated.

Objectives: This study objectively evaluates endoscopic macroscopic and histopathologic changes within 12-month follow-up (FU) in patients who underwent ESG.

Setting: Retrospective study on a prospective database of patients who underwent ESG at our tertiary referral center between October 2016 and March 2019.

Methods: All consecutive patients undergoing upper endoscopy (EGD) preoperatively and 6 and 12 months after ESG were included. The upper gastrointestinal tract was evaluated for mucosal abnormalities and biopsies were systematically taken.

Results: Eighty-six patients were included. EGD results were as follows: esophagitis decreased from 14% preoperatively to 3.6% and 1.2% at 6- and 12-month FU, respectively (P = .001); 19.8% of patients presented preoperatively a type I hiatal hernia <4 cm and showed no size increment or de novo hiatal hernia at 6- and 12-months. The rate of preoperative hyperemic (23.2%) and erosive (3.5%) gastropathy decreased to 9.5% and 1.2% at 6 months and 17.4% and 1.2% at 12 months, respectively. Gastric ulcer (4.7%), duodenal hyperemic mucosa (1.2%) and duodenal micro-ulcerations (2.3%) detected preoperatively were not present at 6- and 12-month EGD. The rate of histopathological disease, which was 68.1% preoperatively, dropped to 29.2% at 12 months, chronic gastritis decreased from 40.3% to 26.4%, acute gastritis from 9.7% to 0%, and acute inflammation on chronic gastritis from 18% to 2.8% (P < .001).

Conclusion: ESG is a safe procedure that does not promote the new onset of macroscopic and histopathologic abnormalities within 1-year follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.soard.2021.03.026DOI Listing
July 2021

Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration.

Surg Innov 2021 Jun 20;28(3):261-271. Epub 2021 Mar 20.

Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.

. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. . 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. . Sensitivity of exact, , adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, < 2.2 × 10) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, = 3.1 × 10). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( = .0459). CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15533506211001236DOI Listing
June 2021

Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis.

Surg Endosc 2021 03 6;35(3):1025-1038. Epub 2020 Nov 6.

Division of Bariatric Surgery, Department of Surgery, Sacré-Cœur de Montréal Hospital, University of Montréal, Montreal, Canada.

Objective: Recently, there has been a burgeoning interest in the utilization of customized bariatric stents (CBS) for management of sleeve gastrectomy leak (SGL). We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of these new stents and to compare them with the conventional esophageal stents (CES).

Methods: A systematic literature search of the PubMed, Cochrane Library, Scopus, Web of Science and Google Scholar databases was conducted through May 1, 2020. Primary outcomes were technical and clinical success and post-procedure adverse events of CBS and CES. Secondary outcomes were number of stents and endoscopic sessions per patient, and time to leak closure. A proportion meta-analysis was performed on outcomes using a random-effects model, and the weighted pooled rates (WPRs) or mean difference with 95% confidence interval (CI) were calculated.

Results: The WPR with 95% CI of technical success, clinical success, and stent migration for CBS were 99% (93-100%) I = 34%, 82% (69-93%) I = 58%, and 32% (17-49%), I = 69%, respectively. For CES, the WPR (95% CI) for technical success, clinical success, and stent migration were 100% (97-100%) I = 19%, 93% (85-98%) I = 30%, and 15% (7-25%), I = 41%, respectively. Adverse events other than migration were very low with both types of stents. On proportionate difference, CBS had lower clinical success (11%) and higher migration rate (17%) in comparison to CES. In successfully treated patients, CBS was associated with lower mean number of stents and endoscopic sessions, and shorter time to leak closure compared to CES. The overall quality of evidence was very low.

Conclusions: In treatment of SGL, there is very low level evidence that CES are superior to CBS in terms of clinical success and migration rate, though may require more stent insertions and endoscopic procedures. The evidence however remains very uncertain. Perhaps relevant to some types of stents, CBS are promising; however design modification is strongly recommended to improve outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-020-08147-6DOI Listing
March 2021

Development and Validation of a Predictive Model for Internal Hernia after Roux-en-Y Gastric Bypass in a Multicentric Retrospective Cohort: The Swirl, Weight Excess Loss, Liquid Score.

Ann Surg 2020 Oct 14. Epub 2020 Oct 14.

Unit of Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland.

Objective: The aim of this study was to develop and validate a prediction score for internal hernia (IH) after Roux-en-Y gastric bypass (RYGB).

Summary Background Data: The clinical diagnosis of IH is challenging. A sensitivity of 63% to 92% was reported for computed tomography (CT).

Methods: Consecutive patients admitted for abdominal pain after RYGB and undergoing CT and surgical exploration were included retrospectively. Potential clinical predictors and radiological signs of IH were entered in binary logistic regression analysis to determine a predictive score of surgically confirmed IH in the Geneva training set (January 2006-December 2014), and validated in 3 centers, Geneva (January 2015-December 2017) and Neuchâtel and Strasbourg (January 2012-December 2017).

Results: Two hundred twenty-eight patients were included, 80 of whom (35.5%) had surgically confirmed IH, 38 (16.6%) had a negative laparoscopy, and 110 (48.2%) had an alternate diagnosis. In the training set of 61 patients, excess body weight loss >95% (odds ratio [OR] 6.73, 95% confidence interval [CI]: 1.13-39.96), swirl sign (OR 8.93, 95% CI: 2.30-34.70), and free liquid (OR 4.53, 95% CI: 1.08-19.0) were independent predictors of IH. Area under the curve (AUC) of the score was 0.799. In the validation set of 167 patients, AUC was 0.846. A score ≥2 was associated with an IH incidence of 60.7% (34/56), and 5.3% (3/56) had a negative laparoscopy.

