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Thématique :
- Endoscopie/Imagerie
- Pratiques professionnelles
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Originalité :
Intermédiaire
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Dans certains cas
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Nom du veilleur :
Docteur Florian ROSTAIN
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Endoscopy
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2015/08
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2015 Aug;47(8):710-8
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doi: 10.1055/s-0034-1391732
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Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes
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Nanda KS, Tutticci N, Burgess NG, Sonson R, Williams SJ, Bourke MJ
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http://www.ncbi.nlm.nih.gov/pubmed/25763831
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BACKGROUND AND STUDY AIMS:
Endoscopic mucosal resection (EMR) of laterally spreading lesions (LSLs) involving the ileocecal valve (ICV) is technically demanding. Conventionally, these lesions are considered too challenging for endoscopic therapy and are primarily managed surgically. The aims of the study were to describe effectiveness, safety, and outcomes following EMR of LSLs at the ICV.
PATIENTS AND METHODS:
This was a single-center, prospective, observational, cohort study performed at an academic, tertiary referral center. Patients undergoing EMR for LSLs ≥ 20 mm involving the ICV were recruited over a 5-year period. Standard or cap-assisted colonoscopy with inject-and-resect EMR technique was performed with standardized post-EMR management. Procedural success, safety, and outcomes compared with non-ICV LSLs managed during the same period were analyzed.
RESULTS:
A total of 53 patients with ICV LSLs were referred for EMR (median age 69 years; median lesion size 35.0 mm; 52.8 % females). Six patients went directly to surgery because of an endoscopic diagnosis of malignancy (n = 2) or technical failure of EMR (n = 4). EMR achieved complete adenoma clearance in 44 out of 47 attempted (93.6 %). Surgery was ultimately avoided in 43/53 (81.1 %). Complications included bleeding in 6.4 %. There were no perforations or strictures. Early adenoma recurrence was detected in 7/40 patients (17.5 %), and 1/22 (4.5 %) had late recurrence. All were successfully managed endoscopically. Factors associated with failure of ICV EMR were ileal infiltration and involvement of both ICV lips.
CONCLUSIONS:
In the majority of cases, LSL involving the ICV can be effectively treated by EMR on an outpatient basis. In specialized centers, complications are infrequent, and > 80 % of patients ultimately avoid surgery.Trial registered at ClinicalTrials.gov (NCT01368289).
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Étudier l’efficacité et la sécurité de la résection endoscopique de lésions colique de plus de 20 mm s’étendant à la valvule iléo-cæcale.
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Sur 53 lésions, 47 ont été réséquées endoscopiquement (88,7%) ; et parmi ces résection, 44 ont été complètes (93,6%). 39 lésions ont été réséquées en une seule séance (83%) et 8 en deux séances (17%). Six patients ont présenté un saignement pendant la procédure (12,8%) avec une efficacité du traitement hémostatique dans tous les cas. Trois patients (6,4%) ont présenté un saignement post-opératoire. Il n’y a pas eu de perforation. Parmi les 40 patients suivis à court terme (coloscopie à 4-5 mois), 7 (17,5%) ont récidivé.
Parmi les 22 patients suivis à long terme (coloscopie à 16 mois), 1 (4,5%) a récidivé. Toutes les récidives ont été traitées endoscopiquement avec succès.
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Cette étude montre la faisabilité de résection endoscopique des polypes envahissant la valvule iléo-caecale. Toutefois l’étude a été menée dans un centre tertiaire. Il parait raisonnable d’adresser ces patients dans un centre habitué à ce type de résection.
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