Publications of Pierrette GAST
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See detailApproche critique du traitement prolonge par inhibiteurs de la pompe a protons chez les personnes agees.
DELHOUGNE, Nicolas ULiege; Allepaerts, Sophie ULiege; GAST, Pierrette ULiege et al

in Revue medicale de Liege (2020), 75(1), 10-16

Proton pump inhibitors (PPI) are drugs frequently used for gastric acid-induced conditions. Their use is constantly increasing and due to the apparent absence of side-effects, the treatment is not ... [more ▼]

Proton pump inhibitors (PPI) are drugs frequently used for gastric acid-induced conditions. Their use is constantly increasing and due to the apparent absence of side-effects, the treatment is not reassessed, even for the elderly. However, there are many cases of misprescribing while concerns about some side-effects are rising. Old people are weakened by their particular homeostasis and their associated medical conditions. Therefore, it seems useful to particularly insist on side-effects of the PPI, their indications and the ways of withdrawal, first of all for the elderly. [less ▲]

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See detailAlcool et complications pancréatiques
LOLY, Jean-Philippe ULiege; MEURISSE, Nicolas ULiege; GAST, Pierrette ULiege et al

in Revue Médicale de Liège (2019), 74(5-6), 342-348

Alcohol consumption is the main cause of development of chronic pancreatitis and the second etiology of acute pancreatitis. The mortality of acute pancreatitis depends on its necrotic haemorrhagic ... [more ▼]

Alcohol consumption is the main cause of development of chronic pancreatitis and the second etiology of acute pancreatitis. The mortality of acute pancreatitis depends on its necrotic haemorrhagic character and the initial inflammatory response, while pain, malnutrition and diabetes are the main issues in the management of chronic pancreatitis. As medical and endoscopic techniques progress, surgical indications have become increasingly rare but remain indispensable for some patients. The multidisciplinary approach of these patients is the key to the success of care.La consommation d’alcool est la cause principale de développement d’une pancréatite chronique et la seconde étiologie de la pancréatite aiguë. La mortalité de la pancréatite aiguë dépend de son caractère nécrotico-hémorragique et de la réponse inflammatoire initiale tandis que les complications de type douleur, dénutrition et diabète sont les principaux enjeux de la prise en charge de la pancréatite chronique. Au fur et à mesure de l’avancée des techniques médicales et endoscopiques, les indications chirurgicales sont devenues de plus en plus rares, mais restent indispensables pour certains patients. L’approche pluridisciplinaire de ces patients est la clé du succès de la prise en charge. [less ▲]

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See detailOn-site comparison of an enzymatic detergent and a non-enzymatic detergent-disinfectant for routine manual cleaning of flexible endoscopes.
Gonzalez, Jonathan Alfageme; Vanzieleghem, Thomas; Dumazy, Axelle ULiege et al

in Endoscopy International Open (2019), 7(4), 412-420

Background and study aims Flexible endoscopes are potential vectors of pathogen transmission to patients that are subjected to cleaning and high-level disinfection after each procedure. Efficient manual ... [more ▼]

Background and study aims Flexible endoscopes are potential vectors of pathogen transmission to patients that are subjected to cleaning and high-level disinfection after each procedure. Efficient manual cleaning is a prerequisite for effective high-level disinfection. The goal of this study was to demonstrate the impact of the cleaning chemistry in the outcome of the manual cleaning of endoscopes. Materials and methods Twelve endoscopes were included in this study: four colonoscopes, four gastroscopes, two duodenoscopes and two bronchoscopes. This study was designed with two phases; in each of them, the manual cleaning procedure remained identical, but a different detergent was used: a non-enzymatic detergent-disinfectant (NEDD) and an enzymatic detergent (ED). Biopsy and suction channels of endoscopes were sampled using 10 mL of physiological saline at two points: before and after manual cleaning, and adenosine triphosphate (ATP) was measured on each sample. In total, 208 procedures were analyzed for the NEDD phase and 253 for the ED phase. Results For each endoscope type, cleaning endoscopes with ED resulted in larger median decrease in ATP than with NEDD: respectively 99.43 % and 95.95 % for bronchoscopes ( P = 0.0007), 99.28 % and 96.93 % for colonoscopes ( P < 0.0001) and 98.36 % and 95.36 % for gastroscopes ( P < 0.0001). In addition, acceptability rates of endoscopes based on defined post-manual cleaning ATP thresholds (200, 150, 100 or 50 relative light units) for all endoscope types were significantly higher with ED compared to NEDD. Conclusions With all other parameters of manual cleaning remaining unchanged, the enzymatic chemistry of ED provided more consistent and improved cleaning of endoscopes compared to NEDD. Therefore, choice of the detergent for endoscope cleaning has an impact on the outcome of this process. [less ▲]