Conclusions: The score could be incorporated in the clinical setting. To reduce the risk of delayed IH diagnosis, emergency explorative laparoscopy in patients with a score ≥2 should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000004370DOI Listing
October 2020

F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism.

J Clin Med 2020 Jun 26;9(6). Epub 2020 Jun 26.

Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France.

The present retrospective study evaluates the diagnostic value of integrated F-Fluorocholine positron emission tomography/four-dimensional contrast-enhanced computed tomography (F-FCH PET/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares F-FCH PET with 4D-CT. Patients with pHPT and negative/discordant first-line imaging addressed for integrated F-FCH PET/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of F-FCH PET/CT, 4D-CT, and PET/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET/CT, 4D-CT, and PET/4D-CT. PET/CT was more sensitive than 4D-CT ( = 0.046). PET/4D-CT performed better than 4D-CT ( = 0.013) but was equivalent to PET/CT alone. On a per gland analysis, sensitivity PET/CT, 4D-CT, and PET/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET/CT and PET/4D-CT were more sensitive than 4D-CT alone ( = 0.01, < 0.001, respectively). However, PET/CT and PET/4D-CT performed similarly. In conclusion, F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of F-FCH PET/4D-CT as a "one-stop shop" second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9062005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356908PMC
June 2020

Postoperative Remote Monitoring with a Transcutaneous Biosensing Patch: Preliminary Evaluation of Data Collection.

Surg Innov 2020 Aug 11;27(4):320-327. Epub 2020 Jun 11.

IHU-Strasbourg, Institute of Image-Guided Surgery, France.

Connected systems transmitting vital parameters could well represent a tool to shorten postoperative hospital stay while providing continuous remote patient monitoring and potentially detect the onset of complications. Our aim was to analyze the functionality of a transcutaneous biosensing data collection patch in morbidly obese patients. . An adhesive patch (The HealthPatch MD™) was applied to patients' chests postoperatively. The patch was connected to a tablet via a bluetooth network to collect the heart rate, respiratory rate, skin temperature, and posture recognition data. The tablet conveyed data to a secure health data central server by means of a WiFi or 3G/4G transmission. Data were stored in a digital health platform to which health care professionals could connect. The evaluation focused on the volume, quality, and security of data transmission. A pilot phase involved 10 patients. Thirty-three additional patients undergoing bariatric surgery were included in the experimental phase. . The mean length of stay was 2.28 days (range: 2-5 days). The mean time of patch application was 51 ± 25.2 hours per patient (range: 19-139 hours), totalizing 1,683 hours of recording for the 33 patients included. During this time, a total of 7.562.531 data measurement points were collected and transmitted to the e-health platform via the patch. Two total disconnections and two partial disconnections were observed. The acquisition of patient postural data was unreliable. . Connected telemetry for remote postoperative monitoring is promising. However, it is still limited by data transmission problems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1553350620929461DOI Listing
August 2020

A fully implantable device for diffuse insulin delivery at extraperitoneal site for physiological treatment of type 1 diabetes.

J Control Release 2020 04 31;320:431-441. Epub 2020 Jan 31.

Defymed S.A.S, Strasbourg, France. Electronic address:

Intraperitoneal insulin delivery has higher benefits than subcutaneous insulin administration but has limitations, including obstruction of the catheter used in delivery devices. To overcome these limitations this study assessed safety and efficacy of an alternative approach involving a new delivery device, named ExOlin® allowing diffuse release of insulin in the extraperitoneal site. The aim of this study is to validate both safety and efficacy of insulin delivery in extraperitoneal using ExOlin® device. Safety of the ExOlin® device implantation in the extraperitoneal site was investigated over a 3-month period in Wistar rat and landrace swine models before comparing efficacy pharmacokinetics and hepatic first-pass metabolism of insulin after focal delivery using a catheter or diffuse release via ExOlin® device in extraperitoneal. Implantation in rat and swine models demonstrated good integration of the device, validating the safety of the extraperitoneal site. In diabetic rats, direct insulin administration at the extraperitoneal showed an efficacy comparable to intraperitoneal and statistically significantly higher than subcutaneous route as shown by 23% lower AUC calculated from glycaemia profile. Diffuse extraperitoneal delivery of insulin via ExOlin® device in diabetic rats exhibited better efficacy than the subcutaneous route with up to six-fold lower peripheral insulin and higher hepatic first-pass than with intraperitoneal injection. Similar results were confirmed in the swine model after injecting insulin lispro via the device at the extraperitoneal site. In conclusion, diffuse administration of insulin at the extraperitoneal site via ExOlin® device is a new promising approach to physiologically treating type 1 diabetes. It can therefore be considered as a promising alternative to intraperitoneal route.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jconrel.2020.01.055DOI Listing
April 2020

6-Month Gastrointestinal Quality of Life (QoL) Results after Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: A Propensity Score Analysis.

Obes Surg 2020 May;30(5):1944-1951

Institute of image-guided surgery (IHU),1 place de l'Hôpital, 67091, Strasbourg, France.

Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure. Endoscopic sleeve gastroplasty (ESG) is a promising new bariatric technique which is less invasive in its approach. To date no study has compared quality of life (QoL) outcomes between LSG and ESG. The aim of this study is to compare QoL after ESG and LSG using a propensity score analysis.

Methods: QoL was evaluated by means of Gastrointestinal Quality of Life Index (GIQLI) questionnaire before and 6 months after the procedure. Patients were matched for age, sex, preoperative weight, and comorbidities.

