SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
 
 
Endoscopy
  2017/05  
 
  2017 May;49(5):484-490.  
  doi: 10.1055/s-0042-122011.  
 
  Long-term outcome of endoscopic ultrasound-guided pelvic abscess drainage: a two-center series.  
 
  Poincloux L, Caillol F, Allimant C, Bories E, Pesenti C, Mulliez A, Faure F, Rouquette O, Dapoigny M, Abergel A, Giovannini M  
  https://www.ncbi.nlm.nih.gov/pubmed/28196390  
 
 

Abstract

Background and study aim Endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported but long-term data remain limited. This two-center study evaluated long-term outcome of EUS-guided pelvic abscess drainage. 

Patients and methods Between May 2003 and December 2015, 37 consecutive patients were treated for perirectal or perisigmoid abscesses via EUS-guided drainage using plastic or lumen-apposing metal stent (LAMS). Clinical success was defined as complete resolution of the abscess on follow-up computed tomography (CT) scan at 4 weeks with symptom relief. Long-term success was defined as abscess resolution without the need for surgery and without recurrence on long-term follow-up (> 12 months). 

Results Median abscess size was 60 mm (interquartile range 41 - 70). Causes were postsurgical (n = 31, 83.8 %) or secondary to medical conditions (n = 6, 16.2 %). EUS-guided drainage involved needle aspiration (n = 4), plastic stent placement (n = 29) or LAMS placement (n = 4 patients). Technical and clinical success was achieved in 37 patients (100 %; 95 % confidence interval [CI] 91 - 100) and 34 patients (91.9 %; 95 %CI 78 - 98), respectively (5 patients needed a second EUS-guided intervention within 14 days after drainage). One patient required surgery and one required best supportive care owing to persistent abscess. Early complications were perforation requiring surgery (n = 1), stent migration (n = 1), and rectal discomfort (n = 1). At a median follow-up of 64 months (IQR 19 - 81), two patients experienced abscess recurrence, at 3 and 12 months, respectively, and were treated surgically. Long-term success was achieved in 32 of 37 patients (86.5 %; 95 %CI 71 - 95). 

Conclusion EUS-guided drainage of pelvic abscess is safe, has good long-term outcome, and should be considered as an alternative to percutaneous and surgical drainage.

 

 
Question posée
 
Quelle est l’efficacité d’un drainage des abcès pelviens par écho-endoscopie ?
 
Question posée
 
Etude bi-centrique chez 37 patients traités pour des abcès péri-rectaux ou péri-sigmoïdiens par drainage sous écho-endoscopie. Le drainage sous-écho-endoscopie a été réalisé soit par aspiration à l’aiguille (n=4), soit par pose de prothèses plastiques (n=29), soit par pose de stent métallique d’apposition (n=4). Succès technique chez 100% des patients et succès clinique chez 34 patients (91.9 %; 95 %CI 78 - 98). Les complications : perforation nécessitant une chirurgie (n=1), migration du stent (n=1), inconfort rectal (n=1). Un succès à long terme a eu lieu chez 32 patients (86.5 %; 95 %CI 71 - 95).
 
Commentaires

Le drainage des collections pelviennes paraît sûr et efficace et devient une véritable option thérapeutique par rapport au drainage radiologique ou chirurgical.

 
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