{"id":2439,"date":"2023-01-24T13:46:53","date_gmt":"2023-01-24T12:46:53","guid":{"rendered":"https:\/\/angh.net\/abstracts\/systeme-dapposition-luminale-biliaire-hot-axios-2020-a-2022-que-sont-nos-amours-devenues\/"},"modified":"2023-01-24T13:46:53","modified_gmt":"2023-01-24T12:46:53","slug":"systeme-dapposition-luminale-biliaire-hot-axios-2020-a-2022-que-sont-nos-amours-devenues","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/systeme-dapposition-luminale-biliaire-hot-axios-2020-a-2022-que-sont-nos-amours-devenues\/","title":{"rendered":"Syst\u00e8me D’apposition luminale biliaire HOT AXIOS\u00b0 : 2020 \u00e0 2022 : que sont nos amours devenues ?"},"content":{"rendered":"

2022<\/strong><\/p>\n

BELLON Serge,BENEZECH Alban,RAOTO Andry, ANDRIANTSENO Tina, SIGRAND JulieARPURT Jean Pierre . C.H.AVIGNON<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02022-05-01 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Le dispositif m\u00e9dical HOT AXIOS\u00b0 est en cours d\u2019obtention d\u2019AMM pour le drainage des voies biliaires( dossier HAS du 15\/02\/2022) mais uniquement r\u00e9serv\u00e9 \u00e0 la 2\u00e8me intention, \u00e0 savoir l\u2019\u00e9chec d\u2019ERCP.
\nIl y a 2 ans, nous pr\u00e9sentions \u00e0 ANNECY notre exp\u00e9rience de ce dispositif dans cette situation. Les r\u00e9sultats \u00e9taient suffisamment encourageants pour que nous d\u00e9cidions de l\u2019utiliser en 1\u00e8re intention chaque fois que cela serait possible.
\nR\u00c9SULTATS :
\nDe Mars 2020 \u00e0 Mai 2022, nous avons utilis\u00e9 le syst\u00e8me HOT AXIOS chez 42 patients porteurs d\u2019une st\u00e9nose maligne de la voie biliaire distale. 32 proth\u00e8ses ont \u00e9t\u00e9 plac\u00e9es en 1\u00e8re intention.
\n97% de succ\u00e8s technique ( 1 \u00e9chec faisant r\u00e9aliser un drainage par ERCP).
\nDur\u00e9e moyenne du geste : 7 min
\n1 inefficacit\u00e9 primaire \u00e0 J7 faisant placer une proth\u00e8se dans l\u2019AXIOS
\n2 complications : 1 h\u00e9morragie n\u00e9cessitant une FOGD pour h\u00e9mostase \u00e0 J2 et 1 chol\u00e9 p\u00e9ritoine n\u00e9cessitant un geste chirurgical ( refus\u00e9 par la famille du fait du statut palliatif, aboutissant au d\u00e9c\u00e8s du patient).
\n5 proth\u00e8ses bouch\u00e9es pr\u00e9cocement ( moins de 3 mois apr\u00e8s la mise en place), faisant r\u00e9aliser un 2\u00e8me geste de d\u00e9sobstruction ( en moyenne \u00e0 la 7\u00e8me sem).
\n2 patients ont b\u00e9n\u00e9fici\u00e9 d\u2019une DPC sans g\u00eane pour le chirurgien.
\nDISCUSSION :
\nL\u2019utilisation biliaire du dispositif HOT AXIOS\u00b0 fait l\u2019objet de nombreuses publications (cf JFHOD 2022), mais les analyses de pose en 1\u00e8re intention sont plus limit\u00e9es et \u00ab r\u00e9serv\u00e9es \u00bb aux centres experts. Ce qui ne permet donc pas pour l\u2019instant de franchir le pas dans tous les centres qui pratiquent L\u2019\u00e9cho endoscopie interventionnelle. L\u2019exp\u00e9rience d\u2019un centre ANGH peut elle aider \u00e0 se positionner ?
\nLes avantages du dispositif se sont bien s\u00fbr v\u00e9rifi\u00e9s dans notre exp\u00e9rience. Temps de pose particuli\u00e8rement rapide, sans changement d\u2019endoscope, la proth\u00e8se \u00e9tant largu\u00e9e juste apr\u00e8s la ponction \u00e9cho endoscopique. Pas de pancr\u00e9atite aigue interf\u00e9rant avec la suite de la prise en charge.
