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Pancreatic Neoplasms: HELP
Articles by Pierre H. Deprez
Based on 9 articles published since 2008
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Between 2008 and 2019, P. Deprez wrote the following 9 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 Editorial EUS elastography: is it replacing or supplementing tissue acquisition? 2013

Deprez, Pierre H. · ·Gastrointest Endosc · Pubmed #23498142.

ABSTRACT: -- No abstract --

3 Review Established EUS-guided therapeutic interventions. 2014

Chevaux, J B / Deprez, P H. ·Hepato‑Gastroenterology Department Cliniques universitaires Saint‑Luc Université catholique de Louvain Brussels, Belgium - pdeprez@uclouvain.be. ·Minerva Med · Pubmed #25028865.

ABSTRACT: Over the three last decades, endosonography ultrasound (EUS) has evolved from a diagnostic tool to an interventional modality through cumulative advances in experience, knowledge, equipment, and devices. EUS-guided therapeutic procedures appear feasible and safe when performed in highly-experienced centers. This review covers the technical aspects, indications, and results of the most commonly performed procedures. Celiac plexus neurolysis and collection drainages are now well-established techniques and considered to be first-line treatments. Biliary and pancreatic EUS-guided drainages are, conversely, more challenging, and there is currently insufficient clinical evidence documenting their superiority over established practice. Well-designed prospective trials are thus needed in order to accurately assess this modality's risks and long-term outcomes compared to radiological or surgical techniques.

4 Article How to treat intestinal obstruction due to malignant recurrence after Whipple's resection for pancreatic head cancer: Description of 2 new endoscopic techniques. 2017

Mouradides, Christina / Taha, Alaa / Borbath, Ivan / Deprez, Pierre H / Moreels, Tom G. ·Cliniques universitaires Saint-Luc, Hépato-Gastroentérologie, B-1200 Brussels, Belgium. · Cliniques universitaires Saint-Luc, Hépato-Gastroentérologie, B-1200 Brussels, Belgium. tom.moreels@uclouvain.be. ·World J Gastroenterol · Pubmed #28970734.

ABSTRACT: The prognosis of pancreatic cancer remains poor, even after initial surgical therapy. Local recurrence after Whipple's pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a self-expandable metal stent (SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple's resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing HotAxios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple's resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.

5 Article Impact of Intraoperative Pancreatoscopy with Intraductal Biopsies on Surgical Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas. 2015

Navez, Julie / Hubert, Catherine / Gigot, Jean-François / Borbath, Ivan / Annet, Laurence / Sempoux, Christine / Lannoy, Valérie / Deprez, Pierre / Jabbour, Nicolas. ·Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. · Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. · Department of Imaging study, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. · Department of Pathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. · Cancer Center Institute Roi Albert II, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. · Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. Electronic address: nicolas.jabbour@uclouvain.be. ·J Am Coll Surg · Pubmed #26304184.

ABSTRACT: BACKGROUND: Because of its known malignant potential, precise histologic diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN) during intraoperative pancreatoscopy (IOP) is essential for complete surgical resection. The impact of IOP on perioperative IPMN patient management was reviewed over 20 years of practice at Cliniques universitaires Saint-Luc, Brussels, Belgium. STUDY DESIGN: Among 86 IPMN patients treated by pancreatectomy between 1991 and 2013, 21 patients had a dilated main pancreatic duct enabling IOP and were retrospectively reviewed. The IOP was performed using an ultrathin flexible endoscope and biopsy forceps, and specimens of all suspicious lesions underwent frozen section examination. RESULTS: Complete IOP with intraductal biopsies was easily and safely performed in 21 patients, revealing 8 occult IPMN lesions. In 5 cases (23.8%), initially planned surgical resection was modified secondary to IOP: 3 for carcinoma in situ and 2 for invasive carcinoma. The postoperative morbidity rate at 3 months was 25.0% (5 of 20); 1 patient died from septic shock postoperatively and was excluded. Median follow-up was 93 months (range 13 to 248 months). Nineteen of 21 patients were still alive and free of disease at last follow-up (90.5%); there was 1 patient with invasive carcinoma at initial pathology (pT3 N1) who died of pulmonary recurrence 21 months after surgery. CONCLUSIONS: Intraoperative pancreatoscopy of the main pancreatic duct combined with intraductal biopsies plays a significant role in the surgical management of IPMN patients and should be used in all patients presenting a sufficiently dilated main pancreatic duct.