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See detailAdenocarcinome obstructif localement avance de la tete du pancreas : importance du drainage biliaire precoce.
Deflandre, Laure-Anne; LOLY, Jean-Philippe ULiege; LECLERCQ, Philippe ULiege et al

in Revue Médicale Suisse (2018), 14(615), 1443-1447

The incidence of pancreatic cancer is increasing, but proportion of resectable cases and survival do not increase. Then, our care strategies have to be optimized. Chemotherapy is the principal treatment ... [more ▼]

The incidence of pancreatic cancer is increasing, but proportion of resectable cases and survival do not increase. Then, our care strategies have to be optimized. Chemotherapy is the principal treatment of locally advanced pancreatic cancer. When the tumour triggers biliary obstruction, chemotherapy-associated morbidity increases, and biliary drainage becomes crucial. Gold-standard is endoscopic retrograde cholangiography, which could be impossible when duodenum or papilla are involved by the tumour. Other options are percutaneous radiologic drainage, surgical double by-pass or EUS-guided drainage. When EUS-guided procedures are available, they are proposed today as the best options. [less ▲]

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See detailIntravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study
Forster, C.; VANHAUDENHUYSE, Audrey ULiege; GAST, Pierrette ULiege et al

in British Journal of Anaesthesia (2018), 121(5), 1059-1064

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery ... [more ▼]

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg−1 then 4 mg kg−1 h−1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists’ working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists’ comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group. Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. Clinical trial registration: NCT 02784860. © 2018 British Journal of Anaesthesia [less ▲]

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See detailEndomicroscopie confocale dans la prise en charge des maladies inflammatoires chroniques de l'intestin.
LOLY, Jean-Philippe ULiege; SOMJA, Joan ULiege; REENAERS, Catherine ULiege et al

in Revue Médicale Suisse (2017), 13(571), 1431-1434

Inflammatory bowel diseases are chronic diseases whose long-term evolution depends on the depth of remission. Their clinical and endoscopic evaluation is imperfect. The development of confocal ... [more ▼]

Inflammatory bowel diseases are chronic diseases whose long-term evolution depends on the depth of remission. Their clinical and endoscopic evaluation is imperfect. The development of confocal endomicroscopy allows microscopic images to be obtained in vivo. These microscopic data are correlated with the activity of the disease. They predict a possible relapse of the disease and also predict the response to treatment with a biological agent, which allows to modify the therapy before the relapse or to make a rational choice between the different biological agents before introducing a new treatment. [less ▲]

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See detailCOMMENT JE TRAITE ... Point de vue critique sur l'approche actuelle du cancer du pancreas localisé
VAN DAELE, Daniel ULiege; Martinive, Philippe ULiege; LOLY, Catherine ULiege et al

in Revue Médicale de Liège (2015), 70(11), 540-5

Surgical resection followed by chemotherapy is the actual standard of care for localized, deemed resectable, pancreatic ductal adenocarcinoma. Despite a better selection of surgical candidates and the ... [more ▼]

