Felix Corre

Advances in colorectal cancer (CRC) screening and endoscopic techniques have led to increased detection of T1 CRC. Patient management relies on histopathological criteria predicting lymph node metastasis (LNM), including submucosal invasion depth (SID) >1000 µm. However, the independent prognostic value of isolated deep invasion remains unclear. We performed a retrospective multicenter study of patients treated at 18 European centers between 2009 and 2022. Patients with T1 CRC endoscopically resected en bloc and with isolated SID >1000 µm (without other high-risk features) were included. Two groups were analyzed: patients who underwent additional surgery and those who were followed with surveillance. Rates of LNM (surgery group) and recurrence (local and distant; surveillance group) were assessed. Exploratory multivariable analyses were performed to evaluate clinicopathological factors associated with LNM. Among 179 included patients (124 surgery, 55 surveillance), LNM was found in 16/124 surgical specimens (12.9%; 95%CI 7.7–20.4) and recurrence occurred in 2/55 patients undergoing surveillance (3.6%; 95%CI 0.4–12.6). LNM occurred in 1/50 patients (2.0%) with SID <2000 µm and in 15/74 patients (20.3%) with SID ≥2000 µm. Multivariable analysis revealed SID ≥2000 µm (odds ratio [OR] 3.59; 95%CI 1.14–13.71) and colonic (vs. rectal) tumor location (OR 3.63; 95%CI 1.07–16.77) as factors associated with LNM. Isolated deep submucosal invasion in T1 CRC was associated with a non-negligible rate of LNM in this real-world cohort. In exploratory analyses, SID ≥2000 µm was associated with LNM.

Lumen-apposing metal stents (LAMS) were initially developed to drain perigastric pancreatic necrotic collections and perform endoscopic necrosectomy. We report the case of a man hospitalized for a 4-cm infected antral perigastric collection secondary to a fishbone that had perforated the gastric antrum ([Fig. 1], [Video 1]). Upper gastrointestinal endoscopy showed a bulging collection in the prepyloric antrum ([Fig. 2]). Given the location of the collection, its size, and the presence of a foreign body within it, we first performed endoscopic cystogastrostomy using a 15×15 mm LAMS ([Fig. 3]). A second upper gastrointestinal endoscopy was performed 7 days later to extract the fishbone through the LAMS ([Fig. 4]). The procedure was successful. No complication occurred. This endoscopic minimally invasive approach avoided surgery, and the patient was discharged from hospital the day after the fishbone extraction. The 6-month follow-up period was uneventful. Endoscopy_UCTN_Code_TTT_1AO_2AL Article published online: 29 May 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Sarcopenia, defined as decreased muscle mass and strength, can be evaluated by a computed tomography (CT) examination and might be associated with reduced survival in patients with carcinoma. The prognosis of patients with metastatic pancreatic carcinoma is poor. The FOLFIRINOX (a combination of 5-fluorouracil, irinotecan, and oxaliplatin) chemotherapy regimen is a validated first-line treatment option. We investigated the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS) in patients with metastatic pancreatic carcinoma. Clinical data and CT examinations of patients treated with FOLFIRINOX were retrospectively reviewed. Sarcopenia was estimated using baseline CT examinations. Seventy-five patients were included. Forty-three (57.3%) were classified as sarcopenic. The median OS of non-sarcopenic and sarcopenic patients were 15.6 and 14.1 months, respectively (p = 0.36). The median PFS was 10.3 in non-sarcopenic patients and 9.3 in sarcopenic patients (p = 0.83). No differences in toxicity of FOLFIRINOX were observed. There was a trend towards a higher probability of short-term death (within 4 months of diagnosis) in sarcopenic patients. In this study, the detection of sarcopenia failed to predict a longer OS or PFS in selected patients deemed eligible by a physician for triplet chemotherapy and receiving the FOLFIRINOX regimen in a first-line setting, confirming the major importance of a comprehensive patient assessment by physicians in selecting the best treatment option.

