Intérêt du nouveau couteau de dissection sous-muqueuse Dual-Knife® pour le traitement endoscopique du diverticule de Zenker View Full Text


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Article Info

DATE

2012-12

AUTHORS

A. Laquière, A. Wendt, J. Bouland, J. Boitard, F. Fumex, T. Manière, T. Manos, J. -L. Peroux, A. Bremondy, X. Moncoucy, E. De Bono, O. Croizet, B. Vedrenne, G. Penaranda, C. Boustière, GELID

ABSTRACT

Le Dual-Knife® (Olympus) est un nouveau couteau fréquemment utilisé pour la dissection sous-muqueuse du fait de sa sûreté et de sa précision. L’objet de cette étude était d’évaluer l’efficacité et la tolérance du traitement endoscopique du diverticule de Zenker avec le Dual-Knife® assisté d’un diverticuloscope (Cook®). De février 2009 à octobre 2011, 21 patients (14 hommes et sept femmes) dont l’âge moyen était de 70,7 ± 10,2 ans, présentant un diverticule de Zenker symptomatique, ont été inclus dans une étude prospective multicentrique non randomisée. La myotomie du muscle cricopharyngien était réalisée avec le Dual-Knife® après exposition du septum diverticulaire grâce au diverticuloscope. En fin de procédure, un ou deux clips étaient positionnés à l’extrémité distale de la dissection. Tous les patients décrivaient des symptômes incluant une dysphagie (n = 15; 71,4 %), des régurgitations et/ou troubles de la déglutition (n = 19; 90 %). Seize patients (75 %) avaient un diverticule dont la profondeur était supérieure ou égale à 30 mm. Toutes les complications étaient notées. Les symptômes des patients (dysphagie, régurgitation, troubles de la déglutition et inhalations) étaient évalués lors de consultations de surveillance régulières ou par téléphone. Le test utilisé détermine la probabilité que les deux paramètres soient fortement liés au seuil p = 0,05 (test CMH). Une p-value inférieure à 0,05 indique une forte liaison entre les deux paramètres, donc on accepte l’hypothèse qu’il n’y a pas d’effet traitement. Les données ont été analysées à l’aide du logiciel SAS (version 9.2; SAS Institute Inc, Cary, NC). Tous les patients ont été traités avec succès lors de la première session. Nous n’avons eu aucune complication grave. Une hémorragie immédiate a été traitée endoscopiquement avec succès à l’aide d’une pince d’hémostase. Tous les patients sont sortis dans les 48 heures suivant l’intervention. À un mois et au moment de l’évaluation de suivi (7,85 mois [3–12]), la dysphagie et les régurgitations étaient significativement améliorées (p = 0,48/0,18 et 0,68/,041 respectivement). Dix-huit patients (85,7 %) n’avaient plus aucun symptôme. Pour trois patients, la dysphagie et/ou les régurgitations persistaient de manières plus modérées. La dysphagie et/ou les régurgitations ont récidivé pour deux patients (9,5 %). Un deuxième traitement endoscopique a été nécessaire et un patient a été opéré. Au final, le traitement endoscopique était efficace dans 90,4 % des cas. La diverticulotomie endoscopique au Dual-Knife® aidé du diverticuloscope est une alternative thérapeutique sûre et efficace pour des patients atteints d’un diverticule de Zenker symptomatique. More... »

PAGES

277-284

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10190-012-0263-3

DOI

http://dx.doi.org/10.1007/s10190-012-0263-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050684366


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22 schema:description Le Dual-Knife® (Olympus) est un nouveau couteau fréquemment utilisé pour la dissection sous-muqueuse du fait de sa sûreté et de sa précision. L’objet de cette étude était d’évaluer l’efficacité et la tolérance du traitement endoscopique du diverticule de Zenker avec le Dual-Knife® assisté d’un diverticuloscope (Cook®). De février 2009 à octobre 2011, 21 patients (14 hommes et sept femmes) dont l’âge moyen était de 70,7 ± 10,2 ans, présentant un diverticule de Zenker symptomatique, ont été inclus dans une étude prospective multicentrique non randomisée. La myotomie du muscle cricopharyngien était réalisée avec le Dual-Knife® après exposition du septum diverticulaire grâce au diverticuloscope. En fin de procédure, un ou deux clips étaient positionnés à l’extrémité distale de la dissection. Tous les patients décrivaient des symptômes incluant une dysphagie (n = 15; 71,4 %), des régurgitations et/ou troubles de la déglutition (n = 19; 90 %). Seize patients (75 %) avaient un diverticule dont la profondeur était supérieure ou égale à 30 mm. Toutes les complications étaient notées. Les symptômes des patients (dysphagie, régurgitation, troubles de la déglutition et inhalations) étaient évalués lors de consultations de surveillance régulières ou par téléphone. Le test utilisé détermine la probabilité que les deux paramètres soient fortement liés au seuil p = 0,05 (test CMH). Une p-value inférieure à 0,05 indique une forte liaison entre les deux paramètres, donc on accepte l’hypothèse qu’il n’y a pas d’effet traitement. Les données ont été analysées à l’aide du logiciel SAS (version 9.2; SAS Institute Inc, Cary, NC). Tous les patients ont été traités avec succès lors de la première session. Nous n’avons eu aucune complication grave. Une hémorragie immédiate a été traitée endoscopiquement avec succès à l’aide d’une pince d’hémostase. Tous les patients sont sortis dans les 48 heures suivant l’intervention. À un mois et au moment de l’évaluation de suivi (7,85 mois [3–12]), la dysphagie et les régurgitations étaient significativement améliorées (p = 0,48/0,18 et 0,68/,041 respectivement). Dix-huit patients (85,7 %) n’avaient plus aucun symptôme. Pour trois patients, la dysphagie et/ou les régurgitations persistaient de manières plus modérées. La dysphagie et/ou les régurgitations ont récidivé pour deux patients (9,5 %). Un deuxième traitement endoscopique a été nécessaire et un patient a été opéré. Au final, le traitement endoscopique était efficace dans 90,4 % des cas. La diverticulotomie endoscopique au Dual-Knife® aidé du diverticuloscope est une alternative thérapeutique sûre et efficace pour des patients atteints d’un diverticule de Zenker symptomatique.
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