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Pancreatic Neoplasms: HELP
Articles by Marc Barthet
Based on 13 articles published since 2008
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Between 2008 and 2019, M. Barthet wrote the following 13 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. 2017

Polkowski, Marcin / Jenssen, Christian / Kaye, Philip / Carrara, Silvia / Deprez, Pierre / Gines, Angels / Fernández-Esparrach, Gloria / Eisendrath, Pierre / Aithal, Guruprasad P / Arcidiacono, Paolo / Barthet, Marc / Bastos, Pedro / Fornelli, Adele / Napoleon, Bertrand / Iglesias-Garcia, Julio / Seicean, Andrada / Larghi, Alberto / Hassan, Cesare / van Hooft, Jeanin E / Dumonceau, Jean-Marc. ·Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland. · Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland. · Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany. · Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy. · Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. · Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain. · Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium. · Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy. · Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France. · Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal. · Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy. · Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France. · Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #28898917.

ABSTRACT: For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

2 Review Endoscopy innovations. 2014

Vanbiervliet, Geoffroy / Gonzalez, Jean-Michel / Barthet, Marc. ·LBA UMRT24, Aix-Marseille University, Faculty of Medicine, Marseille, France. ·Endoscopy · Pubmed #25133480.

ABSTRACT: Innovation everywhere for everybody - this is the way we can summarize the 2014 Digestive Disease Week, which was held in Chicago, Illinois, last May. Many sessions introduced new innovative materials and concepts. From the robot of the future to the simplest ideas, the congress was fertile and sometimes full of surprises. Abstracts representing significant progress and innovations in the field of digestive endoscopy are reviewed here.

3 Review Cystic and ductal tumors of the pancreas: diagnosis and management. 2013

Scoazec, J Y / Vullierme, M P / Barthet, M / Gonzalez, J M / Sauvanet, A. ·Anatomie pathologique et centre de recherche en cancérologie de Lyon, Inserm U1052/CNRS UMR5286, hospices civils de Lyon, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France. ·J Visc Surg · Pubmed #23518192.

ABSTRACT: Incidentally discovered cystic tumors of the pancreas (CTP) are an increasingly frequent entity. It is essential to differentiate lesions whose malignant potential is either nil or negligible (pseudocyst, serous cystadenoma, simple cysts) from lesions with intermediate malignant potential (intraductal papillary mucinous tumor of the pancreas [IPMN] involving the secondary ducts, cystic endocrine tumor) or those with high malignant potential (mucinous cystadenoma, solid pseudopapillary tumors and IPMN involving the main pancreatic duct). The approach to defining malignant potential is based on diagnostic CT scan, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), often complemented by EUS-guided cyst puncture for biochemical and cytological analysis of cyst fluid. Surgery for diagnostic purposes should be avoided because of its significant morbidity. For pseudocysts, simple cysts and serous cystadenomas, abstention is the general rule. Resection, preserving as much pancreatic parenchyma as possible, is the rule for IPMN involving the main pancreatic duct, mucinous cystadenomas, solid and pseudopapillary tumors, and cystic endocrine tumors. Resection is rarely indicated at the outset for IPMN involving secondary pancreatic ducts; morphologic observation is the general rule and preventive excision may be indicated secondarily. Good collaboration between surgeons, radiologists and endosonographists is necessary for optimal management of CTP.

4 Article Transcriptomic analysis predicts survival and sensitivity to anticancer drugs of patients with a pancreatic adenocarcinoma. 2015

