{"id":2382,"date":"2021-10-06T13:54:23","date_gmt":"2021-10-06T11:54:23","guid":{"rendered":"https:\/\/angh.net\/abstracts\/ou-en-est-on-du-recours-au-tips-en-france-resultats-dune-enquete-nationale-sur-laccessibilite-et-les-indications-des-tips\/"},"modified":"2021-10-06T13:54:23","modified_gmt":"2021-10-06T11:54:23","slug":"ou-en-est-on-du-recours-au-tips-en-france-resultats-dune-enquete-nationale-sur-laccessibilite-et-les-indications-des-tips","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/ou-en-est-on-du-recours-au-tips-en-france-resultats-dune-enquete-nationale-sur-laccessibilite-et-les-indications-des-tips\/","title":{"rendered":"Ou en est \u2013on du recours au TIPS en France ? R\u00e9sultats d’une enqu\u00eate nationale sur l’accessibilit\u00e9 et les indications des TIPS."},"content":{"rendered":"

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

Isabelle Rosa (1), Armand Garioud (2), Christophe Bureau (3), Dominique Thabut (4) et le groupe ANGH enqu\u00eate TIPS.
\n(1) \u2013 Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Intercommunal \u2013 Cr\u00e9teil
\n(2) \u2013 Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Intercommunal \u2013 Villeneuve-Saint-Georges
\n(3) – Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Universitaire Rangueuil \u2013 Toulouse \u2013
\n(4) Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Universitaire La Piti\u00e9-Salp\u00eatri\u00e8re \u2013 Paris<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02021-05-21 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Contexte et objectifs: La conf\u00e9rence Baveno VI a bien d\u00e9fini la place des TIPS chez les patients cirrhotiques. Cependant, le nombre de patients cirrhotiques adress\u00e9s pour pose d\u2019un TIPS en France n\u2019a pas augment\u00e9 de fa\u00e7on spectaculaire depuis. Le but de cette \u00e9tude \u00e9tait de d\u00e9crire la pratique actuelle des h\u00e9patogastro-ent\u00e9rologues fran\u00e7ais concernant le TIPS, et d’identifier les barri\u00e8res \u00e0 la proc\u00e9dure TIPS.
\nM\u00e9thode: Un questionnaire r\u00e9dig\u00e9 par l’ANGH et valid\u00e9 par l’AFEF a \u00e9t\u00e9 envoy\u00e9 \u00e0 tous les praticiens (P) travaillant dans les unit\u00e9s d’h\u00e9patogastroent\u00e9rologie des h\u00f4pitaux g\u00e9n\u00e9raux et universitaires (GH et UH) par e-mail. Cette enqu\u00eate a \u00e9t\u00e9 men\u00e9e entre octobre et d\u00e9cembre 2020.
\nR\u00e9sultats: 94 h\u00e9patogastroent\u00e9rologues ont r\u00e9pondu au questionnaire (53 praticiens de 35 CHG et 41 de 24 CHU). L’\u00e2ge moyen du praticien \u00e9tait de 44,7 (29-66) ans. Le TIPS \u00e9tait principalement disponible en CHU (93%), tr\u00e8s limit\u00e9 en CHG (14%) et toujours r\u00e9alis\u00e9 par des radiologues interventionnels. Le nombre d’indications de TIPS \u00e9tait diff\u00e9rent entre CHG et CHU: 57% des praticiens de CHG proposaient un TIPS chez moins de 5 patients par an versus 5% en CHU tandis que 63% des praticiens de CHU prescrivaient des TIPS chez plus de 10 patients par an versus 10% en CHG. Le transfert des patients de CHG au CHU pour la proc\u00e9dure TIPS a \u00e9t\u00e9 consid\u00e9r\u00e9 comme facile pour 83% des praticiens. Les indications des TIPS \u00e9taient similaires entre CHG et CHU pour l’ascite r\u00e9fractaire, l’hydrothorax, l’h\u00e9morragie variqueuse r\u00e9fractaire, l’\u00e9chec de la prophylaxie secondaire. En revanche, seulement 45% des praticiens de CHG proposaient un early TIPS en cas de rupture de VO chez un patients Child C<12 ou B avec h\u00e9morragie active, versus 95% dans les CHU. En cas d'h\u00e9morragie r\u00e9fractaire, un TIPS \u00e9tait discut\u00e9 par les h\u00e9patologues dans 98% des cas et par les r\u00e9animateurs dans 52% des cas. Pour les early-TIPS, la proc\u00e9dure a \u00e9t\u00e9 discut\u00e9e dans 57% des cas (64% en CHG et 98% en CHU) par un h\u00e9patologue et par des r\u00e9animateurs dans seulement 31% des cas. Les raisons pour lesquelles les early-TIPS n'ont pas \u00e9t\u00e9 r\u00e9alis\u00e9s \u00e9taient des difficult\u00e9s organisationnelles pour 23% et un manque de confiance sur l\u2019efficacit\u00e9 de cette proc\u00e9dure pour 11% des praticiens de CHG. L'\u00e9chocardiographie et la recherche d'une enc\u00e9phalopathie h\u00e9patique \u00e9taient syst\u00e9matiquement effectu\u00e9es avant l'intervention. Le suivi du patient se faisait \u00e0 3 mois puis tous les 6 mois avec consultation et echo-Doppler du foie.\n\n\nConclusion: Le TIPS est principalement disponible en CHUmais les patients de CHG sont facilement transf\u00e9r\u00e9s au CHU pour la proc\u00e9dure. Les indications des TIPS sont conformes aux directives de Baveno VI, mais les patients de CHG ont moins acc\u00e8s \u00e0 l\u2019early- TIPS, en raison de difficult\u00e9s organisationnelles et \u00e9galement du manque de conviction des r\u00e9animateurs et des h\u00e9patologues de CHG. Une meilleure connaissance des pratiques est n\u00e9cessaire surtout en CHG pour augmenter l\u2019accessibilit\u00e9 des patients \u00e0 l\u2019early TIPS en France.\n<\/p>\n","protected":false},"excerpt":{"rendered":"

2021 Isabelle Rosa (1), Armand Garioud (2), Christophe Bureau (3), Dominique Thabut (4) et le groupe ANGH enqu\u00eate TIPS. (1) \u2013 Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Intercommunal \u2013 Cr\u00e9teil (2) \u2013 Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Intercommunal \u2013 Villeneuve-Saint-Georges (3) – Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 Centre Hospitalier Universitaire Rangueuil \u2013 Toulouse \u2013 (4) Service d\u2019h\u00e9pato-gastroent\u00e9rologie \u2013 […]<\/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":[4],"tags":[34],"class_list":["post-2382","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-34"],"yoast_head":"\nOu en est \u2013on du recours au TIPS en France ? 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