Results: Propensity score matching resulted in 23 pairs of patients homogeneous for age (p = 0.3), preoperative BMI (p = 0.3), sex (p = 0.74), and comorbidities (p = 0.9). Post-ESG patients, despite a less important %EWL (39.9 (17.5-58.9)vs 54.9 (46.2-65); p = 0.01) and %TWL (13.4 (7.8-20.9) vs 18.8 (17.6-21.8); p = 0.03), presented better QoL (14 [3-24] vs 13 (- 1-23) ΔGIQLI score; p = 0.79) with clear advantage for the gastrointestinal symptoms subdomain (66.5 (61-70.5) vs 59 (55-63); p = 0.001), while post-LSG patients presented a worsening of GERD symptoms (30.7% vs 0%) and an increased use of PPI therapy (p = 0.004). Resolution or improvement of comorbidities was similar (ESG 53% vs LSG 45.8%; p = 0.79) in both groups.

Conclusion: LSG may significantly affect QoL and results in worsening of gastrointestinal symptoms including GERD. ESG is a promising less invasive bariatric endoscopic procedure that demonstrated a positive impact on both QoL and comorbidities, which could lead to greater patient acceptance earlier in their disease or at a younger age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-020-04419-1DOI Listing
May 2020

Does endoscopic sleeve gastroplasty stand the test of time? Objective assessment of endoscopic ESG appearance and its relation to weight loss in a large group of consecutive patients.

Surg Endosc 2020 08 13;34(8):3696-3705. Epub 2020 Jan 13.

IHU-Strasbourg, Institute of Image-Guided Surgery, 1 place de l'Hôpital, 67000, Strasbourg, France.

Introduction: Endoscopic sleeve gastroplasty (ESG) is a promising bariatric treatment. Gastric volume reduction and delayed gastric emptying are the probable mechanisms driving weight loss. However, there are concerns regarding the overtime ESG effectiveness. This study aims to evaluate the correlation between endoscopic gastroplasty integrity overtime and weight loss.

Patients And Methods: Patients undergoing follow-up endoscopy (6 and 12 months) after ESG were included. ESG were classified in three groups according to endoscopic appearance: open when all the stiches were loose; partially intact if at least one stitch was loose; intact if all the stitches were present and tight. Initial BMI, excess weight loss (%EWL) and total weight loss (%TWL) at 6 and 12 months were assessed against gastroplasty endoscopic appearance.

Results: From October 2016 to April 2019, 133 patients underwent ESG, 87 (65.4%) had a follow-up EGD at 6 months. ESG was open in six cases (6.9%), partially intact in 38 (43.7%) and intact in 43 (49.4%). The overall %EWL and %TWL was 34.5 ± 19.8 and 13.2 ± 7.4, respectively; 25.7 ± 26.9 and 11.8 ± 11.8 for the open group, 30.8 ± 20.1 and 12.4 ± 7.8 for the partially intact group; 39.1 ± 19.7 and 14.0 ± 6.4 for the intact gastroplasty. Forty-one patients underwent a 12 months endoscopy: 10 (24.4%) had an intact ESG, 24 (58.5%) had a partially intact gastroplasty, and in 7 (17.0%) cases the sutures were lost. Overall %EWL and %TWL at 12 months was 34.3 ± 21.9 and 13.1 ± 8.1: 19.3 ± 13.4 and 8.9 ± 6.1 for the open group; 36.0 ± 24.2 and 13.1 ± 8.9 for the partially intact group; 40.3 ± 17.3 and 17.2 ± 5.4 for the intact group. ESG appearance correlated with preoperative BMI (r 0.34; p 0.001) and %EWL at 6 months (r 0.22; p 0.035) and 12 months (r 0.29; p 0.065).

Conclusion: This preliminary work shows that weight loss correlates with ESG endoscopic appearance over time. Initial BMI predicts endoscopic suture duration over time. Larger studies and longer follow-up are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-019-07329-1DOI Listing
August 2020

Interleukin-32 Contributes to Human Nonalcoholic Fatty Liver Disease and Insulin Resistance.

Hepatol Commun 2019 Sep 19;3(9):1205-1220. Epub 2019 Jul 19.

Service d'Hépato-Gastroentérologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France.

Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder due to increased accumulation of fat in the liver and in many cases to enhanced inflammation. Although the contribution of inflammation in the pathogenesis of NAFLD is well established, the cytokines that are involved and how they influence liver transformation are still poorly characterized. In addition, with other modifiers, inflammation influences NAFLD progression to liver cirrhosis and hepatocellular carcinoma, demonstrating the need to find new molecular targets with potential future therapeutic applications. We investigated gene signatures in 38 liver biopsies from patients with NAFLD and obesity who had received bariatric surgery and compared these to 10 control patients who had received a cholecystectomy, using DNA microarray technology. A subset of differentially expressed genes was then validated on a larger cohort of 103 patients who had received bariatric surgery for obesity; data were thoroughly analyzed in terms of correlations with NAFLD pathophysiological parameters. Finally, the impact of a specific cytokine, interleukin-32 (), was addressed on primary human hepatocytes (PHHs). Transcript analysis revealed an up-regulation of proinflammatory cytokines , chemokine (C-X-C motif) ligand 9 (CXCL9), and CXCL10 and of ubiquitin D (UBD), whereas down-regulation of insulin-like growth factor-binding protein 2 (IGFBP2) and hypoxanthine phosphoribosyltransferase 1 (HPRT1) was reported in patients with NAFLD. Moreover, , which is the major deregulated gene, correlated with body mass index (BMI), waist circumference, NAFLD activity score (NAS), aminotransferases (alanine aminotransferase [ALAT] and aspartate aminotransferase [ASAT]), and homeostasis model assessment of insulin resistance (HOMA-IR) index in patients. Consistent with an instrumental role in the pathophysiology of NAFLD, treatment of control human hepatocytes with recombinant leads to insulin resistance, a hallmark metabolic deregulation in NAFLD hepatocytes. has a critical role in the pathogenesis of NAFLD and could be considered as a therapeutic target in patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hep4.1396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719754PMC
September 2019

Early F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma.

Eur J Nucl Med Mol Imaging 2019 03 7;46(3):686-695. Epub 2019 Jan 7.

Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France.

Purpose: Data on the diagnostic value of F-FDOPA PET/CT in patients with insulinoma are limited and are focused on small patient populations explored using different PET/CT protocols and the inconsistent use of carbidopa premedication. The aim of this study was to improve the current knowledge about the diagnostic value of F-FDOPA PET/CT combined with oral carbidopa premedication and early pancreatic imaging for tumour localization in patients with insulinoma-related hyperinsulinaemic hypoglycaemia (HH). The relationships among F-FDOPA quantitative uptake parameters, insulin secretion and tumour pathological features were also investigated.

Methods: Of 34 patients with suspicion of insulinoma-related HH examined by dual time-point carbidopa-assisted F-FDOPA PET/CT, 24 with histologically proven insulinoma were retrospectively included. One patient underwent two PET/CT examinations for relapsing insulinoma after surgical excision. Thus, 25 preoperative F-FDOPA PET/CT studies were finally retained and analysed. All studies were performed under carbidopa premedication (200 mg orally, 1-2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after F-FDOPA injection) over the upper abdomen and a delayed whole-body acquisition starting 20-30 min later. The cytological and/or histopathological diagnosis of insulinoma was the diagnostic standard of truth.

Results: F-FDOPA PET/CT localized insulinoma in 21 of the 25 studies, leading to a primary lesion detection rate of 84%. Four lesions (19%) were detected only on early acquisitions. The false-negative tumour detection rates were, respectively, 22% and 12.5% in patients receiving and not receiving treatment for hypoglycaemic symptoms at the time of PET/CT. In benign insulinomas, the early maximum standardized uptake value (SUVmax) was significantly higher than the delayed SUVmax. Compared to the 21 benign lesions, four malignant insulinomas showed significantly higher F-FDOPA uptake. Lesion size, fasting-end insulin and C-peptide levels correlated with tumour F-FDOPA uptake, dopaminergic tumour volume and metabolic burden.

Conclusion: The present study showed that F-FDOPA PET/CT combined with carbidopa premedication and early pancreatic acquisitions is a valuable diagnostic option in patients with insulinoma when GLP1R-based imaging is not available. The results also provide new insights into the relationships between tumour secretion and imaging phenotype in insulinomas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-018-4245-3DOI Listing
March 2019

Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue Before Resection.

Surg Innov 2019 Apr 23;26(2):141-148. Epub 2018 Nov 23.

1 University Hospital of Strasbourg, Strasbourg, France.

Background: Frozen section is the standard method to histologically distinguish parathyroid tissue from thyroid tissue during endocrine neck surgery. Frozen section can be time-consuming and costly. Its drawback is that it is to be performed only after the removal of a suspected pathological tissue. This study demonstrates the use of probe-based confocal laser endomicroscopy (pCLE) to confirm histology prior to tissue resection.

Design: A prospective, single-institution, nonrandomized study was conducted. No sample size calculation was performed for this observational trial. The primary objective was the description of histological rendering of normal and pathological tissues through pCLE. Real-time in vivo fluorescence microscopy imaging was performed with the CystoFlex UHD probe after intravenous injection of 2.5 mL of 10% fluorescein sodium.

Results: Eleven patients with hyperparathyroidism and thyroid conditions were included. A total of 104 videos showing thyroid, parathyroid, adipose tissue, muscle, laryngeal nerve, and lymph nodes were recorded. Videos were compared with visual information and pathological samples (when sampling was indicated). Thyroid tissue could be identified based on the presence of colloid follicles (intensely fluorescent area surrounded by a small ridge of low-fluorescence epithelial cells) including the pathognomonic aspect of resorption vacuole. Parathyroid tissue could be identified based on a regular, "diamond-shaped" capillary network encompassing parathyroid chief cells. Blinded reinterpretation of pCLE videos demonstrated an 89.3% sensitivity and a 90% specificity as compared with histology in tissue recognition.

Conclusion: This pilot study describes representative renderings of intraoperative pCLE to nontraumatically differentiate thyroid, parathyroid, and lymph nodes before surgical removal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1553350618814078DOI Listing
April 2019

Prospective Evaluation of Precision Multimodal Gallbladder Surgery Navigation: Virtual Reality, Near-infrared Fluorescence, and X-ray-based Intraoperative Cholangiography.

Ann Surg 2017 11;266(5):890-897

*IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France †IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France ‡University Hospital of Strasbourg, Department of General, Digestive, and Endocrine Surgery, Strasbourg, France §University Hospital of Strasbourg, Department of Radiology B, Strasbourg, France.

Objective: We aimed to prospectively evaluate NIR-C, VR-AR, and x-ray intraoperative cholangiography (IOC) during robotic cholecystectomy.

Background: Near-infrared cholangiography (NIR-C) provides real-time, radiation-free biliary anatomy enhancement. Three-dimensional virtual reality (VR) biliary anatomy models can be obtained via software manipulation of magnetic resonance cholangiopancreatography, enabling preoperative VR exploration, and intraoperative augmented reality (AR) navigation.

Methods: Fifty-eight patients were scheduled for cholecystectomy for gallbladder lithiasis. VR surgical planning was performed on virtual models. At anesthesia induction, indocyanine green was injected intravenously. AR navigation was obtained by overlaying the virtual model onto real-time images. Before and after Calot triangle dissection, NIR-C was obtained by turning the camera to NIR mode. Finally, an IOC was performed. The 3 modality performances were evaluated and image quality was assessed with a Likert-scale questionnaire.

