Occlusion intestinale aigue 3 - Hepatowebhepatoweb.com/DES/exposes/DES_13032010_MARTEAU/DIOR.pdf ·...
Transcript of Occlusion intestinale aigue 3 - Hepatowebhepatoweb.com/DES/exposes/DES_13032010_MARTEAU/DIOR.pdf ·...
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Indications : Cancer pancréatique, vésiculo-biliaire, gastrique, duodénal
cancers avancés non opérables, sténosants
Alternative au traitement chirurgical de dérivation
Technique la plus utilisée : endoprothèse non couverte Simmons DT. Nat Clin Prac 2005;2:365
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Prothèse gastro-duodénale non couverte dans un cas de cancer non résécable de l’antre
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Complications : migration, angiocholite, perforation, saignement
Efficacité clinique : 80%
Diminution morbi-mortalité ttt endoscopique Vs chirurgie
Holt et al , Gastrointest Endosc 2004 60 (6) Del Piano et al , Gastrointest Endosc 2005
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Grosmann .Dis Colon Rectum 2000
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Volvulus sigmoïde (2)
1. Détorsion endoscopique avec insufflation minimale
2. +/- Mise en place d’un tube rigide
3. Progression douce et examen complet si possible (recherche d’une zone ischémique)
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Volvulus sigmoïde (3)
Taux succès : 58-81%
CI : - ischémie - perforation
Risques : - perforation colique - récidive (30-90%) Ttt radio
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OGILVIE ?
Pseudo obstruction
Traitement conservateur
Traitement Etiologique
Echec
Néostigmine
Echec
colo-exsufflation
Echec Chirurgie
Obstruction mécanique
Résolution
Résolution
Résolution
Ponec et al. NEJM 1999
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Taux de réussite : 70%
CI : - pneumopéritoine - ischémie
Risques : - perforation - récidive (30%)
Rex et al. Gastrointest Endoc Clin N Am 1997
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Cosnes J. Inflamm Bowel Dis 2002; 8: 244 Freeman HJ, J Clin Gastroenterol 2003; 37: 216
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Dilatation hydrostatique :
Indication : longueur sténose < 5cm
Taux succès technique: 84% Taux succès clinique : 58% Taux de récidive : 40% Morbidité : 10%
Sabaté Alim Ther 2003 Rutgeerts, Infl Bowel Dis, 2004
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Maladie de Crohn (3)
Endoprothèse :
Indication : sténose fibreuse, échec ou récidive après plusieurs dilatations
Bickstone et al, Dis Colon Rectum 2005
Objectif : rémission clinique prolongée
Risque : migration spontanée
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Siddiqui et al. Aliment Pharm Ther 2007
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Prothèse non couverte sigmoïdienne
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CI: 1. Péritonite 2. Sténose > 12cm 3. Sténoses multiples ou associées à un sténose du grêle 4. Localisation au bas rectum (<5 cm de la MA)
Succès technique: 90-100%
Succès clinique: 84-93% ES : migration, obstruction, perforation, hémorragie Mortalité : 0-5%
Tielnay et al. Surg Endosc 2007;21:225
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Conclusion
Traitement endoscopique en plein développement
Objectif : éviter la chirurgie en urgence
Intérêt dans le ttt palliatif des lésions tumorales
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