|
| |
|
Thématique :
- Endoscopie/Imagerie
|
|
|
Originalité :
Intermédiaire
|
|
|
| Doit faire évoluer notre pratique : |
|
Dans certains cas
|
|
|
|
|
| |
| |
|
Nom du veilleur :
Docteur Florian ROSTAIN
|
|
|
|
|
|
| |
 |
Endoscopy
|
|
| |
2015/11
|
|
| |
| |
2015 Nov;47(11):988-96
|
|
| |
doi: 10.1055/s-0034-1392262
|
|
| |
| |
Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study
|
|
| |
| |
Christophorou D, Valats JC, Funakoshi N, Duflos C, Picot MC, Vedrenne B, Prat F, Bulois P, Branche J, Decoster S, Coron E, Charachon A, De Chambrun GP, Nocca D, Bauret P, Blanc P
|
|
|
| |
http://www.ncbi.nlm.nih.gov/pubmed/26111361
|
|
| |
| |
BACKGROUND AND STUDY AIMS
Fistula is the main complication of laparoscopic sleeve gastrectomy (LSG), for which healing is difficult to achieve. The aims of the study were to evaluate the efficacy of interventional endoscopy for post-LSG fistula treatment, to evaluate various endoscopic techniques used and identify their complications, and to identify predictive factors of healing following endoscopic treatment.
PATIENTS AND METHODS
This retrospective multicenter study included patients with post-LSG fistula. Therapeutic procedures were evaluated, taking into account complications and healing times. Endoscopic procedures were considered to have promoted healing if no other surgical procedure was performed. Predictive factors of healing were identified by univariate and multivariate analysis.
RESULTS
A total of 110 patients were included, of whom 6 (5.5 %) healed spontaneously, 81 (73.6 %) healed following endoscopic treatment, and 19 (17.3 %) healed following surgery. Healing rates following endoscopic treatment were 84.4 % in the first 6 months of treatment (65/77), 52.4 % for treatment lasting 6 - 12 months (11/21), and 41.7 % after 12 months of treatment (5/12). A drainage procedure (surgical, endoscopic, or percutaneous) was performed in 92 patients (83.6 %). A total of 177 esogastric stents were placed in 88 patients (80.0 %). Surgical debridement, clip placement, glue sealing, and plug placement were also performed. Multivariate analysis identified four predictive factors of healing following endoscopic treatment: interval < 21 days between fistula diagnosis and first endoscopy (P = 0.003), small fistula (P = 0.01), interval between LSG and fistula ≤ 3 days (P = 0.01), no history of gastric banding (P = 0.04).
CONCLUSION
Endoscopic treatment facilitated healing of post-LSG fistula in 74 % of patients. Early endoscopic treatment increased the likelihood of success, and was most effective during the first 6 months of management. After this point, surgical treatment should be considered.
|
|
|
|
| |
Quelle est l’efficacité du traitement endoscopique des fistules post sleeve gastrectomie laparoscopiques ?
|
|
| |
|
|
| |
Etude rétrospective sur 110 patients dans 7 centres français.
73,6% des patients ont obtenus une cicatrisation de la fistule après le traitement endoscopique. Le taux de cicatrisation après traitement endoscopique était de 84,4% (65/77) dans les 6 premiers mois de traitement, 52,4% (11/21) entre le 6ième et 12ième mois et de 41,7% (5/12) après le 12ème mois.
En analyse multivariée, il existe 4 facteurs prédictifs de cicatrisation après le traitement endoscopique : un délai de moins de 21 jours entre le diagnostic de fistule et la première endoscopie (p : 0,003), une fistule de petite taille (p : 0,01), un délai de moins de 3 jours entre la chirurgie et la survenue de la fistule (p : 0,01), et l’absence d’antécédent d’anneau gastrique.
|
|
| |
|
|
| |
|
Le traitement endoscopique des fistules post-sleeve gastrectomie est efficace et est devenu un des principaux traitements de ces complications chirurgicales. La cicatrisation est obtenue principalement dans les 6 premiers mois.
Plusieurs traitements endoscopiques sont aujourd’hui utilisés ; une étude prospective comparative de ces différents traitements pourrait nous guider dans nos choix thérapeutiques.
|
| |
|
