{"id":1797,"date":"2005-10-01T01:00:00","date_gmt":"2005-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-des-soins-en-endoscopie-audit-de-400-cpre\/"},"modified":"2018-10-20T18:39:37","modified_gmt":"2018-10-20T16:39:37","slug":"evaluation-de-la-qualite-des-soins-en-endoscopie-audit-de-400-cpre","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-des-soins-en-endoscopie-audit-de-400-cpre\/","title":{"rendered":"Evaluation de la qualit\u00e9 des soins en endoscopie : audit de 400 CPRE"},"content":{"rendered":"

2005<\/strong><\/p>\n

Bernard Denis, Andr\u00e9 Peter
\nService de M\u00e9decine A – H\u00f4pitaux civils de COLMAR (Haut-Rhin)<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02005-06-23 –\u00a0COS –<\/p>\n

________________________________<\/p>\n

La cholangiopancr\u00e9atographie r\u00e9trograde endoscopique (CPRE) a les caract\u00e9ristiques requises pour relever d\u2019un programme d\u2019am\u00e9lioration de la qualit\u00e9 : c\u2019est un examen complexe, \u00e0 risque et co\u00fbteux qui mobilise des ressources importantes. L\u2019American Society for Gastrointestinal Endoscopy recommande l\u2019adoption d\u2019une d\u00e9marche d\u2019am\u00e9lioration de la qualit\u00e9 avec enregistrement syst\u00e9matique d\u2019un certain nombre d\u2019indicateurs. Le but de ce travail \u00e9tait d\u2019\u00e9valuer la qualit\u00e9 des CPRE r\u00e9alis\u00e9es dans notre unit\u00e9 d\u2019endoscopie dans le but de l\u2019am\u00e9liorer.
\nPatients et m\u00e9thodes : Audit prospectif de 400 CPRE cons\u00e9cutives r\u00e9alis\u00e9es par deux op\u00e9rateurs entre le 1\/7\/2002 et le 15\/3\/2005. 45 crit\u00e8res de processus et de r\u00e9sultats \u00e9taient collig\u00e9s pour chaque examen. Les complications \u00e9taient recens\u00e9es sur un registre morbi-mortalit\u00e9.
\nR\u00e9sultats : les CPRE concernaient 239 femmes et 161 hommes d\u2019\u00e2ge moyen de 69 ans (extr\u00eames 21-99 ans). 27,5 % d\u2019entre eux provenaient d\u2019un autre \u00e9tablissement. 28,3 % avaient un score ASA 3. Les 2 op\u00e9rateurs se partagaient respectivement 55,5 % et 40,5 % des examens et 4 % \u00e9taient r\u00e9alis\u00e9s \u00e0 4 mains.
\n143 CPRE (35,8 %) \u00e9taient pr\u00e9c\u00e9d\u00e9es d\u2019une \u00e9choendoscopie (EE) r\u00e9alis\u00e9e dans 133 cas (93 %) au cours de la m\u00eame anesth\u00e9sie (65 fois pour pathologie lithiasique, 48 fois pour pathologie tumorale). Au cours de la m\u00eame p\u00e9riode, 454 EE bilio-pancr\u00e9atiques \u00e9taient r\u00e9alis\u00e9es dont 217 (47,8 %) en salle de radiologie pour permettre la r\u00e9alisation, si n\u00e9cessaire, d\u2019une CPRE imm\u00e9diatement apr\u00e8s l\u2019EE au cours de la m\u00eame anesth\u00e9sie g\u00e9n\u00e9rale. Les r\u00e9sultats de ces EE pr\u00e9alables permettaient d\u2019\u00e9viter la r\u00e9alisation d\u2019une CPRE dans 84 cas (38,7 %).
\nL\u2019indication de la CPRE \u00e9tait diagnostique dans 36 cas (9 %), th\u00e9rapeutique dans 182 cas (45,5 %) et mixte dans 182 cas (45,5 %). Les principales indications \u00e9taient : lithiase biliaire (n = 263 soit 65,8 %), pathologie tumorale (n = 108 soit 27 %) , pathologie inflammatoire (n = 25) et complications post-op\u00e9ratoires (n = 5). Il s\u2019agissait d\u2019un premier examen sur papille \u00ab vierge \u00bb dans 82,8 % des cas et d\u2019une deuxi\u00e8me tentative apr\u00e8s \u00e9chec pr\u00e9alable dans 3 % des cas (la moiti\u00e9 avec op\u00e9rateur diff\u00e9rent). Dans 57 cas (14,3 %), la papille \u00e9tait le si\u00e8ge d\u2019une sphinct\u00e9rotomie pr\u00e9alable. La papille \u00e9tait en situation anatomique normale dans 335 cas (83,8 %), juxta-diverticulaire dans 54 cas (13,5 %) et intra-diverticulaire dans 15 cas (3,8 %). Deux CPRE ont \u00e9t\u00e9 r\u00e9alis\u00e9es dans un contexte de gastrectomie avec anastomose selon Polya et 7 avec un drain transcystique en place. En