Results: The three-dimensional VR planning enabled the identification of 12 anatomical variants in 8 patients, of which only 7 were correctly reported by the radiologists (P = 0.037). A dangerous variant identified at VR induced a "fundus first" approach. The cystic-common bile duct junction was visualized before Calot triangle dissection at VR in 100% of cases, at NIR-C in 98.15%, and in 96.15% at IOC.Mean time to obtain relevant images was shorter with NIR-C versus AR (P = 0.008) and versus IOC (P = 0.00000003). Image quality scores were lower with NIR-C versus AR (P = 0.018) and versus IOC (P < 0.0001).

Conclusions: This high-tech protocol illustrates the multimodal imaging of biliary anatomy towards precision cholecystectomy. Those visualization techniques could complement to reduce the likelihood of biliary injuries (NCT01881399).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000002400DOI Listing
November 2017

Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up.

Surg Endosc 2017 03 5;31(3):1469-1477. Epub 2016 Aug 5.

Digestive and Endocrine Surgery Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Institute of Image-Guided Surgery (IHU Mix-Surg), 1 place de l'Hôpital, 67000, Strasbourg, France.

Background: Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence.

Methods: A review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient's characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence.

Results: From 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54 years and 31 kg/m. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72 %), metal tacks (24 %), or intraperitoneal sutures (4 %). Intraoperative complications occurred in three patients. Overall morbidity included 8.25 % of minor complications and 2.5 % of major complications without mortality. The overall recurrence rate was 9.8 %. Median time for recurrence was 15.3 months (3-72) and median follow-up was 31.6 months (8-119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15-1.79; p = 0.01), postoperative complications (OR 2.57; CI 1.09-6.03; p = 0.03), and Clavien-Dindo score >2 (OR 1.43; CI 1.031-1.876; p = 0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7 % of recurrence and major complications with 30 % of recurrence. Emergency LVHR (6 %) did not increase the rate of complications. Overall seroma rate was 18.7 %, with 1.4 % of persisting or complicated seroma. BMI (OR 1.05; CI 1.01-1.08; p = 0.026) and vascular surgery history (OR 5.74; CI 2.11-15.58; p < 0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma.

Conclusion: LVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM-LVHR a reference procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-016-5140-2DOI Listing
March 2017

Technical steps for removal of duodenojejunal bypass liner (endobarrier device).

Gastrointest Endosc 2016 Dec 14;84(6):1063. Epub 2016 Jun 14.

Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gie.2016.06.002DOI Listing
December 2016

Once versus twice daily injection of enoxaparin for thromboprophylaxis in bariatric surgery: effects on antifactor Xa activity and procoagulant microparticles. A randomized controlled study.

Surg Obes Relat Dis 2016 Mar-Apr;12(3):613-621. Epub 2015 Sep 19.

Faculty of Pharmacy, UMR CNRS 7213, University of Strasbourg, Strasbourg, France.

Background: The optimal scheme of thromboprophylaxis in bariatric surgery remains uncertain, because clinical practice is different between countries and randomized trials are lacking.

Objectives: The primary objective of this randomized multicenter study was to determine the optimal regimen of enoxaparin providing an antifactor Xa peak activity between .3 and .5 IU/mL at equilibrium and to evaluate the course of procoagulant microparticles (MPs).

Setting: University hospital.

Methods: A total of 164 patients scheduled for gastric bypass were allocated to 3 groups (A, B, and C) of enoxaparin treatment (4000, 6000, or 2×4000 IU, respectively). Antifactor Xa activity was measured before and 4 hours after each injection from D0 to D2. Doppler screening of the lower limbs was performed at D1, D9, and D30. Bleeding (BE) and thrombotic events (TE) were recorded during the first postoperative month. Total MPs were measured at D0, D9, and D30. MPs of leucocyte, platelet, and granulocyte origin were assessed in one third of the patients from each group. The 3 groups were compared by ANOVA.

Results: A total of 135 patients were analyzed. The equilibrium of antifactor Xa peak levels was obtained 52 hours after the presurgery injection and 12.8%, 56.4%, and 27.3% of the patients reached the target in groups A, B, and C, respectively (P<.001). No TE was detected. BE occurred in 1, 2, and 6 patients in groups A, B, and C, respectively). Total MPs remained unchanged over time. While no significant variation was observed in the other groups, platelet GP1 b(+)-MPs increased (P = .01) at D9 in group C, suggesting an incomplete control of anticoagulation leading to cell activation and procoagulant MP release that was confirmed by the higher MP levels measured at D30 (P = .04). CD66(+)-MPs were also highly elevated at J9 and D30 in group C indicating a granulocyte contribution.

Conclusions: This study shows that a single dose of enoxaparin 6000 IU/d allowed most of the patients to reach the target range of antifactor Xa activity without increasing the bleeding risk, with the most likely efficient reduction of procoagulant MPs. (Surg Obes Relat Dis 2015;0:000-000.) © 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.soard.2015.08.505DOI Listing
October 2017

18F-FDOPA PET/CT imaging of insulinoma revisited.

Eur J Nucl Med Mol Imaging 2015 Mar 1;42(3):409-18. Epub 2014 Nov 1.

Department of Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France.

Purpose: (18)F-FDOPA PET imaging is increasingly used in the work-up of patients with neuroendocrine tumours. It has been shown to be of limited value in localizing pancreatic insulin-secreting tumours in adults with hyperinsulinaemic hypoglycaemia (HH) mainly due to (18)F-FDOPA uptake by the whole pancreatic gland. The objective of this study was to review our experience with (18)F-FDOPA PET/CT imaging with carbidopa (CD) premedication in patients with HH in comparison with PET/CT studies performed without CD premedication in an independent population.