Duconseil, Pauline / Gilabert, Marine / Gayet, Odile / Loncle, Celine / Moutardier, Vincent / Turrini, Olivier / Calvo, Ezequiel / Ewald, Jacques / Giovannini, Marc / Gasmi, Mohamed / Bories, Erwan / Barthet, Marc / Ouaissi, Mehdi / Goncalves, Anthony / Poizat, Flora / Raoul, Jean Luc / Secq, Veronique / Garcia, Stephane / Viens, Patrice / Iovanna, Juan / Dusetti, Nelson. ·Cancer Research Center of Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille University and Paoli-Calmettes Institute, Scientific and Technological Park of Luminy, Marseille, France. · Cancer Research Center of Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille University and Paoli-Calmettes Institute, Scientific and Technological Park of Luminy, Marseille, France; Department of Surgery, Hôpital Nord, Marseille, France. · Cancer Research Center of Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille University and Paoli-Calmettes Institute, Scientific and Technological Park of Luminy, Marseille, France; Paoli-Calmettes Institute, Marseille, France. · Genomic Center, CHUL Research Centre, Quebec City, Quebec, Canada. · Paoli-Calmettes Institute, Marseille, France. · Department of Gastroenterology, Hôpital Nord, Marseille, France. · Department of Surgery, La Timone Hospital, Marseille, France. · Cancer Research Center of Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille University and Paoli-Calmettes Institute, Scientific and Technological Park of Luminy, Marseille, France. Electronic address: juan.iovanna@inserm.fr. · Cancer Research Center of Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille University and Paoli-Calmettes Institute, Scientific and Technological Park of Luminy, Marseille, France. Electronic address: nelson.dusetti@inserm.fr. ·Am J Pathol · Pubmed #25765988.

ABSTRACT: A major impediment to the effective treatment of patients with pancreatic ductal adenocarcinoma (PDAC) is the molecular heterogeneity of this disease, which is reflected in an equally diverse pattern of clinical outcome and in responses to therapies. We developed an efficient strategy in which PDAC samples from 17 consecutive patients were collected by endoscopic ultrasound-guided fine-needle aspiration or surgery and were preserved as breathing tumors by xenografting and as a primary culture of epithelial cells. Transcriptomic analysis was performed from breathing tumors by an Affymetrix approach. We observed significant heterogeneity in the RNA expression profile of tumors. However, the bioinformatic analysis of these data was able to discriminate between patients with long- and short-term survival corresponding to patients with moderately or poorly differentiated PDAC tumors, respectively. Primary culture of cells allowed us to analyze their relative sensitivity to anticancer drugs in vitro using a chemogram, similar to the antibiogram for microorganisms, establishing an individual profile of drug sensitivity. As expected, the response was patient dependent. We also found that transcriptomic analysis predicts the sensitivity of cells to the five anticancer drugs most frequently used to treat patients with PDAC. In conclusion, using this approach, we found that transcriptomic analysis could predict the sensitivity to anticancer drugs and the clinical outcome of patients with PDAC.

5 Article Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). 2015

Barthet, Marc / Binmoeller, Kenneth F / Vanbiervliet, Geoffroy / Gonzalez, Jean-Michel / Baron, Todd H / Berdah, Stéphane. ·Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France. · Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA. · Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, University Hospital of Nice, Nice, France. · Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA. ·Gastrointest Endosc · Pubmed #25527056.

ABSTRACT: BACKGROUND: We established feasibility and safety for natural orifice transluminal endoscopic surgery (NOTES) GI anastomosis with a lumen-apposing stent in live pigs. This approach was performed in 3 patients. OBJECTIVE: Creation of a NOTES gastroduodenal anastomosis in patients. DESIGN: Case series. SETTING: Two tertiary-care referral centers at large academic hospitals in France and in the United States. PATIENTS: Patients with refractory benign duodenal stenosis and malignant duodenal obstruction. INTERVENTION: NOTES GI anastomosis with a lumen-apposing stent. MAIN OUTCOME MEASUREMENTS: Disappearence of gastric outlet obstruction. RESULTS: All 3 procedures were technically successful and uneventful, except 1 minor adverse event. There were no instances of stent occlusion or migration during follow-up. All patients resumed a normal diet. LIMITATIONS: Small case series. CONCLUSION: NOTES gastroenteric anastomosis is feasible and safe in humans. A prospective pilot study is warranted.

