{"id":2372,"date":"2021-10-06T13:54:23","date_gmt":"2021-10-06T11:54:23","guid":{"rendered":"https:\/\/angh.net\/abstracts\/a-propos-de-20-patients-ayant-beneficie-de-la-pose-dendoprothese-auto-expansive-sx-ella-stent-danis-dans-le-cadre-dune-hemorragie-digestive-massive-par-rupture-de-varices-oesophagi\/"},"modified":"2021-10-06T13:54:23","modified_gmt":"2021-10-06T11:54:23","slug":"a-propos-de-20-patients-ayant-beneficie-de-la-pose-dendoprothese-auto-expansive-sx-ella-stent-danis-dans-le-cadre-dune-hemorragie-digestive-massive-par-rupture-de-varices-oesophagi","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/a-propos-de-20-patients-ayant-beneficie-de-la-pose-dendoprothese-auto-expansive-sx-ella-stent-danis-dans-le-cadre-dune-hemorragie-digestive-massive-par-rupture-de-varices-oesophagi\/","title":{"rendered":"A propos de 20 patients ayant b\u00e9n\u00e9fici\u00e9 de la pose d\u2019endoproth\u00e8se auto-expansive (SX-ELLA Stent Danis) dans le cadre d\u2019une h\u00e9morragie digestive massive par rupture de varices \u0153sophagiennes. Etude r\u00e9trospective 2011-2020."},"content":{"rendered":"

2021<\/strong><\/p>\n

A.RAOTO\u00a0; S.BELLON\u00a0; A.BENEZECH\u00a0; S.BRAMLI\u00a0; N.ANDRIANTSEHENO\u00a0; J.SIGRAND\u00a0; J.P. ARPURT (CHG Avignon)<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02021-05-25 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

En cas d\u2019h\u00e9morragie cataclysmique par rupture de VO, r\u00e9fractaire au traitement vasoactif et \u00e0 la ligature, le tamponnement, soit par sonde (Blackmore, Linton) soit plus r\u00e9cemment par une proth\u00e8se auto-expansible d\u00e9di\u00e9e est une indication recommand\u00e9e selon la r\u00e9union d\u2019experts BAVENO VI 2015.<\/p>\n

M\u00e9thodes\u00a0:
\n20 hommes, \u00e2ge moyen\u00a0: 60,7 ans (47 \u2013 85 ans). Cirrhose Child B\u00a0: 10 (B7:5\u00a0; B8:4; B9:1) Child C\u00a0: 10 ( C10:3; C11:3; C12:4) .Etiologies: \u00e9thylique:17, VHC:1, \u00e9thylique + VHC:2. Complications avant \u00e9pisode actuel\u00a0: carcinome h\u00e9patocellulaire\u00a0: 4, thrombose porte\u00a0: 3, thrombose TIPS\u00a0: 4. Mode de r\u00e9v\u00e9lation \u00e0 l\u2019arriv\u00e9e\u00a0: h\u00e9mat\u00e9m\u00e8se massive 100%\u00a0avec premier \u00e9pisode d\u2019h\u00e9morragie par RVO\u00a0: 8\u00a0et ant\u00e9c\u00e9dents de LVO\u00a0: 12. Taux d\u2019h\u00e9moglobine moyen\u00a0: 6.8g\/dl, Nombre moyen de culots globulaires\/patient\u00a0: 3,1.
\nLa pose a \u00e9t\u00e9 r\u00e9alis\u00e9e au bloc endoscopie sous intubation par un op\u00e9rateur s\u00e9nior avec IDE endoscopie d\u2019astreinte pour 15 patients avec contr\u00f4le par scopie pour 5 patients ou en service de r\u00e9animation pour 5 patients. L\u2019heure de r\u00e9alisation s\u2019est faite en astreinte d\u2019endoscopie digestive pour 12 patients \/20.
\nR\u00e9sultats\u00a0:
\nLa dur\u00e9e moyenne du geste d\u2019implantation a \u00e9t\u00e9 de 18 minutes [12-30 minutes]\u00a0
\nLe taux de r\u00e9ussite imm\u00e9diat a \u00e9t\u00e9 de 95% (1 \u00e9chec par d\u00e9faut de largage au d\u00e9but de l\u2019exp\u00e9rience).
\nLe d\u00e9lai moyen de retrait \u00e0 7,8 jours [7-11 jours] sans utiliser le dispositif de retrait d\u00e9di\u00e9. Une simple pince \u00e0 corps \u00e9trangers \u00e9tait suffisante.
\nAu retrait du dispositif, 1 r\u00e9cidive h\u00e9morragique n\u00e9cessitant la remise en place d\u2019une proth\u00e8se. Pas eu de r\u00e9cidive h\u00e9morragique J7 \u00e0 J30\u00a0:6 d\u00e9c\u00e8s, 1 perforation \u0153sophagienne trait\u00e9e par proth\u00e8se sp\u00e9cifique et 4TIPS de sauvetage (d\u00e9lai entre h\u00e9morragie et TIPS 2- 20jours).<\/p>\n

Conclusion\u00a0:
\nL\u2019endoproth\u00e8se auto-expansible SX-ELLA Stent Danis a donc sa place dans le traitement d\u2019urgence d\u2019une h\u00e9morragie digestive par rupture de varices \u0153sophagiennes non contr\u00f4l\u00e9e par les traitements conventionnels.
\nCe dispositif reste un traitement temporaire en attendant un TIPS de sauvetage si le patient est \u00e9ligible
\nApr\u00e8s la r\u00e9union de r\u00e9f\u00e9rencement au sein de la HAS 2020, ce dispositif a acc\u00e9d\u00e9 au niveau ASA III et est en cours de n\u00e9gociation avec le Comit\u00e9 Economique des Produits de sant\u00e9 (CEPS).
\nUn projet d\u2019observatoire national sur l\u2019HTP va \u00eatre mis en place en 2021 regroupant CHU-CHG-Lib\u00e9raux sous l\u2019\u00e9gide du Club Fran\u00e7ais de l\u2019Hypertension Portale.<\/p>\n","protected":false},"excerpt":{"rendered":"

2021 A.RAOTO\u00a0; S.BELLON\u00a0; A.BENEZECH\u00a0; S.BRAMLI\u00a0; N.ANDRIANTSEHENO\u00a0; J.SIGRAND\u00a0; J.P. ARPURT (CHG Avignon) Endoscopie – \u00a02021-05-25 –\u00a0CO – ________________________________ En cas d\u2019h\u00e9morragie cataclysmique par rupture de VO, r\u00e9fractaire au traitement vasoactif et \u00e0 la ligature, le tamponnement, soit par sonde (Blackmore, Linton) soit plus r\u00e9cemment par une proth\u00e8se auto-expansible d\u00e9di\u00e9e est une indication recommand\u00e9e selon la r\u00e9union […]<\/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":[34],"class_list":["post-2372","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-34"],"yoast_head":"\nA propos de 20 patients ayant b\u00e9n\u00e9fici\u00e9 de la pose d\u2019endoproth\u00e8se auto-expansive (SX-ELLA Stent Danis) dans le cadre d\u2019une h\u00e9morragie digestive massive par rupture de varices \u0153sophagiennes. 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