{"id":2349,"date":"2020-09-25T22:14:03","date_gmt":"2020-09-25T20:14:03","guid":{"rendered":"https:\/\/angh.net\/abstracts\/drainage-endoscopique-des-stenoses-malignes-de-la-voie-biliaire-vintage-ou-new-age\/"},"modified":"2020-09-25T22:14:03","modified_gmt":"2020-09-25T20:14:03","slug":"drainage-endoscopique-des-stenoses-malignes-de-la-voie-biliaire-vintage-ou-new-age","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/drainage-endoscopique-des-stenoses-malignes-de-la-voie-biliaire-vintage-ou-new-age\/","title":{"rendered":"DRAINAGE ENDOSCOPIQUE DES STENOSES MALIGNES DE LA VOIE BILIAIRE : VINTAGE ou NEW AGE ?"},"content":{"rendered":"

2020<\/strong><\/p>\n

Serge BELLON, Andry RAOTO, Tina ANDRIANTSENO, Alban BENEZECH, Coline BOSSHARDT, Slim BRAMLI, Jean-Pierre ARPURT<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02020-06-28 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Le drainage endoscopique des st\u00e9noses malignes de la voie biliaire (SNVB) est actuellement r\u00e9alis\u00e9 de fa\u00e7on pr\u00e9f\u00e9rentielle par endoscopie interventionnelle conventionnelle : l\u2019ERCP. Les techniques chirurgicales puis radiologiques disparaissent au fil des ann\u00e9es. L’\u00e9cho endoscopie interventionnelle (EEI) est aussi utilis\u00e9e dans cette indication depuis le d\u00e9but des ann\u00e9es 2000. Cependant, elle est rest\u00e9e r\u00e9serv\u00e9e aux impossibilit\u00e9s de l’ERCP (anatomie modifi\u00e9e, \u00e9checs techniques). Pourtant le rapport b\u00e9n\u00e9fice\/risque de cette technique m\u00e9rite d’\u00eatre analys\u00e9. Ainsi, dans la litt\u00e9rature r\u00e9cente, les \u00e9tudes ont d\u00e9montr\u00e9 la non inf\u00e9riorit\u00e9 de l’EEI, avec des taux de faisabilit\u00e9 et d’efficacit\u00e9 identiques mais moins de complications que l’ERCP.<\/p>\n

Sur Avignon, nous avons utilis\u00e9 l’EEI dans 27 cas de SNVB soit 16 cas d’h\u00e9paticogastrostomie (HGS) et 11 cas de chol\u00e9doquobulbostomie (CBS).<\/p>\n

Motif :\t17 cas : st\u00e9noses ou proth\u00e8ses duod\u00e9nales
\n\t\t 4 cas : anatomies modifi\u00e9es
\n\t\t 3 cas : \u00e9chec technique ERCP
\n\t\t 3 cas : abords en premi\u00e8re intention<\/p>\n

Faisabilit\u00e9 : 25 cas sur 27<\/p>\n

Efficacit\u00e9 : 100 % des cas avec une baisse de la bilirubine +\/- rapide ( de 1 \u00e0 19 jours)<\/p>\n

Complications : 3 cas tous trait\u00e9s m\u00e9dicalement<\/p>\n

Dur\u00e9e de l’examen : 59 minutes pour HGS et 21 minutes pour CBS<\/p>\n

Le drainage des SNVB par EEI est r\u00e9alis\u00e9 depuis 20 ans en deuxi\u00e8me intention. Du fait de l’accumulation d’exp\u00e9rience des op\u00e9rateurs et des progr\u00e8s du mat\u00e9riel (proth\u00e8ses d\u2019apposition luminale), il conna\u00eet actuellement un essor important avec un rapport b\u00e9n\u00e9fice\/risque qui semble favorable. Plusieurs \u00e9tudes r\u00e9centes ont donc essay\u00e9 de comparer cette technique \u00e0 l\u2019ERCP, en premi\u00e8re intention. Elles confirment l’int\u00e9r\u00eat de l’EEI avec des avantages en termes de gain de temps et de taux de complications (notamment quant \u00e0 la pancr\u00e9atite aigu\u00eb). Il faut cependant noter qu’il existe un surco\u00fbt li\u00e9 au mat\u00e9riel et que les r\u00e9sultats ont \u00e9t\u00e9 obtenu par des centres experts et pas \u00ab dans la vraie vie \u00bb. Nos r\u00e9sultats sur le Centre Hospitalier G\u00e9n\u00e9ral d\u2019Avignon sont donc int\u00e9ressants \u00e0 ce titre et montrent des chiffres globalement superposables \u00e0 ceux de cette litt\u00e9rature. Ils peuvent de ce fait apporter des arguments en faveur de l\u2019EEI en premi\u00e8re intention. <\/p>\n

Une \u00e9tude multicentrique de la SFED est en cours et devrait permettre de r\u00e9pondre d\u00e9finitivement aux places respectives de l’endoscopie conventionnelle (vintage ?) et de l’\u00e9cho endoscopie interventionnelle (new age ?), en premi\u00e8re intention, pour le drainage des SNVB.<\/p>\n","protected":false},"excerpt":{"rendered":"

2020 Serge BELLON, Andry RAOTO, Tina ANDRIANTSENO, Alban BENEZECH, Coline BOSSHARDT, Slim BRAMLI, Jean-Pierre ARPURT Endoscopie – \u00a02020-06-28 –\u00a0CO – ________________________________ Le drainage endoscopique des st\u00e9noses malignes de la voie biliaire (SNVB) est actuellement r\u00e9alis\u00e9 de fa\u00e7on pr\u00e9f\u00e9rentielle par endoscopie interventionnelle conventionnelle : l\u2019ERCP. Les techniques chirurgicales puis radiologiques disparaissent au fil des ann\u00e9es. L’\u00e9cho […]<\/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":[31],"class_list":["post-2349","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-31"],"yoast_head":"\nDRAINAGE ENDOSCOPIQUE DES STENOSES MALIGNES DE LA VOIE BILIAIRE : VINTAGE ou NEW AGE ? - 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\/drainage-endoscopique-des-stenoses-malignes-de-la-voie-biliaire-vintage-ou-new-age\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"DRAINAGE ENDOSCOPIQUE DES STENOSES MALIGNES DE LA VOIE BILIAIRE : VINTAGE ou NEW AGE ? 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