6 Article A subgroup of pancreatic adenocarcinoma is sensitive to the 5-aza-dC DNA methyltransferase inhibitor. 2015

Gayet, Odile / Loncle, Celine / Duconseil, Pauline / Gilabert, Marine / Lopez, Maria Belen / Moutardier, Vincent / Turrini, Olivier / Calvo, Ezequiel / Ewald, Jacques / Giovannini, Marc / Gasmi, Mohamed / Bories, Erwan / Barthet, Marc / Ouaissi, Mehdi / Goncalves, Anthony / Poizat, Flora / Raoul, Jean Luc / Secq, Veronique / Garcia, Stephane / Viens, Patrice / Dusetti, Nelson / Iovanna, Juan. ·Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Parc Scientifique et Technologique de Luminy, Marseille, France. · Hôpital Nord, Marseille, France. · Institut Paoli-Calmettes, Marseille, France. · Centre Génomique du Centre de recherche du CHUL Research Center, Quebec, Canada. · Hôpital Nord, Département de Gastroentérologie, Marseille, France. · Hôpital de la Timone, Marseille, France. ·Oncotarget · Pubmed #25481873.

ABSTRACT: Pancreatic Ductal Adenocarcinoma (PDAC) is a disease with a great heterogeneity in the response to treatments. To improve the responsiveness to treatments there are two different approaches, the first one consist to develop new and more efficient drugs that intent to cure all patients and the second one is to use already-approved drugs, alone or in combination, but selecting beforehand the most sensitive patients. In this work we explored the efficiency of the second possibility. We developed a collection of 17 PDAC samples collected by Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) or surgery and preserved as xenografts and as primary cultures. This collection was characterized at molecular level by a transcriptomic analysis using an Affymetrix approach. In this paper we present data demonstrating that a subgroup of PDAC responds to low doses of 5-aza-dC. These tumors show a specific RNA expression profile that could serve as a marker, but there is no correlation with Dnmt1, Dnmt3A or Dnmt3B expression. Responder tumors corresponded to well-differentiated samples and longer survival patients. In conclusion, we present data obtained with the well-known drug 5-aza-dC as a proof of concept that a drug that seems to be inefficient in solid tumors in general could be applicable to a particular subgroup of patients with PDAC.

7 Article Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. 2014

Vanbiervliet, Geoffroy / Napoléon, Bertrand / Saint Paul, Marie Christine / Sakarovitch, Charlotte / Wangermez, Marc / Bichard, Philippe / Subtil, Clément / Koch, Stéphane / Grandval, Philippe / Gincul, Rodica / Karsenti, David / Heyries, Laurent / Duchmann, Jean-Christophe / Bourgaux, Jean François / Levy, Michaël / Calament, Gilles / Fumex, Fabien / Pujol, Bertrand / Lefort, Christine / Poincloux, Laurent / Pagenault, Maël / Bonin, Eduardo Aimé / Fabre, Monique / Barthet, Marc. ·Université de Nice Sophia Antipolis, Faculté de Médecine and Centre Hospitalier Universitaire de l'Archet 2, Pôle digestif, Nice, France. · Hôpital Privé Mermoz, Gastroentérologie, Lyon, France. · Centre Hospitalier Universitaire Pasteur, Anatomopathologie, Nice, France. · Centre Hospitalier Universitaire Cimiez, Département de la recherche clinique, Nice, France. · Centre Hospitalier Universitaire de Poitiers, Gastroentérologie, Poitiers, France. · Hôpitaux Universitaires de Genève, Gastroentérologie, Genève, Switzerland. · Centre hospitalier Universitaire du Haut-Lévêque, Gastroentérologie, Pessac, France. · Centre hospitalier Universitaire de Besançon, Gastroentérologie, Besançon, France. · Assistance publique des hôpitaux de Marseille, Hôpital de la Timone, Gastroentérologie, Marseille, France. · Hospices civils de Lyon, Gastroentérologie, Lyon, France. · Clinique de Bercy, Pôle digestif, Charenton le Pont, France. · Assistance publique des hôpitaux de Marseille, Hôpital de la Conception, Gastroentérologie, Marseille, France. · Centre Hospitalier Général de Compiègne, Gastroentérologie, Compiègne, France. · Centre Hospitalier Universitaire Carémeau, Gastroentérologie, Nîmes, France. · Assistance Publique des hôpitaux de Paris, Hôpital Mondor, Gastroentérologie, Créteil, France. · Centre Hospitalier Universitaire de la Cavale Blanche, Gastroentérologie, Brest, France. · Centre Hospitalier Universitaire Estaing, Gastroentérologie, Clermont Ferrand, France. · Centre Hospitalier Universitaire de Pontchaillou, Gastroentérologie, Rennes, France. · Assistance publique des hôpitaux de Marseille, Hôpital Nord, Gastroentérologie, Marseille, France. · Gustave Roussy, Pathologie Morphologique, Villejuif, France. ·Endoscopy · Pubmed #25098612.

