J F Bretagne

Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France

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Publications (210)574.36 Total impact

  • Source
    Acta oncologica (Stockholm, Sweden) 10/2012; 51(8):1102-4. · 2.27 Impact Factor
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    ABSTRACT: The aim of this study was to compare the performance of the guaiac-based faecal occult blood test (G-FOBT), with that of three immunochemical faecal occult blood tests (I-FOBT) which allow automatic interpretation. Under the French organised screening programme, 85,149 average-risk individuals aged 50-74 participating in the third screening round, performed both the G-FOBT (Hemoccult-II test) and one of the I-FOBTs: FOB-Gold, Magstream and OC-Sensor. Given the chosen threshold, the positivity ratio between the different I-FOBTs and the G-FOBT was 2.4 for FOB-Gold, 2.0 for Magstream and 2.2 for OC-Sensor (P=0.17). The three I-FOBTs were superior to the G-FOBT for colorectal cancer (CRC) detection. The ratios for detection rates were 1.6 (FOB-Gold), 1.7 (Magstream) and 2.1 (OC-Sensor) (P=0.74). For non-invasive CRC they were, respectively, 2.5, 3.0 and 4.0 (P=0.83) and for advanced adenomas 3.6, 3.1 and 4.0 (P=0.39). This study provides further evidence that I-FOBT is superior to G-FOBT. None of the three I-FOBTs studied appeared to be significantly better than the others.
    European journal of cancer (Oxford, England: 1990) 05/2012; 48(16):2969-76. · 4.12 Impact Factor
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    ABSTRACT: The risks associated with pancreaticoduodenectomy (PD) in elderly patients continue to be debated. The aim of our study was to assess the incidence of death and postoperative complications following PD and identify the risk factors in patients >75 y. All patients who underwent PD between January 2000 and September 2009 were analyzed retrospectively. Patients were divided into two groups according to age (Group 1: patients aged <75 y, and Group 2: patients aged ≥75 y). Morbidity and perioperative mortality risk factors were analyzed using univariate and multivariate analyses. Among the 314 patients, 273 were included in Group 1 (sex ratio 1.4) and 41 in Group 2 (sex ratio 1). In multivariate analysis, postoperative hemorrhage (PH) (OR 6.61, IC95% [1.96; 22.31], P = 0.002) and age >75 y proved to be predictive factors for mortality (OR 11.04, IC95% [2.57; 47.49], P = 0.001). When compared with Group 1, Group 2 was associated with increased postoperative deaths (24.4% versus 3.66%, P < 0.001) and pancreatic fistulas (26.8% versus 13.2%, P = 0.041), in particular, Grade C fistulas (14.6% versus 4.4%, P = 0.023). In multivariate analysis, only PH proved to be an independent predictive factor for mortality (OR 12.9, IC95% [1.07; 155.5], P = 0.04). PD in elderly patients aged over 75 y appears to be associated with an increased risk of postoperative death and pancreatic fistula. No single preoperative factor made it possible to predict this risk.
    Journal of Surgical Research 04/2012; 178(1):181-7. · 2.02 Impact Factor
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    JFHOD 2012, Paris; 03/2012
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    ABSTRACT: Measuring neoplasia yield is a priority in the quality improvement process for colonoscopy. However, neither the most appropriate quality indicator nor the standard threshold has been established. To determine the most appropriate quality indicators to assess the yield of routine colonoscopy. Retrospective. Population-based colorectal cancer screening program in 3 French administrative areas. One hundred gastroenterologists and their average-risk asymptomatic patients aged 50 to 74 years undergoing colonoscopy for positive guaiac-based fecal occult blood test results. Comparison of several indicators, mainly the adenoma detection rate (ADR) and polyp detection rate (PDR), the mean number of adenomas per colonoscopy (MNA) and mean number of polyps (MNP) and the proportion of adenomas among polyps (PAP). Correlations were good between the ADR and PDR (Pearson coefficient r = 0.88 [95% CI, 0.78-0.94]) and between MNA and MNP (r = 0.89 [95% CI, 0.79-0.94]) (P < .0001 for both). Gastroenterologists were classified as higher or lower detectors in comparison with the lower limit of the 95% confidence interval of the median value for each indicator. The MNP (MNA) provided better discrimination than the PDR (ADR). Concordance between classifications of gastroenterologists according to their MNA and MNP was excellent (κ = 0.89). PAP varied dramatically from 38% to 95% between gastroenterologists and was very poorly correlated with the ADR (r = -0.27 [95% CI, -0.54 to 0.07; P = .11]) and the MNA (r = 0.03 [95% CI, -0.29 to 0.36; P = .88]). Some factors influencing the neoplasia yield were not taken into account. The MNP could replace the ADR for the assessment of adenoma detection in routine practice. A separate indicator, PAP, would be necessary to assess adenoma discrimination ability.