Surgical resection followed by chemotherapy is the actual standard of care for localized, deemed resectable, pancreatic ductal adenocarcinoma. Despite a better selection of surgical candidates and the actual performance of expert teams, the proportion of patients with a prolonged survival has not been ameliorated during the last three decades. The morphological determinants of resectability are the subject of limitations. In the future, only a better understanding of the biological process, an earlier diagnosis of purely localized disease and more efficient systemic therapies may lead to a better prognosis. Meanwhile, taking into account the prognostic factors associated with a lower chance of cure is currently a matter of debate. The optimal therapeutic sequence, being a surgery-first or a neoadjuvant approach is controversial. The theoretical advantages of preoperative chemotherapy eventually associated with chemo-radiation are demonstrated in other tumours and applicable to pancreatic cancer without any excess of operative mortality, early progression rates and, on the contrary with positive survival data. The completion rates of multi-modal therapy are in favour of the preoperative approach, which also gives the opportunity to select the best candidates for surgical resection. [less ▲]

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See detailPrise en charge de l'angiocholite
GAST, Pierrette ULiege

in Revue Médicale de Liège (2014), 69(4), 226-228

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See detailApproche diagnostique d’une angiocholite
GAST, Pierrette ULiege

in Revue Médicale de Liège (2014), 69(3), 162-166

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See detailBelgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment.
Delhaye, Myriam; Van Steenbergen, Werner; Cesmeli, Ercan et al

in Acta Gastro-Enterologica Belgica (2014), 77(1), 47-65

Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue ... [more ▼]

Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue. Clinicians should attempt to classify patients into one of the six etiologic groups according to the TIGARO classification system. MRI/MRCP, if possible with secretin enhancement, is considered the imaging modality of choice for the diagnosis of early-stage disease.In CP, pain is the most disabling symptom, with a significant impact on quality of life. Pain should be assessed using the Izbicki score and preferably treated using the "pain ladder" approach. In painful CP, endoscopic therapy (ET) can be considered as early as possible. This procedure can be combined with extracorporeal shock-wave lithotripsy (ESWL) in the presence of large (> 4 mm), obstructive stone(s) in the pancreatic head, and with ductal stenting in the presence of a single main pancreatic duct (MPD) stricture in the pancreatic head with a markedly dilated MPD. Pancreatic stenting should be pursued for at least 12 months in patients with persistent pain relief. On-demand stent exchange should be the preferred strategy. The simultaneous placement of multiple, side-by-side, pancreatic stents can be recommended in patients with MPD strictures persisting after 12 months of single plastic stenting. We recommend surgery in the following cases: a) technical failure of ET ; b) early (6 to 8 weeks) clinical failure ; c) definitive biliary drainage at a later time point; d) pancreatic ductal drainage when repetitive ET is considered unsuitable for young patients; e) resection of an inflammatory pancreatic head when pancreatic cancer cannot be ruled out; f) duodenal obstruction. Duodenopancreatectomy or oncological distal pancreatectomy should be considered for patients with suspected malignancy. Pediatricians should be aware of and systematically search for CP in the differential diagnosis of chronic abdominal pain. As malnutrition is highly prevalent in CP patients, patients at nutritional risk should be identified in order to allow for dietary counseling and nutritional intervention using oral supplements. Patients should follow a healthy balanced diet taken in small meals and snacks, with normal fat content. Enzyme replacement therapy is beneficial to symptomatic patients, but also in cases of subclinical insufficiency. Regular follow-up should be considered in CP patients, primarily to detect subclinical maldigestion and the development of pancreatogenic diabetes. Screening for pancreatic cancer is not recommended in CP patients, except in those with the hereditary form. [less ▲]

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See detailThe thyrogastric syndrome : an under diagnosed etiology for acquired gastric neuroendocrine tumors. A case report
VALDES SOCIN, Hernan Gonzalo ULiege; LOLY, Jean ULiege; GAST, Pierrette ULiege et al

in Abstract Book - 13th International Workshop on Multiple Endocrine Neoplasia (2012, September)

