Vincent Lepilliez

CHU de Lyon - Groupement Hospitalier Edouard Herriot, Lyons, Rhône-Alpes, France

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Publications (39)166.64 Total impact

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    ABSTRACT: Background and study aims: The differential diagnosis of solitary pancreatic cystic lesions is frequently difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a new technology enabling real-time imaging of the internal structure of such cysts. The aim of this pilot study was to identify and validate new diagnostic criteria on nCLE for pancreatic cystic lesions. Patients and methods: A total of 31 patients with a solitary pancreatic cystic lesion of unknown diagnosis were prospectively included at three centers. EUS-FNA was combined with nCLE. The final diagnosis was based on either a stringent gold standard (surgical specimen and/or positive cytopathology) or a committee consensus. Six nonblinded investigators reviewed nCLE sequences from patients with the most stringent final diagnosis, and identified a single feature that was only present in serous cystadenoma (SCA). The findings were correlated with the pathology of archived specimens. After a training session, four blinded independent observers reviewed a separate independent video set, and the yield and interobserver agreement for the criterion were assessed. Results: A superficial vascular network pattern visualized on nCLE was identified as the criterion. It corresponded on pathological specimen to a dense and subepithelial capillary vascularization only seen in SCA. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this sign for the diagnosis of SCA were 87 %, 69 %, 100 %, 100 %, and 82 %, respectively. Interobserver agreement was substantial (κ = 0.77). Conclusion: This new nCLE criterion seems highly specific for the diagnosis of SCA. The visualization of this criterion could have a direct impact on the management of patients by avoiding unnecessary surgery or follow-up.Clinicaltrials.gov NCT01563133.
    Endoscopy 10/2014; 47(1). DOI:10.1055/s-0034-1390693 · 5.20 Impact Factor
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    ABSTRACT: Introduction As part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract, a new hospital sterile and non-pyrogenic preparation of fructose (5%)–glycerol (10%) was realized. Under pharmaceutical legislation, the provision of this hospital preparation involves of aseptic process validation and achieve a stability study. Materials and methods After the aseptic process validation with Mediafill Test, the preparation was made under aseptic conditions associated with a sterilizing filtration according to the good practices preparation. Prepared flexible bags (100 mL of solution) were stored for one year in a climatic chamber (25 ± 2 °C). To assess stability, the physicochemical controls (fructose concentration, glycerol concentration, hydroxy-methyl-5 furfural [5-HMF] concentration, sodium concentration, pH measure, osmolality and sub-visible particles count) and microbiological (bioburden, bacterial endotoxin and sterility) were performed at regular intervals for one year. Results Neither significant decrease of fructose concentration, glycerol concentration and sodium concentration nor pH, 5-HMF, osmolality variations out of specifications were observed for one year. The sub-visible particles count, the bacterial endotoxin and sterility were in accordance with the European pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation. Discussion and conclusion The hospital preparation was stable over one year at 25 ± 2 °C, ensuring safe administration in humans within the framework of this clinical research.
    Annales Pharmaceutiques Françaises 10/2014; DOI:10.1016/j.pharma.2014.09.002
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    ABSTRACT: Background & Aims: Fully covered self-expanding metal stents (FCSEMS) are gaining acceptance for treatment of benign biliary strictures. We performed a large prospective multinational study to study the ability to remove these stents after extended indwell and the frequency and durability of stricture resolution. Methods In a nonrandomized study at 13 centers in 11 countries, 187 patients with benign biliary strictures received FCSEMS. Removal was scheduled at 10-12 months for patients with chronic pancreatitis or cholecystectomy and 4-6 months for patients who received liver transplants. The primary outcome measure was removal success, defined as either scheduled endoscopic removal of the stent with no removal-related serious adverse events or spontaneous stent passage without need for immediate restenting. Results Endoscopic removal of FCSEMS was not performed for 10 patients because of death (from unrelated causes), withdrawal of consent, or switch to palliative treatment. For the remaining 177 patients, removal success was accomplished in 74.6% (95% confidence interval [CI], 67.5%-80.8%). Removal success was more frequent in the chronic pancreatitis group (80.5%) than the liver transplantation (63.4%) or cholecystectomy (61.1%) groups (P= .017). FCSEMS were removed by endoscopy from all patients in which this procedure was attempted. Stricture resolution without restenting upon FCSEMS removal occurred in 76.3% of patients (95% CI, 69.3%-82.3%). The rate of resolution was lower in patients with FCSEMS migration (odds ratio, 0.22; 95% CI, 0.11-0.46). Over a median follow-up period of 20.3 months (interquartile range, 12.9-24.3 months), the rate of stricture recurrence was 14.8% (95% CI, 8.2%-20.9%). Stent- or removal-related serious adverse events, most often cholangitis, occurred in 27.3% of patients. There was no stent- or removal-related mortality Conclusions In a large prospective multinational study, removal success of FCSEMS after extended indwell and stricture resolution were achieved for approximately 75% of patients.
