{"id":2282,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/complications-des-coloscopies-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique-une-etude-de-cohorte-en-population\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"complications-des-coloscopies-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique-une-etude-de-cohorte-en-population","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/complications-des-coloscopies-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique-une-etude-de-cohorte-en-population\/","title":{"rendered":"Complications des coloscopies du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique : une \u00e9tude de cohorte en population."},"content":{"rendered":"

2019<\/strong><\/p>\n

B Denis, I Gendre, S Weber, P Perrin, pour les gastroent\u00e9rologues de la r\u00e9gion Alsace<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02019-05-16 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

La balance b\u00e9n\u00e9fice \/ risque du programme de d\u00e9pistage organis\u00e9 (DO) du cancer colorectal (CCR) par test immunologique (FIT) est inconnue. La fiche d\u2019information \u00e9labor\u00e9e par l\u2019INCa accompagnant la lettre d\u2019invitation au d\u00e9pistage stipule \u00ab la coloscopie peut entrainer des complications dont les formes graves restent rares (3 cas pour 1000) \u00bb. Pourtant, les complications du programme fran\u00e7ais de DO CCR par FIT n\u2019ont jamais \u00e9t\u00e9 \u00e9valu\u00e9es.
\nButs : Evaluer les \u00e9v\u00e9nements ind\u00e9sirables (EI) des coloscopies du DO CCR par FIT.
\nM\u00e9thodes : Recensement dans une r\u00e9gion fran\u00e7aise des EI des coloscopies effectu\u00e9es par 114 gastro-ent\u00e9rologues pour ga\u00efac (G) positif entre 2003 et 2014 et pour FIT positif entre 2015 et 2018 par notification par les gastro-ent\u00e9rologues et enqu\u00eates postales r\u00e9trospectives aupr\u00e8s des patients.
\nR\u00e9sultats : Les principaux r\u00e9sultats sont dans le tableau. Un d\u00e9c\u00e8s \u00e9tait observ\u00e9 au cours de toute la p\u00e9riode, G puis FIT, soit un taux de 3,6\/100.000 coloscopies. Avec le FIT, un total de 180 (18,8\u2030) EI \u00e9taient recens\u00e9s chez 178 patients. Il n\u2019y avait pas de diff\u00e9rence entre femmes et hommes, par contre le taux d\u2019EI augmentait significativement avec l\u2019\u00e2ge, de 13,4\u2030 chez les 50-59 ans \u00e0 23,5\u2030 chez les 70-75 ans (p=0,02). 114 (11,9\u2030) EI n\u00e9cessitaient une hospitalisation, dont la moiti\u00e9 (56 soit 5,8\u2030) une hospitalisation > 24h. Parmi 114 EI avec hospitalisation (3,3\u2030 pour les coloscopies diagnostiques vs 16,6\u2030 pour les th\u00e9rapeutiques (p<0.001)), \u00e9taient collig\u00e9s 18 (1,9\u2030) perforations, 31 (3,2\u2030) h\u00e9morragies, 4 (0,4\u2030) syndromes post polypectomie, 2 (0,2\u2030) ruptures de rate et 10 (1,0\u2030) complications non digestives. Parmi ces hospitalisations, 46 (4,8\u2030) relevaient d\u2019une simple hospitalisation pour surveillance sans v\u00e9ritable complication \u00e0 proprement parler. 55 (5,7\u2030) EI \u00e9taient source d\u2019hospitalisation > 24h, 3,0\u2030 pour les coloscopies diagnostiques vs 7,3\u2030 pour les th\u00e9rapeutiques (p<0.01). 8 (0,8\u2030) EI n\u00e9cessitaient une sanction chirurgicale, 1,2\u2030 pour les coloscopies diagnostiques vs 0,6\u2030 pour les th\u00e9rapeutiques (p=0,4). \nLe taux global de perforations a augment\u00e9, non significativement, de1,1\u2030 avec le G \u00e0 1,9\u2030 avec le FIT (p=0,1), alors que leur gravit\u00e9 (70% de perforations chirurgicales vs 39%, respectivement (p=0,05)) et leur dur\u00e9e moyenne de s\u00e9jour (DMS) ont significativement diminu\u00e9 (de 10 \u00e0 6 jours). 