{"id":2350,"date":"2020-09-25T22:14:03","date_gmt":"2020-09-25T20:14:03","guid":{"rendered":"https:\/\/angh.net\/abstracts\/debut-dexperience-du-drainage-biliaire-sous-controle-echo-endoscopique-par-mise-en-place-dune-prothese-dapposition-luminale-en-alternative-au-drainage-transcutane-au-centre\/"},"modified":"2020-09-25T22:14:03","modified_gmt":"2020-09-25T20:14:03","slug":"debut-dexperience-du-drainage-biliaire-sous-controle-echo-endoscopique-par-mise-en-place-dune-prothese-dapposition-luminale-en-alternative-au-drainage-transcutane-au-centre","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/debut-dexperience-du-drainage-biliaire-sous-controle-echo-endoscopique-par-mise-en-place-dune-prothese-dapposition-luminale-en-alternative-au-drainage-transcutane-au-centre\/","title":{"rendered":"D\u00e9but d\u2019exp\u00e9rience du drainage biliaire sous contr\u00f4le \u00e9cho-endoscopique par mise en place d\u2019une proth\u00e8se d\u2019apposition luminale en alternative au drainage transcutan\u00e9 au Centre Hospitalier de Valenciennes."},"content":{"rendered":"

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

Julien Lollivier, Rachida Leblanc, Marie Colin, Arnaud Boruchowicz<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02020-07-03 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction : <\/p>\n

Le drainage biliaire par mise en place d\u2019une proth\u00e8se d\u2019apposition luminale sous contr\u00f4le \u00e9choendoscopique est une technique r\u00e9cente.
\nIl est propos\u00e9 actuellement en deuxi\u00e8me intention en cas d\u2019\u00e9chec de drainage biliaire par voie transpapillaire. Il est le plus souvent r\u00e9alis\u00e9 en centre expert. Il constitue une alternative au drainage biliaire transcutan\u00e9 par voie radiologique compte tenu de sa plus faible morbidit\u00e9. Nous pr\u00e9sentons notre retour d\u2019exp\u00e9rience des premiers patients trait\u00e9s dans notre centre. <\/p>\n

Mat\u00e9riels et m\u00e9thodes<\/p>\n

Entre D\u00e9cembre 2019 et Juin 2020 les patients pr\u00e9sentant un ict\u00e8re avec dilatation de la voie biliaire principale sup\u00e9rieure \u00e0 15 mm, secondaire \u00e0 une tumeur biliaire ou pancr\u00e9atique et apr\u00e8s \u00e9chec du cath\u00e9t\u00e9risme biliaire par voie transpapillaire ont b\u00e9n\u00e9fici\u00e9 de cette technique. Les patients \u00e9taient en situation palliative sans projet de traitement chirurgical.
\nLe drainage biliaire guid\u00e9 par \u00e9chographie per endoscopique a \u00e9t\u00e9 r\u00e9alis\u00e9 sous anesth\u00e9sie g\u00e9n\u00e9rale \u00e0 l\u2019aide d\u2019une proth\u00e8se d\u2019apposition luminale (type \u00ab HOT AXIOS \u00bb). En cas de choledoco-bulbostomie une proth\u00e8se de 6 mm de diam\u00e8tre et de longueur de 8 mm \u00e9tait utilis\u00e9e. En cas de drainage par cholecysto-gastrostomie une proth\u00e8se de 8 mm de diam\u00e8tre et de 8 mm de longueur \u00e9tait utilis\u00e9e.
\nLes op\u00e9rateurs, form\u00e9s \u00e0 l\u2019endoscopie interventionnelle biliaire et pancr\u00e9atique, avaient b\u00e9n\u00e9fici\u00e9 d\u2019une formation pr\u00e9alable \u00e0 la mise en place de ce type de proth\u00e8se.<\/p>\n