Methods: A retrospective study including 16 HH patients who were investigated between January 2011 and December 2013 using (18)F-FDOPA PET/CT (17 examinations) in two academic endocrine tumour centres was conducted. All PET/CT examinations were performed under CD premedication (200 mg orally, 1 - 2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after (18)F-FDOPA injection) centred over the upper abdomen and a delayed whole-body acquisition starting 20 - 30 min later. An independent series of eight consecutive patients with HH and investigated before 2011 were considered for comparison. All patients had a reference whole-body PET/CT scan performed about 1 h after (18)F-FDOPA injection. In all cases, PET/CT was performed without CD premedication.

Results: In the study group, (18)F-FDOPA PET/CT with CD premedication was positive in 8 out of 11 patients with histologically proven insulinoma (73 %). All (18)F-FDOPA PET/CT-avid insulinomas were detected on early images and 5 of 11 (45 %) on delayed ones. The tumour/normal pancreas uptake ratio was not significantly different between early and delayed acquisitions. Considering all patients with HH, including those without imaging evidence of disease, the detection rate of the primary lesions using CD-assisted (18)F-FDOPA PET/CT was 53 %, showing 9 insulinomas in 17 studies performed. In the control group (without CD premedication, eight patients), the final diagnosis was benign insulinoma in four, nesidioblastosis in one, and no definitive diagnosis in the remainder. (18)F-FDOPA PET/CT failed to detect any tumour in these patients.

Conclusion: According to our experience, CD administration before (18)F-FDOPA injection leads to low residual pancreatic (18)F-FDOPA activity preserving tumoral uptake with consequent insulinoma detection in more than half of adult patients with HH and more than 70 % of patients with a final diagnosis of insulinoma. If (18)F-FDOPA PET/CT is indicated, we strongly recommend combining CD premedication with early acquisition centred over the pancreas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-014-2943-zDOI Listing
March 2015

Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients.

Surg Laparosc Endosc Percutan Tech 2015 Feb;25(1):89-93

Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, Strasbourg, France Department of General Surgery, UCSC, Catholic University of Sacred Heart, Policlinico Gemelli, Rome, Italy IRCAD-AITS, Show Chow Health Care System, Changhua, Taiwan.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance as a stand-alone bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities. A specific and potentially severe complication of LSG is the staple line leak (SLL). Our aim was to report the SLL rate and its management in a prospective cohort of 378 LSGs.

Patients And Methods: A total of 378 patients underwent LSG from July 2005 to July 2011. The gastric transection was performed by an initial 60 mm firing of 4.5 mm staples at the antrum and successive 60 mm firings of 3.5 mm staples at the gastric body and fundus toward the left diaphragmatic crus. A 36 Fr bougie was used to calibrate the gastric tube. The staple line was systematically reinforced with a partial-thickness running suture.

Results: The overall complications and SLL rate were 20/378 (5.29%) and 9/378 (2.38%), respectively. SLLs were managed by laparoscopic (n=2) or open (n=1) exploration, drainage and endoscopic self-expandable covered stent, computed tomography-guided percutaneous drainage (n=2), or a self-expandable covered stent alone (n=4). Medical support including total parenteral nutrition and adapted antibiotics was started in all patients. The combined treatment modalities were successful in all cases.

Conclusions: SLL was the most common complication of LSG accounting for half of the overall complications. Percutaneous drainage and self-covered stents combined with antibiotics and parenteral nutrition are effective for SLL and should be proposed as first-line treatment in stable patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLE.0000000000000026DOI Listing
February 2015

Age impact on weight loss and glycolipid profile after laparoscopic sleeve gastrectomy: experience with 308 consecutive patients.

Surg Endosc 2014 Mar 12;28(3):803-10. Epub 2014 Feb 12.

Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France,

Background: The aim of this study was to evaluate the impact of age on weight loss and on related glycolipid profile changes at 2-year follow-up after laparoscopic sleeve gastrectomy (LSG).

Methods: From 2005 to 2010, a total of 308 consecutive patients undergoing LSG were enrolled. Mean age was 39.7 ± 10.7 years, mean weight was 127.9 ± 24.5 kg, and mean body mass index (BMI) was 45.9 ± 6.8 kg/m(2). Patients were divided into three age groups: young (18-29 years, n = 64), intermediate (30-49 years, n = 183), and senior (50-68 years, n = 61). BMI, excess weight loss (%EWL), and several biochemical examinations for the evaluation of glycolipid profile transition, including homeostasis model assessment for insulin resistance (HOMA-IR), were assessed at 6, 12, and 24 months (M6, M12, and M24) after LSG.

Results: All three groups had a significant BMI reduction and %EWL at 2 years' follow-up. The young group obtained significantly better %EWL at M6, M12, and M24 (62.6 ± 14.4, 73.4 ± 17.1, and 72.5 ± 18.9 %) compared to intermediate (53.2 ± 18.0, 64.8 ± 19.9, and 66.8 ± 23.0 %) and senior group (48.0 ± 15.5, 54.6 ± 15.3, and 54.4 ± 15.4 %). Fasting serum glucose levels improved significantly in all three groups at all follow-up assessment points (M6, M12, and M24). A significant improvement in HbA1c was also observed in the three groups at M6 and M12, while at M24 only patients in the young and intermediate groups still presented a significantly improved glycemic control. A significantly lower HOMA-IR improvement was observed at M6 in the senior group (2.83 ± 1.86) compared to both young (1.30 ± 0.54) and intermediate (1.43 ± 0.82) groups of patients. Total and low-density lipoprotein cholesterol level was significantly improved only in the young group.

Conclusions: An age-dependent trend toward better %EWL and glycolipid profile improvement was observed in young patients after LSG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-013-3261-4DOI Listing
March 2014

A modular magnetic anastomotic device for minimally invasive digestive anastomosis: proof of concept and preliminary data in the pig model.

