Traitement transmural sous écho-endoscopie de collections pelviennes symptomatiques : ponction ou drainage

Abstract : Introduction: Pelvic collections may occur after abdominal-pelvic surgery or in medical diseases. Recently, EUS transmural (TM) treatment has been shown as highly effective and safe, becoming an alternative to surgery or radiology. We aimed to assess the results of EUS management of pelvic collections. Patients and methods: This is a retrospective, single center observational study conducted between 2004 and 2018. Patients with symptomatic pelvic collections treated by EUS-TM approach were enrolled. The procedures were performed with a therapeutic EUS-scope, following two possible options: a puncture-aspiration-injection of antibiotics PAIA (group 1) or a EUS-drainage by plastic double pigtail stents (DPS) associated or not with an ano-cavitary drain (ACD) or Lumen-apposing metal Stent (LAMS) (group 2). The main objective was to assess the clinical effectiveness based on symptoms and collection resolution. Secondary objectives were to document the safety, predictive factors for failure, and the recurrence rate. Results: 73 patients were included, with mean age of 42.5 years [12-87]. 30 patients in group 1 (41%) underwent PAIA and 43 in group 2 (59%) underwent DPS +/- ACD in 41 patients (95%) and LAMS in 2. The collection was postoperative in 58%. The mean size of pelvic collection was 48.9mm [8-120], 33 +/- 17mm in group 1, compared to 67 +/- 21mm in group 2 (p<0.0001). All the procedures were technically successful. Overall clinical success was overall 96% (93% in group 1 (28/30), 98% (42/43) in group 2). Failures occurred in two post sigmoiditis abscesses and one ileo-colic Crohn. No adverse event was reported. During the median follow-up of 7.5 years [4.4-8.9], no patient had recurrence. Conclusion: EUS-TM treatment with either PAIA or drainage depending on the collection size is confirmed to be effective and safe. It could be proposed as a first-line treatment.
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https://dumas.ccsd.cnrs.fr/dumas-02170702
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Marine Guingand. Traitement transmural sous écho-endoscopie de collections pelviennes symptomatiques : ponction ou drainage. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02170702⟩

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