    Gastroenterology 08/2014; 147(2). DOI:10.1053/j.gastro.2014.04.043 · 12.82 Impact Factor
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    ABSTRACT: Background and study aims: Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate for superficial colorectal tumors. The aims of this study were to assess the feasibility of ESD in France and to evaluate the complete resection rate at 1 year. Patients and methods: Patients with superficial rectal tumors ≥ 10 mm in size were prospectively included in the study at nine French expert centers between February 2010 and June 2012. The study was stopped temporarily because of a high complication rate. Study recruitment resumed following remedial action. Results: A total of 45 patients were included (mean age 67 years; 24 males). The immediate perforation rate was 18 % (n = 8), and salvage surgery was not required. Six patients (13 %) had late bleeding, which was treated endoscopically in five patients and surgically in one patient who had required blood transfusion. The mortality rate was zero. The en bloc resection rate was 64 % (29/45), and the curative R0 resection rate was 53 % (24/45). Three patients (7 %) had an invasive tumor (two sm1, one T2). At 1-year follow-up, endoscopic examinations showed complete resection in 38 /43 patients (88 %). At the end of the study, after the remedial action, the en bloc resection rate had increased from 52 % to 82 %, and the perforation rate had decreased significantly from 34 % to 0 %. Conclusions: The study reflects the initial prospective experience of ESD in France, and suggests that curative R0 resection rates should increase and complication rates should decrease with experience and corrective actions.
    Endoscopy 06/2014; 46(8). DOI:10.1055/s-0034-1365810 · 5.20 Impact Factor
  • Endoscopy 02/2014; 46(03). DOI:10.1055/s-0033-1364106 · 5.20 Impact Factor
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    ABSTRACT: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
    Surgical Endoscopy 01/2014; 28(5). DOI:10.1007/s00464-013-3378-5 · 3.31 Impact Factor
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    ABSTRACT: With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
    Gastroentérologie Clinique et Biologique 11/2013; 38(2). DOI:10.1016/j.clinre.2013.10.010 · 0.80 Impact Factor
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    ABSTRACT: Background and study aim: Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20 mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD.Patients and methods: We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS. Results: 11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm². Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9 /11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4 /11 patients (36.4 %) with resolution after 1 - 5 dilations.Conclusion: Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.
    Endoscopy 10/2013; 45(12). DOI:10.1055/s-0033-1344855 · 5.20 Impact Factor
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    ABSTRACT: Background and study aims: The ENKI-2 water-jet system for endoscopic submucosal dissection (ESD) combines submucosal saline pressure injection with dissection. The aim of this study was to compare ENKI-2 with a standard device in terms of procedure time and perforation rate during colorectal ESD.Methods: In this randomized comparative study, 10 30-mm-diameter lesions were created in the colon and rectum of 10 healthy adult pigs. The ESD procedure time and perforation rates were recorded for the ENKI-2 system and a standard Dual Knife method. Each pig had half the lesions dissected by ENKI-2 and half dissected by Dual Knife. One experienced and one inexperienced endoscopist took part in the study.Results: A total of 95 lesions were dissected (47 by ENKI-2 and 48 by Dual Knife). The experienced endoscopist was able to excise comparably sized 30-mm lesions using both techniques. The dissection time was shorter for ENKI-2 (18.9 vs. 25.6 minutes; P = 0.034) and the perforation rate was lower compared with the Dual Knife (one perforation [4 %] vs. nine perforations [36 %]; P = 0.011). The inexperienced endoscopist performed significantly larger dissections using the ENKI-2 (934 ± 405 mm2 vs. 673 ± 312 mm2; P = 0.021) despite pre-marking similarly sized artificial lesions. Multivariate analysis demonstrated that for all lesions the dissection time was significantly longer for lesions in the proximal colon (P = 0.001) and the distal colon (P < 0.0001) and shorter for the experienced operator (P < 0.0001). ENKI-2 shortened the dissection time, but not significantly (P = 0.093).Conclusions: In experienced hands, the ENKI-2 system shortens dissection time and reduces the perforation rate. This effect was not statistically significant for an inexperienced operator. Dissection was faster in the rectum than the colon.
