SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Pancréas/Voies biliaires
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2015/11  
 
  2015 Nov 5. pii: S0016-5107(15)03056-4  
  doi: 10.1016/j.gie.2015.10.040  
 
  Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study  
 
  Yang D, Amin S, Gonzalez S, Mullady D, Hasak S, Gaddam S, Edmundowicz SA, Gromski MA, DeWitt JM, El Zein M, Khashab MA, Wang AY, Gaspar JP, Uppal DS, Nagula S, Kapadia S, Buscaglia JM, Bucobo JC, Schlachterman A, Wagh MS, Draganov PV, Jung MK, Stevens T, Vargo JJ, Khara HS, Huseini M, Diehl DL, Keswani RN, Law R, Komanduri S, Yachimski PS, DaVee T, Prabhu A, Lapp RT, Kwon RS, Watson RR, Goodman AJ, Chhabra N, Wang WJ, Benias P, Carr-Locke DL, DiMaio CJ  
  http://www.ncbi.nlm.nih.gov/pubmed/26548849  
 
 

BACKGROUND AND AIMS
The need for transpapillary drainage (TP) in patients undergoing transmural drainage (TM) of pancreatic fluid collections (PFC) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TM versus combined (TM and TP) drainage (CD) and to identify predictors of symptomatic and radiologic resolution.

METHODS
Retrospective review of 375 consecutive patients with PFC who underwent endoscopic ultrasound (EUS)-guided TM from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression.

RESULTS
A total of 375 patients underwent EUS-guided TM drainage of a PFC, of which 174 were pseudocysts. TM alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success: TM 92(97%) versus CD 35(44%) (P=0.0001). There was no difference in adverse events between the TM (15%) and CD (14%) cohorts (P=0.23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TM and 201 days (interquartile range: 150-493 days) (P=0.37). There was no difference in LT symptomatic resolution (TM: 69% vs CD: 62%, P=0.61) or LT radiologic resolution (TM: 71% vs CD: 67%, P=0.79). TP attempt was negatively associated with LT radiologic resolution of pseudocyst (OR, 0.11; 95% CI, 0.02-0.8; P=0.03).

CONCLUSIONS
TP has no benefit on treatment outcomes in patients undergoing EUS-guided TM of pancreatic pseudocysts and negatively impacts long-term resolution of PFC.

 
Question posée
 
Le drainage transpapillaire a-t-il un intérêt pour le traitement des pseudokystes pancréatiques en complément du drainage transmural (DTM) échoguidé ?
 
Question posée
 
Cette étude rétrospective multicentrique américaine sur 375 patients suggère que le drainage combiné (transpapillaire par CPRE + transmural échoguidé) est nettement plus difficile que le DTM seul (taux de succès technique 44% vs 97%) et qu’il n’apporte pas de bénéfice évident (même taux de succès clinique et radiologique).
 
Commentaires

Etude intéressante basée sur la pratique clinique mais qui comporte des biais inhérents à son caractère rétrospectif et mériterait d’être confirmée par des études prospectives pour répondre à cette question.

 
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