{"id":2098,"date":"2018-10-20T18:40:28","date_gmt":"2018-10-20T16:40:28","guid":{"rendered":"https:\/\/angh.net\/abstracts\/traitement-des-polypes-colorectaux-benins-de-20-mm-et-plus-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique\/"},"modified":"2018-11-29T11:18:34","modified_gmt":"2018-11-29T10:18:34","slug":"traitement-des-polypes-colorectaux-benins-de-20-mm-et-plus-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/traitement-des-polypes-colorectaux-benins-de-20-mm-et-plus-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique\/","title":{"rendered":"Traitement des polypes colorectaux b\u00e9nins de 20 mm et plus du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique"},"content":{"rendered":"

2018<\/strong><\/p>\n

Bernard Denis, Isabelle Gendre, Philippe Perrin,
\nADECA Alsace<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02018-05-09 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

INTRODUCTION
\nLa r\u00e9section endoscopique (RE) des gros polypes (GP) colorectaux (>= 20 mm) devient la r\u00e8gle. Suite au dernier congr\u00e8s de l\u2019ESGE, les rapporteurs de la SFED consid\u00e9raient qu\u2019il \u00ab n’y a plus de place \u00e0 la chirurgie des l\u00e9sions b\u00e9nignes colo-rectales vu le nombre d’outils \u00e0 notre disposition \u00bb. Pourtant, le recours \u00e0 une r\u00e9section chirurgicale (RC) n\u2019est pas si rare en population, variant de 0 \u00e0 47% selon l\u2019endoscopiste. But : \u00e9valuer le parcours de soins des patients porteurs de GP b\u00e9nins en population.
\nPATIENTS ET METHODE
\nEtude r\u00e9trospective de la prise en charge de tous les GP colorectaux b\u00e9nins diagnostiqu\u00e9s par la 1\u00e8re campagne de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique dans une r\u00e9gion.
\nRESULTATS
\n8160 coloscopies \u00e9taient r\u00e9alis\u00e9es par 115 endoscopistes. Parmi elles, 4935 coloscopies r\u00e9alis\u00e9es par 88 endoscopistes permettaient le diagnostic de 12.601 polypes dont 676 GP (5,4%) chez 633 patients (460 GP chez 426 hommes). Un GP \u00e9tait pr\u00e9sent chez 8% des patients. 55% des GP \u00e9taient p\u00e9dicul\u00e9s, 34% sessiles et 8% plans. 13% \u00e9taient situ\u00e9s dans le rectum, 53% dans le colon distal et 34% dans le colon proximal. Il s\u2019agissait d\u2019ad\u00e9nomes tubulo-villeux (68%), tubuleux (23%), villeux (7%) et de polypes\/ad\u00e9nomes festonn\u00e9s sessiles (2%). 24% \u00e9taient en dysplasie de haut grade et 10% le si\u00e8ge d\u2019un carcinome in situ. 540 polypes (80%) de 26 mm de taille moyenne (20 – 70 mm) b\u00e9n\u00e9ficiaient d\u2019une RE chez 508 patients. La proportion de GP trait\u00e9s par RE variait selon l\u2019op\u00e9rateur, la forme, la taille et la localisation du polype : polypes p\u00e9dicul\u00e9s (94,9%), l\u00e9sions sessiles et planes (63,9%), rectum (85,9%), colon distal (91,6%), colon proximal (59,5%), endoscopiste expert (86,4%), non expert (68,6%) (p<0,01). La RE \u00e9tait assur\u00e9e lors de la coloscopie initiale dans 415 cas (65,5%), lors d\u2019une 2\u00e8me coloscopie par le m\u00eame op\u00e9rateur dans 48 cas (7,2%) ou par un des 6 op\u00e9rateurs experts dans 45 cas (7,1%). Le taux global de RE \u00e9tait de 80% et variait de 0 \u00e0 100% selon l\u2019endoscopiste. 6 (7%) endoscopistes recevaient des patients adress\u00e9s par des coll\u00e8gues et \u00e9taient consid\u00e9r\u00e9s comme experts. Leurs taux de succ\u00e8s de RE \u00e9taient de 85\/91 soit 93% [RE par dissection sous muqueuse dans 10 cas (20 \u2013 60 mm), 9 par un seul op\u00e9rateur]. 32 (36%) endoscopistes avaient un taux de RE de 90 \u00e0 100%, 11 (12%) un taux entre 80 et 100%, et 40 (45%) un taux = 30 mm \u00e9tait de 64% et variait de 0 \u00e0 100% selon l\u2019endoscopiste. 136 polypes (20%) de 34 mm de taille moyenne (20 – 90 mm) b\u00e9n\u00e9ficiaient d\u2019une RC chez 125 patients (20%). Le recours \u00e0 la RC \u00e9tait direct apr\u00e8s la 1\u00e8re coloscopie dans 115 cas (18%), apr\u00e8s \u00e9chec d\u2019une 2\u00e8me tentative dans 10 cas (2%) et jamais apr\u00e8s recours \u00e0 un 2\u00e8me endoscopiste expert. Plus de la moiti\u00e9 des RC ont \u00e9t\u00e9 consid\u00e9r\u00e9es comme abusives : 17 (3%) patients porteurs de GP p\u00e9dicul\u00e9s (20 \u2013 45 mm) (cf recommandations American Society for Gastrointestinal Endoscopy 2015) et 66 (10,4%) porteurs de polypes plans ou sessiles de 20 \u00e0 39 mm. Les taux de complications \u00e9taient de 4,6% pour la RE (dont 6 perforations, 5 trait\u00e9es endoscopiquement et 1 op\u00e9r\u00e9e, 6 h\u00e9morragies diff\u00e9r\u00e9es trait\u00e9es par endoscopie, et 1 arr\u00eat cardiaque d\u2019\u00e9volution favorable) et de 14,4% pour les RC (p=0,001).
\nCONCLUSIONS
\n8% des coloscopies du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique r\u00e9v\u00e8lent un gros polype de 20 mm et plus. Dans la vraie vie, un patient sur 5 porteurs de gros polype(s) est op\u00e9r\u00e9. Le taux de recours \u00e0 la chirurgie varie de 0 \u00e0 100% selon l\u2019endoscopiste. Plus de la moiti\u00e9 des r\u00e9sections chirurgicales sont abusives, sources d\u2019une morbi-mortalit\u00e9 excessive. Les trois quarts des endoscopistes non experts ne recourent jamais \u00e0 un endoscopiste expert, ce qui constitue une perte de chance pour leurs patients. La dissection sous muqueuse reste confidentielle.<\/p>\n[download id=\u00a0\u00bb2231″]\n","protected":false},"excerpt":{"rendered":"

2018 Bernard Denis, Isabelle Gendre, Philippe Perrin, ADECA Alsace Endoscopie – \u00a02018-05-09 –\u00a0CO – ________________________________ INTRODUCTION La r\u00e9section endoscopique (RE) des gros polypes (GP) colorectaux (>= 20 mm) devient la r\u00e8gle. Suite au dernier congr\u00e8s de l\u2019ESGE, les rapporteurs de la SFED consid\u00e9raient qu\u2019il \u00ab n’y a plus de place \u00e0 la chirurgie des l\u00e9sions […]<\/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":[29],"class_list":["post-2098","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-29"],"yoast_head":"\nTraitement des polypes colorectaux b\u00e9nins de 20 mm et plus du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique - 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\/traitement-des-polypes-colorectaux-benins-de-20-mm-et-plus-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Traitement des polypes colorectaux b\u00e9nins de 20 mm et plus du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique - 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