6 Article Pancreatic neuroendocrine tumour grading on endoscopic ultrasound-guided fine needle aspiration: high reproducibility and inter-observer agreement of the Ki-67 labelling index. 2014

Weynand, B / Borbath, I / Bernard, V / Sempoux, C / Gigot, J-F / Hubert, C / Lannoy, V / Deprez, P H / Jouret-Mourin, A. ·Department of Pathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. ·Cytopathology · Pubmed #24750272.

ABSTRACT: OBJECTIVES: Assessment of proliferation by the Ki-67 labelling index (Ki67-LI) is an important parameter of pancreatic neuroendocrine tumour (pNET) prognosis on resection specimens. Ki67-LI values for grading are not fully established on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to determine the accuracy of Ki67-LI on EUS-FNA to predict a final grade of pNET and to analyse the relationship between cytological grading and progression-free survival (PFS). METHODS: Between 1996 and 2010, 46 pNETs (33 were resected) from 45 patients were diagnosed by EUS-FNA. Ki67-LI was evaluated on cytological and histological material for each tumour and classified according to the 2010 WHO grading system. RESULTS: A very good inter-observer agreement for Ki67-LI on EUS-FNA and surgical specimens, respectively, were obtained. Discrepancies were observed between histology and cytology, especially in grade 2 (G2) tumours, where cytology underestimated grading owing to tumour heterogeneity. Still, EUS-FNA was able to distinguish a poor prognostic group, as the actuarial PFS of cytological (c) G3 tumours was 10 ± 4 months versus 29 ± 7 and 68 ± 10 for cG2 and cG1 tumours, respectively (P < 0.0001). CONCLUSION: This study attests the reproducibility of Ki67-LI of pNETs whether counted on cytology or histology with a very good inter-observer correlation. Determination of Ki67-LI on EUS-FNA of pNETs should be included systematically in their prognostic work-up.

7 Article Clinical and morphological characteristics of sporadic genetically determined pancreatitis as compared to idiopathic pancreatitis: higher risk of pancreatic cancer in CFTR variants. 2013

Hamoir, Coralie / Pepermans, Xavier / Piessevaux, Hubert / Jouret-Mourin, Anne / Weynand, Birgit / Habyalimana, Jean-Baptiste / Leal, Teresinha / Geubel, André / Gigot, Jean-François / Deprez, Pierre H. ·Hepato-Gastroenterology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. ·Digestion · Pubmed #23751316.

ABSTRACT: BACKGROUND/AIMS: Idiopathic pancreatitis is considered to be a multigenic and multifactorial disease. Genetically determined pancreatitis is associated with mutations in the PRSS1,SPINK1 and CFTR genes. This study aimed at examining the clinical and morphological characteristics of patients diagnosed with genetically determined sporadic pancreatitis. METHODS: Inclusion criteria were the presence of PRSS1,CFTR or SPINK1 gene mutations in patients with idiopathic recurrent or chronic pancreatitis. Patients with hereditary pancreatitis were excluded. Age- and sex-matched patients with idiopathic pancreatitis and negative genetic testing served as controls (n = 68). RESULTS: Genetic testing was performed in 351 probands referred to our centre since 1999. Sixty-one patients (17.4%) carried at least 1 detected mutation in 1 of the 3 tested genes (34 CFTR, 10 PRSS1 and 13 SPINK1 mutations), and 4 patients showed a combination of mutations. Follow-up has been currently extended to a median of 5 years (range 1-40). Similar clinical features were noted in the case and matched groups except for an earlier age of onset of pancreatic symptoms and a higher incidence of pancreatic cancer in the case group and in patients with CFTR mutations compared to the control group (p < 0.05). The standardized incidence ratio, the ratio of observed to expected pancreatic cancers, averaged 26.5 (95% confidence interval 8.6-61.9). All pancreatic cancer patients were smokers. CONCLUSION: Clinical parameters of patients with sporadic idiopathic pancreatitis and gene mutations are similar to those of age- and sex-matched patients without gene mutations, except for the age of pancreatic disease onset. A significantly higher occurrence of pancreas cancer was observed in the case group, particularly in those patients carrying CFTR mutations. We therefore suggest to include patients with CFTR variants presenting with risk factors in a screening and surveillance programme and to strongly advise them to stop smoking.