R\u00e9sultats <\/p>\n

Nous avons r\u00e9alis\u00e9 trois drainages biliaires par la mise en place d\u2019une proth\u00e8se d\u2019apposition luminale guid\u00e9 par \u00e9chographie per endoscopique. Les \u00e9checs du cath\u00e9t\u00e9risme de la papille \u00e9taient : la pr\u00e9sence d\u2019une st\u00e9nose duod\u00e9nale pour deux patients n\u00e9cessitant la pose d\u2019une proth\u00e8se duod\u00e9nale et un envahissement tumoral de la papille ne permettant pas son acc\u00e8s.
\nDeux chol\u00e9doco-bulbostomies et une cholecysto-gastrostomie ont \u00e9t\u00e9 r\u00e9alis\u00e9. <\/p>\n

L\u2019\u00e2ge moyen des patients \u00e9tait de 72 ans. Les trois patients pr\u00e9sentaient un ict\u00e8re avec un taux de bilirubine totale moyen de 179 mg\/L et une dilatation du chol\u00e9doque sup\u00e9rieure \u00e0 15 mm (moyenne de 23 mm).
\nUn patient pr\u00e9sentait une cirrhose CHILD A6 avec ascite secondaire \u00e0 une carcinose p\u00e9riton\u00e9ale mais sans \u00e9panchement liquidien au site de la mise en place de la proth\u00e8se. Deux patients \u00e9taient sous anticoagulation \u00e0 vis\u00e9e curative pour fibrillation atriale et ne pr\u00e9sentaient pas de maladie m\u00e9tastatique au moment de l\u2019intervention endoscopique.<\/p>\n

Dans les trois cas il existait un succ\u00e8s technique, clinique avec disparition du prurit, de la douleur, diminution de l\u2019intensit\u00e9 de l\u2019ict\u00e8re et biologique avec un taux de bilirubine total moyen dans les 10 jours post op\u00e9ratoire \u00e0 94 mg\/l.
\nUne complication post op\u00e9ratoire \u00e0 type de pneumopathie d\u2019inhalation \u00e9tait observ\u00e9e chez un patient trait\u00e9e par antibiotiques. La dur\u00e9e moyenne d\u2019hospitalisation \u00e9tait de 11 jours.<\/p>\n

Deux patients sont d\u00e9c\u00e9d\u00e9s, respectivement deux et quatre mois et demi apr\u00e8s le drainage. Le troisi\u00e8me patient est \u00e0 domicile deux mois et demi apr\u00e8s le drainage. <\/p>\n

Conclusion : <\/p>\n

Le drainage biliaire par la mise en place d\u2019une proth\u00e8se d\u2019apposition luminale guid\u00e9 par \u00e9cho endoscopie a \u00e9t\u00e9 efficace et r\u00e9alis\u00e9 sans complication chez 3 patients en situation palliative dans notre exp\u00e9rience. Cette technique a permis un retour \u00e0 domicile et d\u2019\u00e9viter un drainage transcutan\u00e9.<\/p>\n","protected":false},"excerpt":{"rendered":"

2020 Julien Lollivier, Rachida Leblanc, Marie Colin, Arnaud Boruchowicz Endoscopie – \u00a02020-07-03 –\u00a0CO – ________________________________ Introduction : Le drainage biliaire par mise en place d\u2019une proth\u00e8se d\u2019apposition luminale sous contr\u00f4le \u00e9choendoscopique est une technique r\u00e9cente. Il est propos\u00e9 actuellement en deuxi\u00e8me intention en cas d\u2019\u00e9chec de drainage biliaire par voie transpapillaire. Il est le plus […]<\/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-2350","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-31"],"yoast_head":"\nD\u00e9but d\u2019exp\u00e9rience du drainage biliaire sous contr\u00f4le \u00e9cho-endoscopique par mise en place d\u2019une proth\u00e8se d\u2019apposition luminale en alternative au drainage transcutan\u00e9 au Centre Hospitalier de Valenciennes. - 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\/debut-dexperience-du-drainage-biliaire-sous-controle-echo-endoscopique-par-mise-en-place-dune-prothese-dapposition-luminale-en-alternative-au-drainage-transcutane-au-centre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"D\u00e9but d\u2019exp\u00e9rience du drainage biliaire sous contr\u00f4le \u00e9cho-endoscopique par mise en place d\u2019une proth\u00e8se d\u2019apposition luminale en alternative au drainage transcutan\u00e9 au Centre Hospitalier de Valenciennes. - 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