Introduction: Proton pump inhibitors (PPIs) are one of the most prescribed classes of drugs worldwide as a first-line treatment of acid-related disorders. Although adverse effects are rare and rapidly reversible after a short exposure, concerns have been recently raised about a greater toxicity on cardiovascular health after a longer exposure, especially when combined with clopidogrel. We aimed to evaluate the safety of long-term PPI use on cardiovascular health in patients with known atheromatous cardiovascular disease. Methods: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases and grey literature in April 2022. Articles published between 2014 and 2022 were considered relevant if they were designed as randomized controlled trials (RCTs) that included post hoc analyses or prospective observational studies and if they investigated clinical cardiovascular outcomes associated with PPI use for 6 months or more in patients suffering from cardiovascular disease requiring antiplatelet agent therapy and/or coronary angioplasty. Statistical analyses were performed using RevMan 5.4 software (Computer program, the Cochrane Collaboration, 2020, London, UK). The risk of bias was assessed using the Cochrane risk-of-bias tool for the RCTs and the Newcastle–Ottawa scale for the observational studies. Results: A total of 10 full-text articles involving 53,302 patients were included. Substantial heterogeneity was found among the 10 included studies. The primary analysis showed no significant differences between the PPI group and the control group for the risks of major adverse cardiovascular events (MACEs), all-cause death (ACD), or target vessel revascularization (TVR) using a random-effects model (OR 1.15, 95% CI 0.98–1.35, p = 0.08, I² = 73%; OR 1.24, 95% CI 0.94–1.65, p = 0.13, I² = 63%; and OR 1.19, 95% CI 0.76–1.87, p = 0.45, I² = 61%, respectively). The primary analysis yielded similar results for the risks of myocardial infarction (MI), stroke, and cardiovascular death (CVD) using a fixed-effects model (OR 0.98, 95% CI 0.88–1.09, p = 0.66, I² = 0%; OR 1.02, 95% CI 0.90–1.17, p = 0.73, I² = 0%; and OR 1.04, 95% CI 0.94–1.16, p = 0.44, I² = 35%, respectively). Likewise, a subgroup analysis based on eight randomized controlled trials failed to identify any association between PPI use and the risks of MACEs, MI, stroke, TVR, ACD, or CVD using a fixed-effects model (overall pooled OR 1.01, 95% CI 0.96–1.06; p = 0.66; I² = 0%). The pulled data from the two included observational studies (OS) demonstrated a significantly increased risk of MACEs in the PPI group (OR 1.42, 95% CI [1.29–1.57], p 2 = 0%). In another subgroup analysis, no evidence of an increased risk of adverse cardiovascular events in the co-therapy PPI/clopidogrel versus clopidogrel alone groups was found with the exception of the risk of ACD (OR 1.50, 95% CI 1.23–1.82, p = 0.001, I² = 0%). Nevertheless, after performing a sensitivity analysis reaching heterogeneity I² = 0%, the co-prescription of PPIs and clopidogrel was at increased risk of MACEs (p < 0.001), CVD (p = 0.008), and TVR (p < 0.001) but remained statistically non-significant for the risk of MI (p = 0.11). Conclusions: The overall results of this meta-analysis showed that long-term PPI use was not associated with an increased risk of adverse cardiovascular events. However, inconsistent results were found for combined PPI/clopidogrel therapy. These results should be considered with caution in light of the significant heterogeneity, the limited number of included studies, and the lack of adjustment for potential confounders.

Aims The progress made over the past ten years in therapeutic endoscopy allows treating superficial colorectal cancers with low morbidity and no mortality. According to ESGE guidelines, additional surgery is required for high-risk tumors, i.e. with at least one of the four following histological risk factors: deep submucosal infiltration (> 1000µm), poorly differentiated tumor, lymphovascular invasion or high-grade tumor budding. We aimed to confirm the validity of these parameters in a Western population. Methods We conducted a retrospective multicenter study in twelve French expert centers between March 2012 and July 2019, and included all patients with an endoscopic mucosal resection or an endoscopic submucosal dissection for a T1 colorectal cancer. Results 271 patients were included. The median follow-up was 28.9 [18.4-42.2] months. 11 (4.1 %) patients had lymph node or metastatic recurrence and 8 (3.0 %) died. Among the 88 low-risk tumors, there was 1 lymph node recurrence and 2 non-cancer-related deaths. Among the 183 high-risk tumors, 3/68 (4.4 %) relapsed in the group of non-operated patients and 7/115 (6.1 %) in the group of operated patients (p = 0.63); 5/68 (7.4 %) died in the group of non-operated patients, among which 1/68 (1.5 %) cancer-related death, and 1/115 (0.9 %) died of a cancer-related death in the group of operated patients (p = 0.71). Recurrence-free survival curves comparison between low-risk and high-risk tumors showed a non-significant tendency (p = 0.13) to relapse more for high-risk tumors. Among these high-risk tumors, recurrence-free survival curves comparison between patients who had endoscopic resection alone and those who had endoscopic resection followed by additional surgery showed no difference (p = 0.69). Conclusions This multicenter study of patients with endoscopically resected T1 colorectal cancers confirms the excellent oncological prognosis with this treatment modality, particularly for low-risk tumors. Complementary surgery did not provide any benefit in terms of recurrence-free survival in patients with high-risk tumors. Citation: Corre F, Barret M, Lepilliez V et al. OP79 LONG-TERM OUTCOMES OF ENDOSCOPIC RESECTION FOR T1 COLORECTAL CARCINOMAS. Endoscopy 2021; 53: S34. Publication Date: 19 March 2021 (online) © 2021. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany