La thoracoscopie médicale en pratique pneumologique: expérience du CHU de Liège

[en] Introduction: The incidence of pleural disease continues to increase worldwide. Medical thoracoscopy remains the standard method for exploration of the pleural cavity. Method: We report the retrospective evaluation, the efficacy and the observed complications in 1024 medical thoracoscopies undertaken in the University Hospital of Liège between 2000 and 2017. Results: In total, 100 pneumothoraces and 400 benign and 501 malignant pleural diseases were identified. The main indication for thoracoscopy remains the diagnosis of an exudative, lymphocytic pleural effusion of unknown aetiology after thoracocentesis. The diagnostic sensibility of thoracoscopy was 99.2% in distinguishing benign from malignant pleural disease. Talc pleurodesis was performed in 69.5% of the total population and in 66.1% of pleural effusions or thickening. Failure of pleurodesis was observed in 11% of the patients with recurrent pneumothorax and in 7.8% of neoplastic pleural effusion. We report a mortality of 0.6% in the 30 days post procedure, long duration of drainage in 8.3% and serious complications in 4.7%. In 22/1024 (2.1%) thoracoscopic evaluation was not feasible because of dense pleural fibrosis. Conclusion: Medical thoracoscopy is a safe, well-tolerated procedure with high accuracy in the diagnostic and therapeutic management of pleural disease. © 2019 SPLF

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

DUYSINX, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Oncologie thoracique

HEINEN, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de pneumologie - allergologie

Corhay, Jean-Louis ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques

VAILLANT, Frédérique ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de pneumologie - allergologie

Gomez, A.; Service de pneumologie, CHU de Sart-Tilman B35, Liège, B4000, Belgium

Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie

Language :

French

Title :

La thoracoscopie médicale en pratique pneumologique: expérience du CHU de Liège

Alternative titles :

[en] Medical thoracoscopy in respiratory medicine: The Liège University Hospital experience

Publication date :

2019

Journal title :

Revue des Maladies Respiratoires

ISSN :

0761-8425

eISSN :

1776-2588

Publisher :

Elsevier Masson SAS

Volume :

Pages :

688-696

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 11 November 2019

Statistics

Number of views

161 (8 by ULiège)

Number of downloads

521 (12 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Maskell, N., British Thoracic Society Pleural Disease Guidelines – 2010 update. Thorax 65 (2010), 667–669.
American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 162 (2000), 1987–2001.
Rodriguez-Panadero, F., Borderas, N.F., Lopez, M.J., Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 2 (1989), 366–369.
Light, R.W., Clinical practice. Pleural effusion. N Engl J Med 346 (2002), 1971–1977.
Duysinx, B., Heinen, V., Corhay, J.L., et al. Méthode d'investigation de la plèvre. 2017, Édition Médico-Chirurgicale [6-000-F-55].
Porcel, J.M., CT versus thoracic ultrasound for discriminating uncomplicated and complicated parapneumonic pleural effusions – Reply. Respirology 23 (2018), 232–233.
Metintas, M., Ucgun, I., Elbek, O., et al. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radiol 41 (2002), 1–9.
Duysinx, B., Corhay, J.L., Larock, M.P., et al. Contribution of positron emission tomography in pleural disease. Rev Mal Respir, 27, 2010 [e47-e53].
Treglia, G., Sadeghi, R., Annunziata, S., et al. Diagnostic accuracy of 18F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and meta-analysis. Acad Radiol 21 (2014), 11–20.
Roca, E., Laroumagne, S., Vandemoortele, T., et al. 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography fused imaging in malignant mesothelioma patients: looking from outside is not enough. Lung Cancer 79 (2013), 187–190.
Schönfeldt, N., Loddenkemper, R., Pleural biopsy and thoracoscopy. Eur Respir Mon, 1998, 135–152 [Ref Type: Serial (Book, Monograph)].
Rodriguez-Panadero, F., Medical thoracoscopy. Respiration 76 (2008), 363–372.
Michaud, G., Berkowitz, D.M., Ernst, A., Pleuroscopy for diagnosis and therapy for pleural effusions. Chest 138 (2010), 1242–1246.
Tschopp, J.M., Schnyder, J.M., Astoul, P., et al. Pleurodesis by talc poudrage under simple medical thoracoscopy: an international opinion. Thorax 64 (2009), 273–274.
Froudarakis, M.E., Bouros, D., Management of pleural empyema: don't miss the point!. Respiration 86 (2013), 277–279.
Rodriguez-Panadero, F., Janssen, J.P., Astoul, P., Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J 28 (2006), 409–422.
Marchetti, G., Valsecchi, A., Indellicati, D., et al. Ultrasound-guided medical thoracoscopy in the absence of pleural effusion. Chest 147 (2015), 1008–1012.
Froudarakis, M.E., Medical thoracoscopy: the green shapes of grey. Chest 147 (2015), 869–871.
Froudarakis, M.E., Diagnostic work-up of pleural effusions. Respiration 75 (2008), 4–13.
Hooper, C., Lee, Y.C., Maskell, N., Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax, 65, 2010 [ii4-17].
Saguil, A., Wyrick, K., Hallgren, J., Diagnostic approach to pleural effusion. Am Fam Physician 90 (2014), 99–104.
Janssen, J.P., Why you do or do not need thoracoscopy. Eur Respir Rev 19 (2010), 213–216.
Tape, T.G., Blank, L.L., Wigton, R.S., Procedural skills of practicing pulmonologists. A national survey of 1,000 members of the American College of Physicians. Am J Respir Crit Care Med 151 (1995), 282–287.
Havelock, T., Teoh, R., Laws, D., et al. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax, 65, 2010 [ii61-ii76].
Corcoran, J.P., Psallidas, I., Hallifax, R.J., et al. Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy. Thorax 70 (2015), 906–908.
Rahman, N.M., Ali, N.J., Brown, G., et al. Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010. Thorax, 65, 2010 [ii54-ii60].
Dresler, C.M., Olak, J., Herndon, J.E., et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 127 (2005), 909–915.
Zavala, D.C., Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest 70 (1976), 584–588.
Nour Moursi, A.S., Saka, H., Mohammadien, H.A., et al. Safety and complications of medical thoracoscopy. Adv Med, 2016, 2016 [3794791].
Noppen, M., Stratakos, G., Verbanck, S., et al. Fluorescein-enhanced autofluorescence thoracoscopy in primary spontaneous pneumothorax. Am J Respir Crit Care Med 170 (2004), 680–682.
Kim, S.J., Choi, S.M., Lee, J., et al. Medical thoracoscopy in pleural disease: Experience from a one-center study. Tuberc Respir Dis (Seoul) 80 (2017), 194–200.
Breen, D.P., Mallawathantri, S., Fraticelli, A., et al. Feasibility of short term drainage for diagnostic thoracoscopy. Monaldi Arch Chest Dis 71 (2009), 54–58.
Reddy, C., Ernst, A., Lamb, C., et al. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest 139 (2011), 1419–1423.
Bhatnagar, R., Kahan, B.C., Morley, A.J., et al. The efficacy of indwelling pleural catheter placement versus placement plus talc sclerosant in patients with malignant pleural effusions managed exclusively as outpatients (IPC-PLUS): study protocol for a randomised controlled trial. Trials, 16, 2015, 48.
Depew, Z.S., Wigle, D., Mullon, J.J., et al. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest 146 (2014), 398–405.
Rahman, N.M., Pepperell, J., Rehal, S., et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA 314 (2015), 2641–2653.
Shojaee, S., Lee, H.J., Thoracoscopy: medical versus surgical-in the management of pleural diseases. J Thorac Dis, 7, 2015 [S339-S351].
Dhooria, S., Singh, N., Aggarwal, A.N., et al. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care 59 (2014), 756–764.
Ishida, A., Ishikawa, F., Nakamura, M., et al. Narrow band imaging applied to pleuroscopy for the assessment of vascular patterns of the pleura. Respiration 78 (2009), 432–439.
Chrysanthidis, M.G., Janssen, J.P., Autofluorescence videothoracoscopy in exudative pleural effusions: preliminary results. Eur Respir J 26 (2005), 989–992.
Gotoh, M., Yamamoto, Y., Igai, H., et al. Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung. J Thorac Cardiovasc Surg 134 (2007), 1498–1501.
Tousheed, S.Z., Manjunath, P.H., Chandrasekar, S., et al. Cryobiopsy of the pleura: an improved diagnostic tool. J Bronchology Interv Pulmonol 25 (2018), 37–41.
Froudarakis, M.E., New challenges in medical thoracoscopy. Respiration 82 (2011), 197–200.