intention de traiter, les taux de succ\u00e8s \u00e9taient respectivement de 91,5 % pour la cholangiographie, 95,7 % pour la Wirsungographie, 89,1 % pour la sphinct\u00e9rotomie, 88,6 % pour l\u2019extraction de calculs et 76,1 % pour la pose de proth\u00e8se biliaire. Une infundibulotomie \u00e9tait n\u00e9cessaire dans 31 cas (7,8 %). Elle permettait d\u2019acc\u00e9der aux voies biliaires dans 87,1 % des cas (71 % au cours de la m\u00eame s\u00e9ance et 16,1 % lors d\u2019une deuxi\u00e8me tentative ult\u00e9rieure). Le taux de succ\u00e8s de la cholangiographie variait significativement selon les conditions anatomiques et l\u2019indication : anatomie normale (93 %), papille juxta-diverticulaire (94,3 %), papille intra-diverticulaire (53,3 %), gastrectomie selon Polya (50 %) ; drain d\u2019Escat en place (100 %) ; pathologie lithiasique (94,7 %) et pathologie tumorale (86,8 %) (p < 0,01). En pathologie lithiasique, la vacuit\u00e9 de la voie biliaire principale n\u2019\u00e9tait pas obtenue dans 30 cas (11,4 %) : 14 \u00e9checs de cholangiographie, 3 \u00e9checs de sphinct\u00e9rotomie et 13 \u00e9checs d\u2019extraction des calculs. Une lithotritie m\u00e9canique \u00e9tait n\u00e9cessaire dans 46 cas (17,5 %). En pathologie tumorale, 21 \u00e9checs de drainage des voies biliaires \u00e9taient comptabilis\u00e9s (23,9 %) : 14 \u00e9checs de cholangiographie dont 2 dus \u00e0 une st\u00e9nose digestive emp\u00eachant d\u2019acc\u00e9der \u00e0 la papille, 2 \u00e9checs de sphinct\u00e9rotomie et 5 \u00e9checs de pose de proth\u00e8se. Les taux de succ\u00e8s n\u2019\u00e9taient pas significativement diff\u00e9rents entre les 2 op\u00e9rateurs, sauf pour la cholangiographie dans un contexte tumoral (p < 0,01). Dans 16 cas d\u2019\u00e9chec de cholangiographie, le changement d\u2019op\u00e9rateur d\u00e9bouchait 3 fois sur 4 sur un succ\u00e8s.
\n18 complications (4,5 %) \u00e9taient collig\u00e9es dans notre registre : 3 pancr\u00e9atites aigu\u00ebs dont 1 s\u00e9v\u00e8re, 3 angiocholites, 3 abc\u00e8s h\u00e9patiques, 1 chol\u00e9cystite aigu\u00eb pr\u00e9coce, 1 perforation de sinus piriforme, 1 h\u00e9morragie et 4 complications cardio-respiratoires dont 1 d\u00e9c\u00e8s par arr\u00eat cardio-circulatoire. Il n\u2019y avait pas de diff\u00e9rence selon l\u2019op\u00e9rateur, l\u2019indication et selon qu\u2019il y ait eu ou non infundibulotomie. L\u2019analyse des co\u00fbts des mat\u00e9riels utilis\u00e9s est en cours.
\nConclusion : cet audit nous a permis de nous \u00e9valuer et de modifier certaines de nos pratiques pour am\u00e9liorer la qualit\u00e9 de nos CPRE : travail \u00e0 4 mains, recours \u00e0 une deuxi\u00e8me tentative en cas d\u2019\u00e9chec. Nos r\u00e9sultats, reflets de la vraie vie, sont comparables \u00e0 ceux publi\u00e9s dans la litt\u00e9rature.<\/p>\n","protected":false},"excerpt":{"rendered":"

2005 Bernard Denis, Andr\u00e9 Peter Service de M\u00e9decine A – H\u00f4pitaux civils de COLMAR (Haut-Rhin) Endoscopie – \u00a02005-06-23 –\u00a0COS – ________________________________ La cholangiopancr\u00e9atographie r\u00e9trograde endoscopique (CPRE) a les caract\u00e9ristiques requises pour relever d\u2019un programme d\u2019am\u00e9lioration de la qualit\u00e9 : c\u2019est un examen complexe, \u00e0 risque et co\u00fbteux qui mobilise des ressources importantes. L\u2019American Society for […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[16],"class_list":["post-1797","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-16"],"yoast_head":"\nEvaluation de la qualit\u00e9 des soins en endoscopie : audit de 400 CPRE - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-des-soins-en-endoscopie-audit-de-400-cpre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evaluation de la qualit\u00e9 des soins en endoscopie : audit de 400 CPRE - 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