{"id":1939,"date":"2011-10-01T01:00:00","date_gmt":"2011-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/lendoscopie-dastreinte-au-centre-hospitalier-general-du-mans\/"},"modified":"2018-10-20T18:40:01","modified_gmt":"2018-10-20T16:40:01","slug":"lendoscopie-dastreinte-au-centre-hospitalier-general-du-mans","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/lendoscopie-dastreinte-au-centre-hospitalier-general-du-mans\/","title":{"rendered":"L\u2019endoscopie d\u2019astreinte au Centre Hospitalier G\u00e9n\u00e9ral du Mans"},"content":{"rendered":"<p><strong>2011<\/strong><\/p>\n<p><em>Bertrand Tissot, Alain Blanchi, Bruno Bour, Christophe Pilette, Arnaud Maurin<\/em><\/p>\n<p><strong>Endoscopie <\/strong>&#8211; \u00a02011-07-24 &#8211;\u00a0PW &#8211;<\/p>\n<p>________________________________<\/p>\n<p>L\u2019endoscopie d\u2019astreinte (EA) se fait par d\u00e9finition en dehors des conditions habituelles de comp\u00e9tence et de s\u00e9curit\u00e9. Nous rapportons notre exp\u00e9rience dans un CHG sans service d\u2019acceuil propre aux h\u00e9morragies digestives, avec un service d\u2019endoscopie qui fonctionne tous les jours de 9H \u00e0 17H et le Samedi matin, et avec une astreinte de s\u00e9curit\u00e9 d\u2019un PH senior sans assistance sp\u00e9cialis\u00e9e.<\/p>\n<p>Sur 2 ans, entre juin 2009 et mai 2011, 134 EA ont \u00e9t\u00e9 r\u00e9alis\u00e9es chez 119 patients d\u2019age moyen 65 ans +\/-19 ans (1-95) avec 64% d\u2019hommes. En moyenne 4,8 +\/- 1,5 EA \u00e9taient faites par mois (3-8). 75% des EA \u00e9taient faites les Week End ou jour f\u00e9ri\u00e9, 25% en semaine. 66% des endoscopies faites les Week End et Jour f\u00e9ri\u00e9s \u00e9taient faites entre 09:00 et 18:00. L\u2019EA \u00e9tait dans 84% une fibroscopie et dans 16% une coloscopie. Seules 27% des EA \u00e9taient faites avec une anesth\u00e9sie : en USC, en r\u00e9animation ou au bloc op\u00e9ratoire. 77% des examens \u00e9tait r\u00e9alis\u00e9s dans de bonnes conditions de s\u00e9curit\u00e9 (avec une IDE et une AS, une surveillance h\u00e9modynamique et oxym\u00e9trique) et 23% dans des services de M\u00e9decine ou Chirurgie avec le personnel du service. <\/p>\n<p>Un geste th\u00e9rapeutique \u00e9tait fait pour 53 EA (40%) et consistait en une h\u00e9mostase dans 33 cas (25%), une extraction de corps \u00e9trangers dans 12 cas et une exsufflation colique dans 8 cas. Les 33 gestes d\u2019h\u00e9mostase \u00e9tait r\u00e9alis\u00e9s pour 32 au cours d\u2019une fibroscopie, pour 1 au cours d\u2019une coloscopie. Techniquement, l\u2019h\u00e9mostase en fibroscopie \u00e9tait faite par injection seule 27 fois (81%), ligature seule 4 fois, les 2 associ\u00e9es 1 fois, injection puis clip 1 fois, aucune \u00e9lectrocoagulation. Une anesth\u00e9sie \u00e9tait faite pour 6 (18,2%) des h\u00e9mostases,  4 (33%) extractions de corps \u00e9trangers et 2 (25%) des exsufflations coliques. Aucune proth\u00e8se n\u2019\u00e9tait pos\u00e9e pendant les astreintes.<\/p>\n<p>Parmi les 33 patients ayant une h\u00e9mostase per fibroscopie, 27,3% avaient une h\u00e9morragie nosocomiale, 67% un score de Rockall \u00b3 7, 61% n\u00e9cessitaient la transfusion de 4 culots globulaires ou plus, 68% avaient au moins une autre endoscopie (en moyenne 2,35+\/-1,4). 3 \u00e9taient op\u00e9r\u00e9s, dont 1 patient \u00e0 deux reprises, 3 b\u00e9n\u00e9ficiaient de la pose d\u2019un TIPS. 6 d\u00e9c\u00e9daient au cours de l\u2019hospitalisation (mortalit\u00e9 21,2% IC95% 0,09-0,39).<\/p>\n<p>L\u2019EA est marginale (2,25% des fibroscopies) mais associ\u00e9e \u00e0 un geste th\u00e9rapeutique pour 40% des examens et \u00e0 une mortalit\u00e9 de 21% lorsqu\u2019un recours \u00e0 l\u2019h\u00e9mostase est n\u00e9cessaire en fibroscopie. L\u2019am\u00e9lioration des conditions techniques (clip, \u00e9lectrocoagulation association des techniques) passe par la cr\u00e9ation d\u2019une astreinte d\u2019aide \u00e0 l\u2019endoscopie qui permettra en outre la pose de proth\u00e8se colique.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2011 Bertrand Tissot, Alain Blanchi, Bruno Bour, Christophe Pilette, Arnaud Maurin Endoscopie &#8211; \u00a02011-07-24 &#8211;\u00a0PW &#8211; ________________________________ L\u2019endoscopie d\u2019astreinte (EA) se fait par d\u00e9finition en dehors des conditions habituelles de comp\u00e9tence et de s\u00e9curit\u00e9. Nous rapportons notre exp\u00e9rience dans un CHG sans service d\u2019acceuil propre aux h\u00e9morragies digestives, avec un service d\u2019endoscopie qui fonctionne tous [&hellip;]<\/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":[22],"class_list":["post-1939","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-22"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>L\u2019endoscopie d\u2019astreinte au Centre Hospitalier G\u00e9n\u00e9ral du Mans - Abstracts des congr\u00e8s de l&#039;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\/lendoscopie-dastreinte-au-centre-hospitalier-general-du-mans\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"L\u2019endoscopie d\u2019astreinte au Centre Hospitalier G\u00e9n\u00e9ral du Mans - 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