ABSTRACT: BACKGROUND AND STUDY AIMS: A new core biopsy needle for endoscopic ultrasound (EUS)-guided sampling has recently been developed. The aim of this prospective multicenter study was to compare this needle with a standard needle in patients with solid pancreatic masses. PATIENTS AND METHODS: Consecutive patients with solid pancreatic masses referred to 17 centers for EUS-guided sampling were included. Each patient had two passes with a standard 22G needle and a single pass with a 22G core needle performed in a randomized order. Samples from both needles were separately processed for liquid-based cytology and cell-block preparation and were assessed independently by two blinded expert pathologists. The primary endpoint was the accuracy of the detection of malignancy. The reference standard was based on further cytohistological analysis obtained under ultrasound or computed tomography scanning, endoscopic or surgical guidance, and/or by clinical follow-up with repeated imaging examinations for at least 12 months. The secondary endpoints were the rate of technical failure and the quality of the cytohistological samples obtained. RESULTS: Of the 80 patients included (49 men; mean age 67.1 ± 11.1), 87.5 % had final malignant diagnoses (adenocarcinoma n = 62, 77.5 %). There was no difference between the needles in diagnostic accuracy (standard needle 92.5 % vs. core needle 90 %; P = 0.68) or technical failure. Both pathologists found the overall sample quality significantly better for the standard needle (expert 1, P = 0.009; expert 2, P = 0.002). CONCLUSIONS: The diagnostic accuracy of EUS sampling for solid pancreatic masses using standard and core needles seems comparable but with a better overall histological sample quality for the former. ClinicalTrial.gov identifier: NCT01479803.

8 Article Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound-guided fine needle aspiration samples. 2012

Bournet, B / Pointreau, A / Souque, A / Oumouhou, N / Muscari, F / Lepage, B / Senesse, P / Barthet, M / Lesavre, N / Hammel, P / Levy, P / Ruszniewski, P / Cordelier, P / Buscail, L. ·INSERM UMR1037, Cancer Research Center of Toulouse, CHU Rangueil, 1 avenue Jean Poulhès, Bât. L3, BP 84225, 31432 Toulouse Cedex 4, France3 ·Pancreatology · Pubmed #22487470.

ABSTRACT: AIMS: The purpose of this study was to investigate the clinical feasibility and utility of low-density array analysis on samples obtained from endoscopic ultrasound-guided fine needle aspiration biopsy in locally advanced and/or metastatic pancreatic ductal adenocarcinoma and chronic pancreatitis. PATIENTS AND METHODS: In this prospective multicenter study, we quantified candidate gene expression in biopsies sampled from 44 locally advanced and/or metastatic pancreatic carcinoma and from 17 pseudotumoural chronic pancreatitis using dedicated low-density array microfluidic plates. RESULTS: We first demonstrated that 18S gene expression is stable and comparable in normal pancreas and pancreatic cancer tissues. Next, we found that eight genes (S100P, PLAT, PLAU, MSLN, MMP-11, MMP-7, KRT7, KRT17) were significantly over expressed in pancreatic cancer samples when compared to pseudotumoural chronic pancreatitis (p value ranging from 0.0007 to 0.0215): Linear discriminative analysis identified S100P, PLAT, MSLN, MMP-7, KRT7 as highly explicative variables. The area under receiver operating curve establishes the clinical validity of the potential diagnostic markers identified in this study (values ranging from 0.69 to 0.76). In addition, combination of S100P and KRT7 gave better diagnosis performances (Area Under Receiver Operating Curve 0.81, sensitivity 81%, specificity 77%). CONCLUSION: We demonstrate that molecular studies on EUS-guided FNA material are feasible for the identification and quantification of markers in PDAC patients diagnosed with non-resectable tumours. Using low-density array, we isolated a molecular signature of advanced pancreatic carcinoma including mostly cancer invasion-related genes. This work stems for the use of novel biomarkers for the molecular diagnosis of patient with solid pancreatic masses.

