SNFGE SNFGE
 
Thématique :
- Foie (hors cancers)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/08  
 
  2016 Aug;64(2):549-55  
  doi: 10.1002/hep.28597  
 
  Randomized trial of 1-week versus 2-week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding.  
 
  Sheibani S, Khemichian S, Kim JJ, Hou L, Yan AW, Buxbaum J, Dara L, Laine L  
  https://www.ncbi.nlm.nih.gov/pubmed/?term=Randomized+trial+of+1-week+versus+2-week+intervals+for+endoscopic+ligation+in+the+treatment+of+patients+with+esophageal+variceal+bleeding.  
 
 

The appropriate interval between ligation sessions for treatment of esophageal variceal bleeding is uncertain. The optimal interval would provide variceal eradication as rapidly as possible to lessen early rebleeding while minimizing ligation-induced adverse events. We randomly assigned patients hospitalized with acute esophageal variceal bleeding who had successful ligation at presentation to repeat ligation at 1-week or 2-week intervals. Beta-blocker therapy was also prescribed. Ligation was performed at the assigned interval until varices were eradicated and then at 3 and 9 months after eradication. The primary endpoint was the proportion of patients with variceal eradication at 4 weeks. Four-week variceal eradication occurred more often in the 1-week than in the 2-week group: 37/45 (82%) versus 23/45 (51%); difference = 31%, 95% confidence interval 12%-48%. Eradication occurred more rapidly in the 1-week group (18.1 versus 30.8 days, difference = -12.7 days, 95% confidence interval -20.0 to -5.4 days). The mean number of endoscopies to achieve eradication or to the last endoscopy in those not achieving eradication was comparable in the 1-week and 2-week groups (2.3 versus 2.1), with the mean number of postponed ligation sessions 0.3 versus 0.1 (difference = 0.2, 95% confidence interval -0.02 to 0.4). Rebleeding at 4 weeks (4% versus 4%) and 8 weeks (11% versus 9%), dysphagia/odynophagia/chest pain (9% versus 2%), strictures (0% versus 0%), and mortality (7% versus 7%) were similar with 1-week and 2-week intervals.

CONCLUSION:

One-week ligation intervals led to more rapid eradication than 2-week intervals without an increase in complications or number of endoscopies and without a reduction in rebleeding or other clinical outcomes; the decision regarding ligation intervals may be individualized based on patient and physician preferences and local logistics and resources. (Hepatology 2016;64:549-555).

 
Question posée
 
Quel est le meilleur intervalle de temps entre 2 séances de ligature chez les patients cirrhotiques hospitalisés pour rupture de varices oesophagiennes : 1 semaine ou 2 semaines ?
 
Question posée
 
En prenant l’éradication virale à 4 semaines comme critère principal de jugement, l’éradication est plus rapide dans le groupe 1 semaine avec un nombre d’endoscopies comparables sans effet cependant sur la récidive hémorragique à 4 semaines, ni sur la mortalité et sur les complications.
 
Commentaires

Les 2 intervalles de temps se valent tant termes d’efficacité que d’effets secondaires, à adapter donc en fonction des contraintes locales.

 
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