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See detailCommentary: endoscopic dilatation for stricturing Crohn's disease.
Louis, Edouard ULiege; GAST, Pierrette ULiege; VAN KEMSEKE, Catherine ULiege et al

in Alimentary Pharmacology and Therapeutics (2012), 36(5), 494-6

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See detailL'oesophagite à éosinophiles chez l'adulte : à propos d'un cas
Marting, Audrey ULiege; Leclercq, Philippe ULiege; Gast, Pierrette ULiege et al

in Revue Médicale de Liège (2008), 63

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See detaileosinophilic esophagitis
Leclercq, Philippe ULiege; Marting, Audrey; Gast, Pierrette ULiege

in New England Journal of Medicine (2007), 357(14),

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See detailAlcoholisation of a hepatocarcinoma guided by echoendoscopy
Gast, Pierrette ULiege; Delwaide, Jean ULiege; Gillard, Vincent ULiege et al

in Acta Endoscopica (2006), 36(1), 74

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See detailRecommandations en matiere de traitement du cancer rectal
Gast, Pierrette ULiege; Bours, Vincent ULiege; Detroz, Bernard ULiege et al

in Revue Médicale de Liège (2000), 55(5), 350-5

Curative resection of primary tumor and metastases is the only way to obtain a prolonged survival. Several additional treatments are under evaluation; some are already routinely proposed, in order to ... [more ▼]

Curative resection of primary tumor and metastases is the only way to obtain a prolonged survival. Several additional treatments are under evaluation; some are already routinely proposed, in order to reduce the tumor size and to allow surgery, to reduce the recurrence rate, and to give a better survival in case of unresectable metastases. Even in case of unresectable metastases, resection of the primary tumor should be envisaged, as quality of life with an evolving rectal tumor is very poor. [less ▲]

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See detailClinical biliary complications after adult liver transplantation: a prospective study
Detry, Olivier ULiege; Maweja, Sylvie ULiege; Delwaide, Jean ULiege et al

in Acta Gastro-Enterologica Belgica (2000, March), 63(1), 56

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See detailPharma clinics. Comment je préviens et je traite ... les ulcères de stress
Fraipont, V.; Lambermont, Bernard ULiege; Gast, Pierrette ULiege et al

in Revue Médicale de Liège (1998), 53(8), 444-9

Stress related ulcers are superficial and extensive gastric mucosal lesions. They occur in almost all critically ill patients but lead to gastrointestinal bleedings in only 5 to 10%. Endoscopy permits ... [more ▼]

Stress related ulcers are superficial and extensive gastric mucosal lesions. They occur in almost all critically ill patients but lead to gastrointestinal bleedings in only 5 to 10%. Endoscopy permits definitive diagnostic. Stress related mucosal diseases encount for substantial morbidity and mortality. The preventive therapeutic choice depends on efficacy, side effects as cost and nosocomial pneumonia. Sulcralfate appears to be the best choice because of its lower cost, comparable efficacy (sucralfate versus anti-H2) and its lower risk of inducing nosocomial pneumonia. Patients who greatly benefit from prevention, present respiratory failure with at least 48 hours mechanical ventilation, coagulopathy, sepsis or burns. Global management avoiding hypoxia, hypotension and acidosis, takes an important part in the prevention. [less ▲]

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See detailComment je préviens et je traite : les ulcères de stress
FRAIPONT, V; LAMBERMONT, Bernard ULiege; GAST, Pierrette ULiege et al

in Revue Médicale de Liège (1998), 53

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See detailLes cellules ECL et leurs récepteurs: rôle physiologique et intérêt physiopathologique
Belaiche, Jacques ULiege; Delwaide, Jean ULiege; Louis, Edouard ULiege et al

in Acta Gastro-Enterologica Belgica (1993), 56(3-4, May-Aug), 235-44

The enterochromaffin-like (ECL) cells represent the predominating endocrine cell population in the oxyntic mucosa of the stomach. They are under the influence of gastrin. Recently, a histamine production ... [more ▼]

The enterochromaffin-like (ECL) cells represent the predominating endocrine cell population in the oxyntic mucosa of the stomach. They are under the influence of gastrin. Recently, a histamine production was shown within the secretory granules of ECL cells. ECL cells appear to play a crucial role in the physiology of gastric acid secretion. There are many unknowns concerning the intervention of other trophic factors in addition to gastrin and concerning the receptors located on the cells. ECL cell hyperplasia is a well documented consequence of hypergastrinemia. The latter can result from a gastrinoma or from a reduction of gastric acid secretion related to pernicious anemia or to long-term treatment with antisecretory drugs. [less ▲]

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