{"id":2375,"date":"2021-10-06T13:54:23","date_gmt":"2021-10-06T11:54:23","guid":{"rendered":"https:\/\/angh.net\/abstracts\/angh-et-immersion-acte-ii\/"},"modified":"2021-10-06T13:54:23","modified_gmt":"2021-10-06T11:54:23","slug":"angh-et-immersion-acte-ii","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/angh-et-immersion-acte-ii\/","title":{"rendered":"ANGH et immersion : acte II"},"content":{"rendered":"

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

S. Bellon, T. Andriantseno, A. Raoto, A. Benezech, J. Sigrand, J.P. Arpurt<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02021-05-20 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Immersion et ANGH : Acte II
\nLes recommandations europ\u00e9ennes de r\u00e9section des polypes sessiles du colon sont \u00e9tablies depuis 2017. Elles pr\u00e9conisent , entre autres, la dissection sous muqueuse(ESD) pour les polypes ayant une taille de plus de 4 cm et\/ou un aspect de d\u00e9g\u00e9n\u00e9rescence superficielle. Cependant, l\u2019ESD est une technique longue, co\u00fbteuse, avec une courbe d\u2019apprentissage particuli\u00e8rement lente. De ce fait, des techniques alternatives sont apparues : syst\u00e8me FTRD, dissection hybride\u2026 La r\u00e9section des polypes en immersion (UEMR : Underwater Endoscopic Mucosal Resection) en fait partie.
\nPRINCIPES
\nL\u2019UEMR utilise l\u2019instillation d\u2019une grande quantit\u00e9 de liquide dans la lumi\u00e8re du colon. Ce qui permet de d\u00e9plisser la musculeuse et de faire flotter la muqueuse et la sous muqueuse. De ce fait, l\u2019utilisation d\u2019une injection sous muqueuse est inutile. De ce fait, avec l\u2019UEMR la surface du polype n\u2019est pas modifi\u00e9e ce qui permet de capturer des polypes de plus grande taille que dans la mucosectomie classique (EMR : Endoscopic Mucosal Resection). De plus en UEMR, la s\u00e9paration (li\u00e9e \u00e0 la pression du liquide) des couches superficielles par rapport \u00e0 la musculeuse d\u2019une part, et, d\u2019autre part, la diminution des ph\u00e9nom\u00e8nes de diffusion du courant dans l\u2019eau font diminuer de fa\u00e7on significative le risque de perforation.
\nEXPERIENCE AVIGNONNAISE
\nDepuis le printemps 2021, nous avons utilis\u00e9 l\u2019UEMR pour 7 l\u00e9sions. Les caract\u00e9ristiques seront d\u00e9crites lors du congr\u00e8s (les r\u00e9sultats du taux de r\u00e9cidive \u00e0 distance sont en attente).
\nDISCUSSION
\nL\u2019UEMR a \u00e9t\u00e9 mise au point en 2012 par K. BINMOELLER \u00e0 partir de son exp\u00e9rience en minisonde d\u2019\u00e9choendoscopie qui montrait une flottabilit\u00e9 importante des l\u00e9sions muqueuses et sous muqueuses, \u00e0 distance de la musculeuse, dans la lumi\u00e8re du colon quand il instillait une quantit\u00e9 importante d\u2019eau. De plus, il remarque que l\u2019utilisation de l\u2019injection sous muqueuse dans l\u2019EMR classique est bas\u00e9e sur un faible niveau de preuves et qu\u2019elle peut m\u00eame comporter des risques. Depuis cette date, lui et de nombreux auteurs ont publi\u00e9 plus de mille cas dans la litt\u00e9rature ; Avec des niveaux de performances sup\u00e9rieurs \u00e0 l\u2019EMR :
\nR\u00e9section en bloc : 81 % (95% pour polype <20 mm et 55% pour polypes>20mm)
\nR\u00e9currence \u00e0 6 mois : 8 %
\nPerforation : 0,2 %
\nDe plus, toutes les \u00e9tudes montrent que la courbe d\u2019apprentissage est particuli\u00e8rement rapide pour les endoscopistes form\u00e9s \u00e0 l\u2019EMR classique.
\nLes performances les plus relevantes ont \u00e9t\u00e9 not\u00e9es pour les r\u00e9sections monobloc de polypes de grandes tailles, les r\u00e9sections des polypes cicatriciels et les localisations difficiles (appendice, valvule il\u00e9ocaecale).
\nNotre exp\u00e9rience confirme la facilit\u00e9 d\u2019apprentissage et la suret\u00e9 de cette technique. Elle est apparue particuli\u00e8rement int\u00e9ressante pour les polypes cicatriciels et pour faciliter les coupes successives lors d\u2019une r\u00e9section piecemeal. Pour les r\u00e9sections monoblocs de gros polypes, le b\u00e9n\u00e9fice parait moins tranch\u00e9.
\nLa fin de la discussion des r\u00e9sultats sera poursuivie en septembre.
\nCONCLUSION
\nL\u2019UEMR est une technique de r\u00e9section avec une courbe d\u2019apprentissage tr\u00e8s rapide et qui permet de suppl\u00e9er parfois \u00e0 l\u2019ESD :
\nPolypes de taille \u00e9l\u00e9v\u00e9e \u00e0 bonne flottabilit\u00e9
\nPolypes d\u00e9j\u00e0 travaill\u00e9s
\nPolypes de localisations difficiles
\nL\u2019Acte I de l\u2019immersion nous a \u00e9t\u00e9 pr\u00e9sent\u00e9 l\u2019ann\u00e9e derni\u00e8re \u00e0 l\u2019ANGH par le Dr Ren\u00e9 Louis Vitte, en d\u00e9montrant le b\u00e9n\u00e9fice quant \u00e0 la progression du coloscope. Aujourd\u2019hui, avec l\u2019expos\u00e9 des r\u00e9sultats de l\u2019UEMR pour la r\u00e9section des polypes, nous proposons l\u2019Acte II de l\u2019immersion.<\/p>\n","protected":false},"excerpt":{"rendered":"

2021 S. Bellon, T. Andriantseno, A. Raoto, A. Benezech, J. Sigrand, J.P. Arpurt Endoscopie – \u00a02021-05-20 –\u00a0CO – ________________________________ Immersion et ANGH : Acte II Les recommandations europ\u00e9ennes de r\u00e9section des polypes sessiles du colon sont \u00e9tablies depuis 2017. Elles pr\u00e9conisent , entre autres, la dissection sous muqueuse(ESD) pour les polypes ayant une taille de […]<\/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-2375","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-34"],"yoast_head":"\nANGH et immersion : acte II - 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\/angh-et-immersion-acte-ii\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ANGH et immersion : acte II - 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