9 Article The reg4 gene, amplified in the early stages of pancreatic cancer development, is a promising therapeutic target. 2009

Legoffic, Aude / Calvo, Ezequiel / Cano, Carla / Folch-Puy, Emma / Barthet, Marc / Delpero, Jean Robert / Ferrés-Masó, Montse / Dagorn, Jean Charles / Closa, Daniel / Iovanna, Juan. ·INSERM U.624, Stress Cellulaire, Parc Scientifique et Technologique de Luminy, Marseille, France. ·PLoS One · Pubmed #19834624.

ABSTRACT: BACKGROUND: The aim of our work was to identify the genes specifically altered in pancreatic adenocarcinoma and especially those that are altered early in cancer development. METHODOLOGY/PRINCIPAL FINDINGS: Gene copy number was systematically assessed with an ultra-high resolution CGH oligonucleotide microarray in DNA from samples of pancreatic cancer. Several new cancer-associated variations were observed. In this work we focused on one of them, involving the reg4 gene. Gene copy number gain of the reg4 gene was confirmed by qPCR in 14 cancer samples. It was also found with increased copy number in most PanIN3 samples. The relationship betweena gain in reg4 gene copy number and cancer development was investigated on the human pancreatic cancer cell line Mia-PaCa2 xenografted under the skin of nude mice. When cells were transfected with a vector allowing reg4 expression, they generated tumors almost twice larger in size. In addition, these tumors were more resistant to gemcitabine treatment than control tumors. Interestingly, weekly intraperitoneal administration of a monoclonal antibody to reg4 halved the size of tumors generated by Mia-PaCa2 cells, suggesting that the antibody interfered with a paracrine/autocrine mechanism involving reg4 and stimulating cancer progression. The addition of gemcitabine resulted in further reduction, tumors becoming 5 times smaller than control. Exposure to reg4 antibody resulted in a significant decrease in intra-tumor levels of pAkt, Bcl-xL, Bcl-2, survivin and cyclin D1. CONCLUSIONS/SIGNIFICANCE: It was concluded that adjuvant therapies targeting reg4 could improve the standard treatment of pancreatic cancer with gemcitabine.

10 Article Endoscopic ultrasound-guided fine-needle aspiration biopsy coupled with KRAS mutation assay to distinguish pancreatic cancer from pseudotumoral chronic pancreatitis. 2009

Bournet, B / Souque, A / Senesse, P / Assenat, E / Barthet, M / Lesavre, N / Aubert, A / O'Toole, D / Hammel, P / Levy, P / Ruszniewski, P / Bouisson, M / Escourrou, J / Cordelier, P / Buscail, L. ·Department of Gastroenterology and INSERM U858, University of Toulouse, CHU Rangueil, Toulouse, France. ·Endoscopy · Pubmed #19533561.

ABSTRACT: BACKGROUND AND STUDY AIMS: Differential diagnosis between pancreatic adenocarcinoma (PADC) and pseudotumoral forms of chronic pancreatitis remains difficult. Mutation of KRAS oncogene is present in 75% to 95% of PADC. This study aimed to evaluate whether the combined analysis of KRAS mutation with cytopathological findings from endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) might improve discrimination between PADC and chronic pancreatitis. PATIENTS AND METHODS: This prospective multicenter study included 178 patients with solid pancreatic masses (men 104, women 74; mean age 64.5 years). Cytopathological examination and KRAS mutation analysis (codon-12 and codon-13, restriction fragment length polymorphism [RFLP] and direct sequencing) were performed on EUS-FNAB material. Final diagnoses were obtained on EUS-FNAB analysis and/or a second biopsy and/or clinical follow-up and/or surgery: PADC, n = 129; chronic pancreatitis, n = 27; other pancreatic neoplasms, n = 16; and benign lesions, n = 6. RESULTS: KRAS status analysis was successful in all EUS-FNAB samples. Codon-12 KRAS point mutation was found in 66% of PADC samples. No case of chronic pancreatitis displayed KRAS mutation. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of cytopathology alone for diagnosis of PADC versus chronic pancreatitis were 83%, 100%, 100%, 56% and 86%, respectively. When KRAS mutation analysis was combined with cytopathology, these values reached 88%, 100%, 100%, 63% and 90% respectively. CONCLUSION: Although the value of KRAS analysis in addition to EUS-FNAB is limited for distinguishing pancreatic mass lesions, when chronic pancreatitis presented as a pseudotumor a negative finding (wild-type KRAS), was useful in strongly suggesting a benign lesion.