Surg Endosc 2014 May 3;28(5):1613-23. Epub 2014 Jan 3.

Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France,

Background: The aim of our study was to assess the feasibility of minimally invasive digestive anastomosis using a modular flexible magnetic anastomotic device made up of a set of two flexible chains of magnetic elements. The assembly possesses a non-deployed linear configuration which allows it to be introduced through a dedicated small-sized applicator into the bowel where it takes the deployed form. A centering suture allows the mating between the two parts to be controlled in order to include the viscerotomy between the two magnetic rings and the connected viscera.

Methods And Procedures: Eight pigs were involved in a 2-week survival experimental study. In five colorectal anastomoses, the proximal device was inserted by a percutaneous endoscopic technique, and the colon was divided below the magnet. The distal magnet was delivered transanally to connect with the proximal magnet. In three jejunojejunostomies, the first magnetic chain was injected in its linear configuration through a small enterotomy. Once delivered, the device self-assembled into a ring shape. A second magnet was injected more distally through the same port. The centering sutures were tied together extracorporeally and, using a knot pusher, magnets were connected. Ex vivo strain testing to determine the compression force delivered by the magnetic device, burst pressure of the anastomosis, and histology were performed.

Results: Mean operative time including endoscopy was 69.2 ± 21.9 min, and average time to full patency was 5 days for colorectal anastomosis. Operative times for jejunojejunostomies were 125, 80, and 35 min, respectively. The postoperative period was uneventful. Burst pressure of all anastomoses was ≥ 110 mmHg. Mean strain force to detach the devices was 6.1 ± 0.98 and 12.88 ± 1.34 N in colorectal and jejunojejunal connections, respectively. Pathology showed a mild-to-moderate inflammation score.

Conclusions: The modular magnetic system showed enormous potential to create minimally invasive digestive anastomoses, and may represent an alternative to stapled anastomoses, being easy to deliver, effective, and low cost.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-013-3360-2DOI Listing
May 2014

Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial.

Surg Endosc 2014 Mar 7;28(3):821-6. Epub 2013 Nov 7.

Department of General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.

Purpose: To assess postoperative outcomes of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). Short-term results on vitamin D and parathormone (PTH) metabolism are reported.

Methods: One hundred patients were randomly assigned to RYGB (n = 45) or SG (n = 55). Vitamin D, PTH, and calcium were assessed at inclusion and after 1, 3, 6, and 12 months (M1, M3, M6, and M12). Eighty-eight patients completed 1-year follow-up.

Results: Mean postoperative excess weight loss (%EWL) at M1, M3, M6, and M12 was 25.39, 43.47, 63.75, and 80.38 % versus 25.25, 51.32, 64.67, and 82.97 % in RYGB and SG, respectively. Vitamin D values were statistically significantly higher after SG compared to RYGB at M3 (61.57 pmol/L, standard deviation [SD] 14.29 vs. 54.81 SD 7.65; p = 0.01) and M12 (59.83 pmol/L, SD 6.41 vs. 56.15 SD 8.18; p = 0.02). Vitamin D deficiency rate decreased from 84.62 to 35 % at M6 (p = 0.04) and 48 % at M12 (p = 0.01) in the SG group, while there was no significant improvement in the RYGB group. Serum parathyroid hormone (sPTH) level was decreased significantly in the SG group by M3 (44.8 ng/L vs. 28.6; p = 0.03), M6 (44.9 ng/L vs. 25.8; p = 0.017), and M12 (41.4 ng/L vs. 20.5; p = 0.017). Secondary hyperparathyroidism rate was 20.83 and 24 % at M1 (p = 1), 16.67 and 8 % at M3 (p = 0.41), 14.29 and 0 % at M6 (p = 0.08), and 15 and 0 % at M12 (p = 0.23) in the RYGB and SG groups, respectively.

Conclusions: Patients after RYGB had a significantly higher postoperative vitamin D deficiency and higher sPTH levels than after SG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-013-3276-xDOI Listing
March 2014

Revisional surgery after failed adjustable gastric banding: institutional experience with 90 consecutive cases.

Surg Endosc 2013 Nov 9;27(11):4044-8. Epub 2013 Jul 9.

Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France.

Background: Revisional surgery may be required in a high percentage of patients (up to 30 %) after laparoscopic adjustable gastric banding (LAGB). We report our institutional experience with revisional surgery.

Methods: From January 1996 to November 2011, 90 patients underwent revisional surgery after failed LAGB. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were proposed. In the presence of gastroesophageal reflux disease, esophageal dysmotility, hiatal hernia, or diabetes, RYGB was preferentially proposed.

Results: In two cases, revisional surgery was aborted due to local severe adhesions. Eighty-eight patients (74 females; mean age 42.79 ± 10.03 years; mean BMI 44.73 ± 6.19 kg/m(2)) successfully underwent revisional SG (n = 48) or RYGB (n = 40). One-stage surgery was performed in 29 cases. Follow-up rate was 78.2 % (n = 61) and 40.9 % (n = 36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage) was observed. Overall postoperative excess weight loss (%EWL) was 31.24, 40.92, 52.41, and 51.68 % at 3, 6, 12, and 24 months of follow-up respectively. There was a statistically significant higher %EWL at 1 year in patients <50 years old (55.9 vs. 41.5 % in patients >50 years old; p = 0.01), of female gender (55.22 vs. 40.73 % in male; p = 0.04), and in patients in which the AGB was in place for <5 years (57.09 vs. 47.43 % if >5 years p = 0.02).