11 (61%) perforations \u00e9taient de diagnostic imm\u00e9diat, dont 8 g\u00e9r\u00e9es imm\u00e9diatement par l\u2019endoscopiste (DMS = 2,2 jours). 7 perforations chirurgicales (DMS = 12 jours) conduisaient \u00e0 4 colectomies, 1 stomie transitoire, et une r\u00e9intervention pour \u00e9visc\u00e9ration. 13 (72%) perforations \u00e9taient dues \u00e0 une polypectomie, 7 d\u2019entre elles caus\u00e9es par un \u00ab expert \u00bb auquel le patient \u00e9tait r\u00e9f\u00e9r\u00e9. \nLe taux global d\u2019h\u00e9morragies n\u2019a pas chang\u00e9 (3,9\u2030 avec le G vs 4,5\u2030 avec le FIT (p=0,4)) malgr\u00e9 l\u2019utilisation accrue de traitements prophylactiques (23 fois sur 43 h\u00e9morragies (53,5%) (clip 22, \u00e9lectrocoagulation 4). Elles n\u00e9cessitaient une hospitalisation dans 31 cas (72% des cas soit 3,2\u2030)(DMS 3,5 jours), une transfusion dans 9 cas (21%), une nouvelle endoscopie dans 30 cas (70%), un traitement endoscopique dans 23 cas (53%), et aucun traitement chirurgical (vs 3 sur 51 (5,8%) en p\u00e9riode G).\nLes gastro-ent\u00e9rologues signalaient 78% des EI avec hospitalisation, 85% des perforations, 78% des h\u00e9morragies et 33% des EI non digestifs. Il survenait 1 EI avec hospitalisation pour 21 ad\u00e9nomes avanc\u00e9s d\u00e9tect\u00e9s par le G et 28 par le FIT.\nConclusions : Le taux d\u2019EI des coloscopies du DO CCR par FIT est plus \u00e9lev\u00e9 que ce qui est rapport\u00e9 habituellement : pour 1000 coloscopies, 12 complications avec hospitalisation, dont 6 avec hospitalisation > 24h, dont 2 perforations et 3 h\u00e9morragies, dont 1 complication n\u00e9cessitant une sanction chirurgicale, 44 incidents ou complications sans hospitalisation et 1 d\u00e9c\u00e8s pour 27.000 coloscopies. La population invit\u00e9e doit en \u00eatre inform\u00e9e loyalement. Les gastro-ent\u00e9rologues ont fait des progr\u00e8s significatifs en termes de s\u00e9curit\u00e9 des coloscopies : taux de complications digestives stable malgr\u00e9 l\u2019augmentation significative des coloscopies th\u00e9rapeutiques et des facteurs de risque de complications ; augmentation significative de la gestion endoscopique des complications.<\/p>\n","protected":false},"excerpt":{"rendered":"

2019 B Denis, I Gendre, S Weber, P Perrin, pour les gastroent\u00e9rologues de la r\u00e9gion Alsace Endoscopie – \u00a02019-05-16 –\u00a0CO – ________________________________ La balance b\u00e9n\u00e9fice \/ risque du programme de d\u00e9pistage organis\u00e9 (DO) du cancer colorectal (CCR) par test immunologique (FIT) est inconnue. La fiche d\u2019information \u00e9labor\u00e9e par l\u2019INCa accompagnant la lettre d\u2019invitation au d\u00e9pistage […]<\/p>\n","protected":false},"author":1,"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":[30],"class_list":["post-2282","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-30"],"yoast_head":"\nComplications des coloscopies du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique : une \u00e9tude de cohorte en population. - 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\/complications-des-coloscopies-du-programme-de-depistage-organise-du-cancer-colorectal-par-test-immunologique-une-etude-de-cohorte-en-population\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Complications des coloscopies du programme de d\u00e9pistage organis\u00e9 du cancer colorectal par test immunologique : une \u00e9tude de cohorte en population. - 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