    Endoscopy 10/2013; 46(2). DOI:10.1055/s-0033-1344892 · 5.20 Impact Factor
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    ABSTRACT: Despite reports of randomized, control trials and cohort studies that do not support the use of drains, most surgeons routinely place prophylactic, intraperitoneal drains at the time of pancreatic resections. We sought to evaluate the outcome of elective pancreatic resection with or without prophylactic peripancreatic drainage. The primary outcome was the rate of postoperative complications. Total pancreatectomy and pancreatectomy for chronic pancreatitis were excluded. From September 2005 to February 2012, of the 375 patients who had pancreatic surgery, 242 were eligible for the study. A drain was used in 130 and no drain was used in 112 patients. The data for the 2 groups were recorded in a prospective database. The statistical analysis compared variables using Chi-square and Fisher's exact tests for categorical variables and the independent-samples t-test for continuous variables. The demographic, operative, and pathologic data were similar between the 2 groups. There was no increase in the frequency or severity of the overall complications in the no drain group. In the drain and no drain groups, postoperative complications occurred in 64% and 67% of patients, respectively (P = .11); post-pancreatectomy hemorrhage occurred in 19% and 23% (P = .33); and pancreatic fistula occurred in 16% and 13% (P = .34). The requirement for an interventional procedure was equivalent for both of the groups (14.6% and 20.5%; P = .15). The median hospital stay was 16 days (range, 2-98) and 18 (range, 7-131; P = .18), and the 90-day hospital mortality was 5.4% and 4.5% (P = .49) in the drain and the no drain groups, respectively. In a tertiary, high-volume, Hepatobiliary and pancreatic (HBP) surgery center, the routine prophylactic draining of the abdominal cavity after pancreatic resection did not decrease the frequency or severity of postoperative complications. Prophylactic peripancreatic drainage also did not decrease the requirement for interventional procedures. Interventional radiology and transgastric endoscopic drainage of the post-pancreatectomy collection are feasible and improve patients' outcomes. Malnutrition and the type of operation were independent factors for postoperative complications.
    Surgery 07/2013; 154(5). DOI:10.1016/j.surg.2013.04.017 · 3.37 Impact Factor
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    ABSTRACT: Spiral enteroscopy (SE) is generally considered as a safe procedure and few major complications have been described. The authors report a case of irreducible gastroesophageal intussusception during per oral SE, secondary hepatic failure, and acute pancreatitis in a context of pneumoperitoneum in a 29-year-old woman after jejunal hamartoma resection. The large preexisting hiatal hernia might have put the patient at risk for gastric intussusception. This article is part of an expert video encyclopedia.
    06/2013; 1(1):230-232. DOI:10.1016/S2212-0971(13)70098-0
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    ABSTRACT: BACKGROUND: Endoscopic submucosal dissection (ESD) allows en bloc resection of early neoplastic lesions of gastrointestinal tract. Lesions are lifted by submucosal fluid injection before circumferential incision and dissection. High-pressure fluid injection using water jet (WJ) technology is already used for lifting and dissection in surgery. The study was designed to assess WJ for ESD submucosal lifting and dissection. METHODS: An experimental, randomized comparative, "in vivo" nonsurvival animal study on 12 pigs was designed. Stomach mucosal areas were delineated and resected using three ESD techniques: technique A-syringe injection and IT knife dissection; technique B-WJ continuous injection and IT knife dissection; technique C-WJ injection and WJ pulsed dissection. Injection and dissection speeds and complications rates were assessed. RESULTS: Water jet continuous injection is faster than syringe injection (B faster than A, p = 0.001 and B nonsignificantly faster than C, p = 0.06). IT knife dissection is significantly faster after WJ continuous injection (B faster than A, p = 0.003). WJ pulsed dissection is significantly slower than IT knife dissection (C slower than A and B, both p < 0.001). The overall procedure speed was significantly higher and the immediate bleedings rate was significantly lower for technique B than A and C (overall procedure speed p = 0.001, immediate bleedings p = 0.032 and 0.038 respectively). There were no perforations with any technique. CONCLUSIONS: Water jet fluid continuous injection speeds up ESD, whereas pulsed WJ dissection does not.
    Surgical Endoscopy 03/2013; 27(8). DOI:10.1007/s00464-013-2857-z · 3.31 Impact Factor
  • V. Lépilliez