Conclusions: Revisional surgery is safe and effective. Patients <50 years, of female gender, and with the AGB in place for <5 years had better %EWL after revisional surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-013-3056-7DOI Listing
November 2013

Virtual neck exploration for parathyroid adenomas: a first step toward minimally invasive image-guided surgery.

JAMA Surg 2013 Mar;148(3):232-8; discussion 238

IRCAD/Institut Hospitalo Universitaire, Strasbourg, France.

Objective: To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided surgery.

Design: Enhanced 3D rendering methods can be used to transform computed tomographic scan images into a model for 3D VNE. In addition to a standard imaging modality, 3D VNE was performed in all patients and used to preoperatively plan minimally invasive parathyroidectomy. All preoperative localization studies were analyzed for their sensitivity, specificity, positive predictive value, and negative predictive value for the correct side of the adenoma(s) (lateralization) and the correct quadrant of the neck (localization). The 3D VNE model was used to generate intraoperative augmented reality in 3 cases.

Setting: Tertiary care center.

Patients: A total of 114 consecutive patients with primary hyperparathyroidism were included from January 8, 2008, through July 26, 2011.

Results: The accuracy of 3D VNE in lateralization and localization was 77.2% and 64.9%, respectively. Virtual neck exploration had superior sensitivity to ultrasonography (P.001), sestamibi scanning (P=.07), and standard computed tomography (P.001). Use of the 3D model for intraoperative augmented reality was feasible.

Conclusions: 3-Dimensional VNE is an excellent tool in preoperative localization of parathyroid adenomas with sensitivity, specificity, and diagnostic accuracy commensurate with accepted first-line imaging modalities. The added value of 3D VNE includes enhanced preoperative planning and intraoperative augmented reality to enable less-invasive image-guided surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamasurg.2013.739DOI Listing
March 2013

Three-dimensional metabolic and radiologic gathered evaluation using VR-RENDER fusion: a novel tool to enhance accuracy in the localization of parathyroid adenomas.

World J Surg 2013 Jul;37(7):1618-25

IRCAD-IHU, University of Strasbourg, Strasbourg, France.

Background: The aim of this study was to assess the accuracy of a novel imaging modality, three-dimensional (3D) metabolic and radiologic gathered evaluation (MeRGE), for localizing parathyroid adenomas (PAs).

Methods: Consecutive patients presenting with primary hyperparathyroidism who underwent both thin-slice cervical computed tomography (CT) and (99m)Tc-sestamibi (MIBI) scanning were included. 3D-CT reconstruction was obtained using VR-RENDER, which was used to perform 3D virtual neck exploration (3D-VNE). The MIBI scan was then fused with the 3D reconstruction to obtain 3D-MeRGE. Sensitivity, specificity, and accuracy were assessed. Parathyroid gland volume and preoperative parathormone (PTH) levels were analyzed as predictive factors of correct localization (i.e., correct quadrant).

Results: A total of 108 cervical quadrants (27 patients) were analyzed. Sensitivities were 79.31, 75.86, 65.51, and 58.61 % with 3D-MeRGE, 3D-VNE, MIBI, and CT, respectively. Specificity was highest with CT (94.93 %) followed by 3D-VNE (92.4 %). MIBI and 3D-MeRGE had the same specificity (88.6 %). 3D-MeRGE and 3D-VNE achieved higher accuracy than MIBI or CT alone. Mean PTH values were significantly higher in patients with lesions that were correctly identified (true positive, TP) than in those whose lesions were missed (false negative, FN) with 3D-VNE (219.60 ± 212.77 vs. 98.75 ± 12.76 pg/ml; p = 0.01) and 3D-MeRGE (217.69 ± 213.76 vs. 09.75 ± 20.48 pg/ml; p = 0.02). The mean parathyroid gland volume difference between TP and FN was statistically significant with all modalities except CT.

Conclusions: 3D-MeRGE and 3D-VNE showed high accuracy for localization of PAs. 3D-MeRGE performed better than MIBI or CT alone for detecting small adenomas and those with a low PTH level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-013-2021-xDOI Listing
July 2013

Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass: results of a prospective randomized clinical trial.

Obes Surg 2013 May;23(5):613-21

IRCAD-IHU, University of Strasbourg, Strasbourg, France.

Background: This study aims to report glycolipid changes after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) in the setting of a prospective randomized clinical trial.

Methods: One hundred patients were randomly assigned to RYGB (n = 45) and SG (n = 55). Fasting glucose, insulin, glycated hemoglobin (HbA1c%), triglycerides, and serum cholesterol (total, HDL, and LDL) were evaluated at inclusion and after 1, 3, 6, and 12 months. The index for homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-B) were assessed.

Results: Mean postoperative 1-, 3-, 6-, and 12-month excess weight loss was 25.39, 43.47, 63.75, and 80.38 % after RYGB and 25.25, 51.32, 64.67, and 82.97 % after SG, respectively. Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG. Mean HOMA-IR improved in both groups, particularly in case of high preoperative values, and mean HOMA-B improved at 1 year after RYGB. HbA1c% dropped from 5.66 % (SD = 0.61) to 5.57 % (SD = 0.32) after RYGB and from 5.64 % (SD = 0.43) to 5.44 % (SD = 0.43) after SG. Total cholesterol was significantly higher at 1 month (p = 0.04), 3 months (p = 0.03), and 1 year (p = 0.005) after SG as compared to RYGB. LDL cholesterol decreased significantly after RYGB at 1 month (p = 0.03), 3 months (p = 0.0001), and 1 year (p = 0.0004) as compared to SG. HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group. Triglycerides decreased similarly in both groups.

Conclusions: Short-term glycemic control was comparable after SG and RYGB. An improved lipid profile was noted after RYGB in patients with abnormal preoperative values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-012-0827-5DOI Listing
May 2013
-->