    Gastrointestinal endoscopy 09/2011; 74(6):1325-36. · 6.71 Impact Factor
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    ABSTRACT: The aim of this study was to define the positive predictive values of a positive guaiac faecal occult blood test according to the number of positive squares, in two consecutive rounds of colorectal cancer mass screening in a French region. A total of 4172 colonoscopies were analyzed. Sex, age, number of positive squares, and colonoscopic and histopathologic findings were studied. In the results obtained, 76.6% of positive tests were positive with one or two squares. The number of positive squares was not related to sex, age and rank of participation. The positive predictive value for cancers and adenomas increased significantly with age, sex (male) and number of positive squares from 6.6% (one to two squares) to 27.6% (five to six squares) and from 15.2% to 22.2%, respectively. Cancer was diagnosed 211 times (54.1%) and advanced neoplasia was diagnosed 696 times (65.3%) following positive tests with one to two squares. The TNM stage of cancer increased significantly with the number of positive squares: 85.8% of stages 0-1-2 for one to two positive squares and 66.3% for five to six positive squares (P<0.001). Multivariate analysis showed an increased risk of cancer and advanced neoplasia for male patients and aged persons. The number of positive squares significantly increased the risk of cancer (odds ratio=4.6 for five to six positive squares) and the risk of advanced neoplasia (odds ratio=2.9). Age, sex and number of positive squares were independent predictive factors of positive guaiac faecal occult blood test. The proportion of TNM stages 3-4 was significantly higher in those with five to six positive squares. Performing a complete colonoscopy in every individual having a positive test, especially aged men with a high number of positive squares, should be a priority in any screening programme.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 07/2011; 20(4):277-82. · 2.21 Impact Factor
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    ABSTRACT: Transcutaneous electrical nerve stimulation (TENS) is a possible alternative to sacral nerve stimulation because the neurophysiologic targets might be similar but the former method is non-invasive and cheaper. The aim of the study was to assess both symptom and quality of life (QoL) improvements in patients suffering from severe FI. Thirty two patients (M/F, 30/2; age, 61 +/- 13 years) were enrolled in a pilot trial because they suffered from a severe and stable FI (Cleveland Score14.5 +/- 2.8 [11-20]) for a long duration (95 +/- 91 months). TENS was delivered 20 min bis in die at home (Schwa Medico, P3). Assessment was realized at 1, 3, and 6 months with both semi-directive and self-administered questionnaires. Main endpoint was the quantified success rate after 1 month of follow-up. Mean subjective improvement was 26 +/- 30%: 20 (63%) patients reported some degree of improvement and 10 (32%) at least a 25% improvement in fecal incontinence. The Cleveland score significantly decreased at 1 (11 +/- 4; p < 0.001), 3 (11 +/- 5; p < 0.001), and 6 (10 +/- 5; p < 0.001) months. All subscales of QoL were significantly improved after a 3-month period of stimulation. However, constipation score and number of pads did not change. There was no adverse event. TENS provides slight improvement in FI. This justifies both neurophysiology assessment and randomized controlled studies before further diffusion of the technique.
    International Journal of Colorectal Disease 09/2010; 25(9):1127-32. · 2.24 Impact Factor
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    ABSTRACT: Nonfistulizing perianal lesions, including ulcerations, strictures, and anal carcinoma, are frequently observed in Crohn's disease. Their clinical course remains poorly known. The management of these lesions is difficult because none of the treatments used is evidence-based. Ulcerations may be symptomatic in up to 85% of patients. Most ulcerations heal spontaneously but may also progress to anal stenosis or fistula/abscess. Topical treatments only improve symptoms, while complete healing can occur in patients with perianal ulcerations receiving infliximab therapy. Half of all patients with anal strictures will require permanent fecal diversion. Dilatation for symptomatic strictures