\n2 de nos patient ( 4 si on rajoute 2 patients avec stents de 2\u00e8me intention) ont \u00e9t\u00e9 op\u00e9r\u00e9 par DPC dans la suite du parcours de soins. Aucune incidence sur l\u2019intervention n\u2019a \u00e9t\u00e9 not\u00e9e par l\u2019\u00e9quipe chirurgicale\u2026
\nEn revanche, le d\u00e9roulement du largage du syst\u00e8me , relativement simple en termes d\u2019ergonomie, a \u00e9t\u00e9 responsable chez nous d\u2019un \u00e9chec technique par mauvais d\u00e9ploiement de la collerette distale et d\u2019une complication grave par chol\u00e9p\u00e9ritoine( + 3 autres similaires si on comptabilise les axios biliaires en 2\u00e8me intention et les axios pour kysto gastrostomie) par mauvais d\u00e9ploiement de la collerette proximale. Ce probl\u00e8me semble avoir disparu depuis que (f\u00e9vrier 2021 dans notre \u00e9quipe) la soci\u00e9t\u00e9 Boston nous a demand\u00e9 de finir le largage non pas sous contr\u00f4le visuel du rep\u00e8re noir dans le bulbe mais \u00e0 l\u2019 \u00ab aveugle \u00bb, dans le canal op\u00e9rateur.
\nPar ailleurs sur les 32 stents mis en 1\u00e8re intention, 5 (15 % ) se sont bouch\u00e9s dans les 3 mois qui ont suivi la pose . Si on rajoute Les 2 patients qui ont eu besoin d\u2019une 2\u00e8me proth\u00e8se imm\u00e9diatement (< J7) par d\u00e9faut d\u2019efficacit\u00e9 ; Et 1 patient qui a n\u00e9cessit\u00e9 une FOGD d\u2019h\u00e9mostase \u00e0 J2 ; On arrive \u00e0 25 % de patients chez qui un 2\u00e8me geste pr\u00e9coce a \u00e9t\u00e9 obligatoire\nCONCLUSION :\nEn 2022 l\u2019int\u00e9r\u00eat des proth\u00e8ses HOT AXIOS\u00b0 dans le drainage \u00e9cho endoscopique des st\u00e9noses malignes distales de la VBP n\u2019est plus \u00e0 d\u00e9montrer. Il faut d\u00e9sormais se positionner par rapport \u00e0 l\u2019utilisation en premi\u00e8re intention. Les \u00e9tudes en centre expert plaident pour. Nos r\u00e9sultats en centre ANGH, apr\u00e8s 2 ans de mise en pratique , vont dans le m\u00eame sens. Il faut n\u00e9anmoins noter que 25 % des patients ont une r\u00e9intervention pr\u00e9coce et qu\u2019il existe des complications potentiellement s\u00e9v\u00e8res. Le processus de formation pour le dispositif doit donc \u00eatre solide et continu. Par ailleurs la coop\u00e9ration avec son \u00e9quipe chirurgicale doit \u00eatre compl\u00e8te pour la gestion de ces complications et l\u2019organisation de la chirurgie pancr\u00e9atique apr\u00e8s HOT AXIOS qui ne parait pas modifi\u00e9e.\n<\/p>\n","protected":false},"excerpt":{"rendered":"

2022 BELLON Serge,BENEZECH Alban,RAOTO Andry, ANDRIANTSENO Tina, SIGRAND JulieARPURT Jean Pierre . C.H.AVIGNON Endoscopie – \u00a02022-05-01 –\u00a0CO – ________________________________ Le dispositif m\u00e9dical HOT AXIOS\u00b0 est en cours d\u2019obtention d\u2019AMM pour le drainage des voies biliaires( dossier HAS du 15\/02\/2022) mais uniquement r\u00e9serv\u00e9 \u00e0 la 2\u00e8me intention, \u00e0 savoir l\u2019\u00e9chec d\u2019ERCP. Il y a 2 ans, […]<\/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":[35],"class_list":["post-2439","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-35"],"yoast_head":"\nSyst\u00e8me D'apposition luminale biliaire HOT AXIOS\u00b0 : 2020 \u00e0 2022 : que sont nos amours devenues ? - 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\/systeme-dapposition-luminale-biliaire-hot-axios-2020-a-2022-que-sont-nos-amours-devenues\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Syst\u00e8me D'apposition luminale biliaire HOT AXIOS\u00b0 : 2020 \u00e0 2022 : que sont nos amours devenues ? 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