11 Article Identification of genomic alterations associated with the aggressiveness of pancreatic cancer using an ultra-high-resolution CGH array. 2009

Legoffic, Aude / Calvo, Ezequiel Luis / Barthet, Marc / Delpero, Jean-Robert / Dagorn, Jean Charles / Iovanna, Juan Lucio. ·INSERM U.624, Stress Cellulaire, Parc Scientifique et Technologique de Luminy, Marseille, France. ·Pancreatology · Pubmed #19407481.

ABSTRACT: BACKGROUND: Genomic alterations present in pancreatic adenocarcinoma have been described only partially. In addition, the relations between these alterations and the aggressiveness of the phenotype remain unknown. METHODS: Genomic DNA and total RNA from 5 pancreatic cell lines, of which 2 have an aggressive phenotype and are gemcitabine-resistant (Mia-Paca2 and Panc-1), and 3 less aggressive and gemcitabine-sensitive (Capan-1, Capan-2 and BxPC3), have been purified. DNA abnormalities have been analyzed using an ultra-high-resolution CGH array and mRNA expression was studied with an Affymetrix GeneChip expression array. RESULTS: We identified 573 amplified and 30 deleted genes common to all 5 cell lines. Some of them have already been described, whereas other genes, implicated in signal transduction, apoptosis, cell cycle or cell migration, are described for the first time as being related to this cancer. Comparison of genomic abnormalities between the 2 most aggressive and the 3 less aggressive cell lines led to the identification of 368 genes specifically amplified in the aggressive cell lines. However, no specific gene deletion seems to be associated with the aggressive phenotype. CONCLUSION: Using a high-resolution approach, we could precisely describe the genomic alterations associated with pancreatic adenocarcinoma and determine those associated with an aggressive phenotype.

12 Article Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy. 2009

Beyer, Laura / Bonmardion, Rémi / Marciano, Sandrine / Hartung, Olivier / Ramis, Olivier / Chabert, Lénaïk / Léone, Marc / Emungania, Olivier / Orsoni, Pierre / Barthet, Marc / Berdah, Stéphane V / Brunet, Christian / Moutardier, Vincent. ·Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la Méditerranée, Chemin des Bourrely, 13915, Marseille Cedex 20, France. ·J Gastrointest Surg · Pubmed #19224299.

ABSTRACT: INTRODUCTION: Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage. PATIENTS AND METHODS: From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage. RESULTS AND DISCUSSION: Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived. CONCLUSION: Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.

13 Article [Endoscopic management of postoperative pancreatic collections]. 2008

Subtil, C / Moutardier, V / Vitton, V / Gasmi, M / Desjeux, A / Grimaud, J-C / Brunet, C / Berdah, S / Barthet, M. ·Département de gastroentérologie et hépatologie, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France. ·Gastroenterol Clin Biol · Pubmed #18494154.

ABSTRACT: INTRODUCTION: Treatment of pancreatic postoperative collections are usually managed with a multidisciplinary team. Different managements are possible: abstention, external drainage, endoscopic treatment or surgery. METHODS: We report on a case series of five patients with a postoperative pancreatic collection, endoscopically managed. Patients underwent all a CT scan associated or not with endoscopic ultrasonography. RESULTS: An endoscopic cystenterosotomy was performed in all the cases, with two double pig tail stents sometimes associated with nasocystic drainage for clearing the cyst lumen and with transpapillary drainage in one case. All the procedures were successful and patients healed in all the cases with the disappearance of the radiological image within a 33 days to three months range with one complication due to superinfection of the drained cyst, endoscopically managed with a nasocystic catheter. CONCLUSION: Therapeutic endoscopy, with a multidisciplinary approach, is a promising way to manage postoperative pancreatic collections.