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    ABSTRACT: L’achalasie primaire est un trouble moteur oesophagien défini par l’absence de contractions propagées (apéristaltisme) au niveau du corps de l’oesophage et par un défaut de relaxation du sphincter inférieur de l’oesophage. Grâce à l’avènement de la manométrie haute résolution avec l’étude de la topographie de la pression oesophagienne, trois soustypes selon la classification de Chicago se distinguent, ce qui a un intérêt direct sur le choix du traitement à utiliser: l’achalasie de type I répond aussi bien à la dilatation (81 %) qu’à la chirurgie (85 %); l’achalasie de type II, qui est en fait la forme la plus fréquente, répond mieux à la dilatation (100 %); quant à l’achalasie de type III dite « spastique », qui la est la forme la moins fréquente, elle répond mieux à la myotomie laparoscopique de Heller-Dor (86 %). Plus récemment est apparue le myotomie par voie endoscopique qui reste à l’étude en France et qui, au vu des résultats préliminaires, pourrait devenir le traitement de référence et notamment dans le type III qui est la forme la plus résistante.
    Acta Endoscopica 03/2013; 43(3). DOI:10.1007/s10190-013-0325-1 · 0.16 Impact Factor
  • Endoscopy 02/2013; 45(03). DOI:10.1055/s-0033-1336109 · 5.20 Impact Factor
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    ABSTRACT: Severe (stage IV) duodenal polyposis is difficult to manage in patients with familial adenomatous polyposis (FAP), with no effective medical treatment, complex endoscopic treatment modalities, and a high morbidity and mortality from pancreaticoduodenectomy. We present the case of a 44-year-old woman with FAP, stage IV duodenal polyposis, and with an ileal pouch adenocarcinoma that required surgery and adjuvant chemotherapy. Her duodenal polyposis regressed to stage II after four sessions of FOLFOX4 adjuvant chemotherapy, which avoided the need for aggressive endoscopic therapy or pancreatoduodenectomy in this patient.
    Endoscopy 12/2012; 44(12):1165-7. DOI:10.1055/s-0032-1325674 · 5.20 Impact Factor
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    ABSTRACT: The 2012 Digestive Disease Week (DDW; 19-22 May, San Diego, California, USA) presented small-step advances in the field of non-Barrett's esophageal and gastric tumors. In patients with ear-nose-throat (ENT) cancer, narrow-band imaging (NBI) might be useful in endoscopic screening for early esophageal squamous neoplasia, but confirmation of its role has yet to be reported. The yield and intervals of endoscopic screening for gastric neoplasia are better understood, and so are the results and complications of gastroesophageal endoscopic submucosal dissection (ESD) together with their predictive factors. Endoscopic therapy of advanced tumors was another important theme at DDW, with ESD after radiotherapy for advanced esophageal cancer and gastrojejunostomy for neoplastic gastric outlet obstruction being reported. Relevant abstracts are discussed below.
    Gastrointestinal endoscopy 09/2012; 76(3):501-5. DOI:10.1016/j.gie.2012.06.027 · 4.90 Impact Factor
  • Endoscopy 03/2012; 44(03). DOI:10.1055/s-0032-1305660 · 5.20 Impact Factor
  • Endoscopy 02/2012; 44 Suppl 2 UCTN:E376-7. DOI:10.1055/s-0032-1310061 · 5.20 Impact Factor
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    ABSTRACT: Background In cases with periampullary tumors, the practice of preoperative biliary drainage (PBD) is still debated without clear uniform indications. Our study focused on resectable cases with an obstructive jaundice candidate for curative surgery. Main endpoints were overall complication and mortality rates between patients treated with and without PBD. Methods From January 2008 to November 2010, 100 consecutive patients with periampullary lesion underwent pancreatectomy. The rates of postoperative complications and mortality were compared between PBD and non-PBD patients. Results The two groups were well matched for demographics, clinical, and operative characteristics. In patients who completed preoperative PBD protocol, biliary stent was placed systematically in 45 % of these cases without any clear indication. Post-PBD complication delayed surgery in 24 % of cases. Postoperative complications did not differ significantly between the two groups except for a significantly higher positive bile culture in PBD group (p = 0.001). There were seven cases of hospital mortality, four in PBD and three in non-PBD group. DFS was equal (32 months) in both groups (p = 0.55), and OS was 43 vs 32 months (p = 0.45). Conclusion PBD did not significantly increase the risk of overall postoperative complications, although it was associated to higher rate of biliary infections. PBD was not associated with any advantages in patients with a resectable periampullary lesion by reducing operative morbidity. PBD should be considered in selected patients when surgery has to be delayed.
    Langenbeck s Archives of Surgery 02/2012; 398(2). DOI:10.1007/s00423-012-1000-2 · 2.16 Impact Factor
  • V. Lépilliez
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    ABSTRACT: La dissection sous-muqueuse endoscopique (ESD) est une technique émergente en France qui permet une résection de type R0 des lésions néoplasiques superficielles. En raison de son haut risque de perforation elle est plus accessible dans le rectum que dans le côlon en raison de sa situation sous-péritonéale qui rend cette complication facilement gérable. Devant la morbidité de cette technique et la courbe d’apprentissage, elle est actuellement à réserver à des centres experts.
    Côlon & Rectum 02/2012; 6(1). DOI:10.1007/s11725-012-0356-3

Publication Stats

202 Citations
166.64 Total Impact Points

Institutions

  • 2007–2014
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2013
    • Lyon Natecia Hospital
      Lyons, Rhône-Alpes, France
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2012
    • HCL
      Noida, Uttar Pradesh, India