SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Vincent VALANTIN
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2018/09  
 
  2018 Sep;88(3):511-518.  
  doi: 10.1016/j.gie.2018.04.2332.  
 
  Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy: a multicenter prospective study.  
 
  Camus M, Napoléon B, Vienne A, Le Rhun M, Leblanc S, Barret M, Chaussade S, Robin F, Kaddour N, Prat F  
  https://www.ncbi.nlm.nih.gov/pubmed/29660322  
 
 

Abstract
 

BACKGROUND AND AIMS:

Endobiliary dysplasia may persist after endoscopic papillectomy. Intraductal radiofrequency ablation (ID-RFA) is a potential alternative to complementary surgery. The aim of this study was to evaluate the efficacy and safety of ID-RFA for the treatment of adenomatous intraductal residue after endoscopic papillectomy.

METHODS:

A prospective open-label multicenter study included patients with histologically proven endobiliary adenoma remnant (ductal extent <20 mm) after endoscopic papillectomy for ampullary tumor. RFA (effect 8, power 10 W, 30 seconds) was performed during ERCP. Biliary ± pancreatic stent was placed at the end of the procedure. Endpoints were (1) the rate of residual neoplasia (ie, low-grade dysplasia [LGD], high-grade dysplasia [HGD], or invasive carcinoma) at 6 and 12 months, (2) rate of surgery, and (3) adverse events.

RESULTS:

Twenty patients (67 ± 11 years of age, 12 men) were included. The endobiliary adenoma was in LGD in 15 patients and HGD in 5 patients. All underwent 1 successful ID-RFA session with biliary stent placement and recovered uneventfully. Five (25%) received a pancreatic stent. The rates of residual neoplasia were 15% and 30% at 6 and 12 months, respectively. Only 2 patients (10%) were referred for surgery. Eight patients (40%) experienced at least 1 adverse event between ID-RFA and 12 months of follow-up. No major adverse event occurred. HGD at inclusion was associated with higher dysplasia recurrence at 12 months (P = .01).

CONCLUSIONS:

ID-RFA of residual endobiliary dysplasia after endoscopic papillectomy can be offered as an alternative to surgery, with a 70% chance of dysplasia eradication at 12 months after a single session and a good safety profile. Patient follow-up remains warranted after ID-RFA. (Clinical trial registration number: NCT02825524.).

 

 
Question posée
 
Efficacité et sécurité de la radio fréquence intra canalaire biliaire dans les résidus biliaires post ampullectomie endoscopique.
 
Question posée
 
Éradication de la dysplasie dans 70% des cas après 12 mois et une seule séance de radio fréquence. Résultats d’autant meilleur que la dysplasie est de bas grade. Très peu de complication d‘autant plus que la séquence de Rx-Frequence était suivie systématiquement de la mise en place d’une endoprothèse biliaire métallique couverte.
 
Commentaires

Technique prometteuse d’autant plus que le résidu est en DBG mais couteuse, et non prise en charge par la nomenclature.

 
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