8 Article Optimizing specimen collection and laboratory procedures reduces the non-diagnostic rate for endoscopic ultrasound-guided fine-needle aspiration of solid lesions of the pancreas. 2013

Weynand, B / Borbath, I / Galant, C / Piessevaux, H / Deprez, P H. ·Pathology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. Birgit.Weynand@uclouvain.be ·Cytopathology · Pubmed #21917031.

ABSTRACT: OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a routine technique to assess solid pancreatic lesions. The aim of this study was to analyse the effect of optimizing laboratory procedures for specimen preparation on the rate and accuracy of the procedure. METHODS: All EUS-FNAs of solid pancreatic lesions performed during the year 2000 (Period 1) and from May 2003 to May 2004 (Period 2) were analysed. During Period 1, one experienced gastroenterologist performed all EUS-FNAs, making direct smears and retrieving small fragments if present on the smear for histology. In Period 2, two endoscopists performed the EUS-FNAs and all the material was emptied into a vial containing a fixative. Slide preparation was carried out in the pathology laboratory: one slide was processed using cytocentrifugation and cell blocks were made from left-over material. Neither period utilized rapid on-site evaluation. RESULTS: During the two periods, 67 and 102 FNAs were analysed and showed significantly different (P < 0.001) non-diagnostic rates of 22.8% and 4.2%, respectively. The increased diagnostic yield can be explained by the modified laboratory procedures and to a lesser extent by the increased experience of the gastroenterologists. Sensitivity, specificity, PPV, NPV and accuracy in the second time period were, respectively, 90.6%, 100%, 100%, 81.8% and 93.4%, not significantly different from the first time period. CONCLUSION: This study shows that accurate EUS-FNA results may be obtained with a low non-diagnostic rate comparable to those reported for rapid on-site evaluation by optimizing laboratory specimen processing in a setting of solid pancreatic lesions.

9 Article Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. 2008

Deprez, Pierre H / Claessens, Anick / Borbath, Ivan / Gigot, Jean François / Maiter, Dominique. ·Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. pdeprez@uclouvain.be ·Acta Gastroenterol Belg · Pubmed #19198582.

ABSTRACT: OBJECTIVE: Most insulinomas are benign sporadic tumours that require complete resection to avoid recurrent symptoms of hypoglycaemia. Alternate minimally invasive therapies are seeked in elderly patients in whom extensive surgery might be life-threatening. We wanted to evaluate the feasibility, safety and efficacy of ethanol injection using endoscopic ultrasound (EUS) guidance to ablate a pancreatic insulinoma. PATIENT AND METHODS: A 78-yr-old female patient was referred in our academic medical centre for symptomatic hypoglycaemia. Laboratory and imaging work-up confirmed the diagnosis of an insulinoma presenting as a small tumour located deeply in the pancreas head, in close vicinity with the Wirsung's duct. Major pancreatic resection was contra-indicated due to the poor condition of the patient. Endosonography using a linear-array endoscope allowed injection of 3.5 ml of 98% ethanol in the pancreatic tumour after endoprosthetic stenting of the biliary and pancreatic ducts. RESULTS: There was no recurrence of hypoglycemia, and fasting tests performed 12 days and 3 months after the procedure showed complete remission of endogenous hyperinsulinism. Complications included a mild and asymptomatic elevation of pancreatic enzymes for 2 days and the later occurrence of medically-controlled hematoma and ulceration of the duodenal wall. Complete normalization of pancreatic head morphology was confirmed by imaging at 3 months and the patient remains currently asymptomatic and normoglycemic more than two years after the procedure. CONCLUSIONS: EUS-guided ethanol ablation of sporadic insulinoma is a new feasible and efficient therapy to be considered for small and localized lesions in poor surgical candidates.