should be performed on a highly selective basis in the absence of active rectal disease in order to avoid infectious complications. Anorectal strictures associated with rectal lesions should first be managed with medical therapy. Skin tags are usually painless and may hide other perianal lesions. Anal cancer is uncommon. Its treatment is similar to that recommended for anal cancer occurring in non-Crohn's disease patients. After reviewing the classification, clinical features, and epidemiology of each type of nonfistulizing perianal lesion (ulceration, stricture, skin tags, and anal cancer), we discuss the efficacy of medical treatment and surgery. This review article may help physicians in decision-making when managing potentially disabling lesions. (Inflamm Bowel Dis 2010)
    Inflammatory Bowel Diseases 07/2010; 16(8):1431 - 1442. · 5.12 Impact Factor
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    ABSTRACT: The incidence of adenocarcinoma of the small bowel is very low in comparison with that of colorectal cancer. Radical surgery is the only curative treatment, and results with chemotherapy and radiotherapy are disappointing. No standard chemotherapy is defined for non-surgical adenocarcinoma of the small bowel. In France, it is usually treated with the same chemotherapy regimens as used for colorectal cancer. We report here the case of a young patient with an initially non-surgical adenocarcinoma of the duodenum treated in a palliative setting with the FOLFOX 4 chemotherapy regimen. After 4 months of treatment, CT scan showed no residual tumor and the patient was well. A multidisciplinary committee decided that a second surgical investigation was necessary, and a duodenal resection was performed, with no residual tumor in the final specimen. After 27 months of follow-up the patient was well and without recurrence. The FOLFOX 4 regimen seems to be efficacious for some small-bowel adenocarcinomas and can be expected to lead to downstaging. If the outcome of a few months of chemotherapy is favorable, it is appropriate for a multidisciplinary expert committee to consider further surgery. This case underscores the value of multidisciplinary expert committees in scrutinizing therapeutic decisions in rare and difficult cases.
    Journal of Gastrointestinal Surgery 08/2009; 13(12):2309-13. · 2.36 Impact Factor
  • Endoscopy 01/2009; 41(03). · 5.74 Impact Factor
  • Acta Endoscopica - ACTA ENDOSC. 01/2009; 39(3):175-178.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2009; 57.
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    ABSTRACT: But Contrairement aux données accumulées avec les AINS, les données relatives à l’effet préventif des IPP sur les complications ulcéreuses des traitements anti-agrégants plaquettaires (AAP) sont pauvres. Aussi, cette étude avait pour but d’estimer cet effet au sein d’une étude de cohorte de patients hospitalisés pour hémorragie digestive haute (HDH) ou basse (HDB) survenue sous AAP. Patients et Méthodes L’étude multicentrique française ASAP a permis de recruter 297 patients consécutifs admis en CHG ou au CHU pour une hémorragie digestive survenue sous AAP (aspirine, clopidogrel ou association des deux traitements), dont 160 cas d’HDH et 127 d’HDB. Considérant que les IPP n’ont pas de rôle protecteur vis-à-vis des HDB, nous avons réalisé une étude cas-témoins où les cas étaient représentés par les patients avec HDH et les témoins les patients avec HDB. Les groupes ont été appariés sur l’âge (> ou < 75 ans), les ATCD d’ulcère ou d’hémorragie digestive, l’association à d’autres traitements à risque digestif (AINS et/ou AVK et/ou héparine). Nous avons comparé par le test chi2, entre les cas et les témoins, les prévalences de prise d’IPP avant la survenue de l’hémorragie, prescrit pour des symptômes ou une gastroprotection, et calculé le risque relatif de protection des HDH par les IPP par la méthode de Mantel-Haenszel. Résultats Les 2 groupes d’HDH et d’HDB, une fois appariés, étaient composés de 121 patients. La prise d’IPP était notée chez 33 cas (27,3 %) et 52 témoins (43,0 %) (p = 0,011). Parmi les patients ayant des facteurs de risque digestif autres que le traitement AAP (43 dans chaque groupe), la proportion de ceux ne recevant pas d’IPP était de 60,5 % et 44,2 %, respectivement pour les cas et les témoins (p = 0,13). Le risque relatif calculé pour la protection des IPP vis-à-vis de la survenue d’HDH était de 0,69 (IC 95 % ; 0,51-0,94). Full-size table Conclusion Cette étude cas-témoins nichée dans une cohorte prospective de patients présentant une hémorragie digestive survenue sous AAP montre que les IPP permettent de diminuer significativement le risque d’HDH de 31 %. Cette étude montre aussi l’insuffisance du recours à la gastroprotection systématique chez des malades présentant outre le traitement AAP, d’autres facteurs de risque digestif.
    Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
  • Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
  • Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
  • Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
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    ABSTRACT: But Les résultats du dépistage du cancer colorectal (CCR) au cours des campagnes (C) ultérieures à C1 ont été analysés sur la base de cohortes fixes dans les essais contrôlés publiés. Connaître les résultats de la vraie vie, à l’échelle d’une population par définition fluctuante, serait utile à une modélisation des résultats du dépistage organisé en France. Patients et Méthodes Nous avons comparé les resultants finalisés des 2 premières campagnes (C1 et C2) réalisées dans notre département : C1 en 2003-2004 (finalisation au 1.01.2006), C2 en 2005-2006 (finalisation au 1.01.2008). De plus, pour C2, nous avons comparé les résultats pour le groupe n’ayant jamais participé au dépistage (C2-1) à ceux des personnes invitées à renouveler le test (C2-2). Pour les lésions diagnostiquées par coloscopie, les résultats ont été exprimés en taux de détection per-protocole -TDPP- (rapports aux personnes ayant fait le test) et en intention de dépister -TDID- (rapportés à la population cible). Test de comparaison Chi2. Analyse multivariée par régression logistique. Résultats Les populations cibles de C1 et C2 étaient de 185 508 et 191 992 personnes, respectivement. Le taux de participation (TP) était de 52,1 % à C1 et 46,5 % à C2 (p < 105). Au sein de C2, les TP étaient de 23,9 % et 76 % pour C2-1 et C2-2. Au sein de C2- 1, les TP étaient de 39 % pour ceux invités pour la 1ère fois et de 19,5 % pour les non répondants à C1. Les taux de positivité du test étaient de 2,6 % à C1 et 2,26 % à C2 (- 0,34 %, p < 105). Les taux de suivi par coloscopie étaient respectivement de 92,6 % et 91,05 % (p < 0,05). La différence des VPP entre C1 et C2 était significative pour les CCR (-1,8 %, p < 0,05) et la somme adénomes (AD) + CCR (-3,2 %, p < 0,05). Les TDPP et TDID étaient significativement moins élevés pour C2 que C1 pour les CCR, les AD, les AD avancés et AD ≥ 10 mm. Pour chacune des lésions, la comparaison des groupes C2-1 et C2-2 montrait des VPP et TDPP significativement plus élevés pour C2-1 que C2-2, mais les resultants étaient inversés pour le TDID : CCR (0,05 vs 0,10, p < 105), AD (0,18 vs 0,40, p < 10−5). La VPP pour le diagnostic de CCR était significativement plus élevée pour C2-2 que C2-1 chez les individus ≥ 60 ans (13,4 % vs 9,4 %, p < 0,001) sans différence chez ceux < 60 ans (6,2 % vs 6 %, ns). La comparaison entre C1 et chacun des sous-groupes de C2 montrait que les TDID étaient très différents entre C1 et C2-1 (p < 10−7), mais semblables entre C1 et C2-2. Les résultats de l’analyse multivariée tenant compte de l’âge et du sexe des individus seront présentés lors du congrès. Conclusion Ces résultats montrent une moindre participation à C2 qu’à C1. Les résultats à C2 sont différents selon qu’il s’agit d’une 1ère (C2-1) ou 2ème (C2-2) participation. Malgré des taux de positivité et des VPP moins élevés à C2, les performances du dépistage, exprimées par les TDID, sont identiques pour le groupe invité à renouveler le test à celles enregistrées à C1. Il est regrettable qu’un quart de ces personnes ne participent pas à C2. Nos résultats soulignent aussi le rôle joué par l’âge et le sexe dans les résultats de C2.
    Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
  • Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
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    ABSTRACT: Outlet constipation is a frustrating condition for both patients and clinicians. The former are reluctant to evoke this disabling condition. For the latter, decision-making remains uncertain since non-specific strategies are unhelpful (constipation). Thus, careful symptomatic assessment (stool consistencies), dynamic examination of the anorectal area (anismus, rectocele) and balloon expulsion test may plan therapeutic options in current situations.
    Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(10).
  • Endoscopy 01/2008; 40(03). · 5.74 Impact Factor

Publication Stats

2k Citations
574.36 Total Impact Points

Institutions

  • 2012
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 1988–2011
    • Centre Hospitalier Universitaire de Rennes
      • Service des maladies de l'appareil digestif
      Roazhon, Brittany, France
  • 1997–2004
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 1993
    • Centre Eugène Marquis
      Roazhon, Brittany, France