RESUMO
Antecedentes: La canulación biliar difícil es un factor de riesgo para la pancreatitis post-CPRE. En estos casos el precorte es la técnica más usada. Objetivo: Demostrar que el precorte tipo fistulotomía es seguro y eficaz. Materiales y métodos: Se revisaron los datos de mayo de 2016 a mayo de 2018. Se definió canulación difícil como: litiasis impactada, canulación inadvertida del conducto pancreático en tres ocasiones e incapacidad para lograr la canulación en 3 minutos. Las medidas de resultados fueron la canulación biliar exitosa y la pancreatitis post-CPRE. Resultados: Se realizó precorte tipo fistulotomía en 96 casos (67 mujeres, 29 hombres). La tasa de éxito de la canulación biliar fue del 95,8% (92/96). Ochenta pacientes tenían factores de riesgo para pancreatitis post CPRE: 29 tuvieron un solo factor de riesgo, 26 tuvieron dos, 19 tuvieron tres y 6 tuvieron cuatro. Factores de riesgo ampulares de canulación difícil: calculo impactado 9 casos, abultamiento de la papila en 10 casos, ubicación inferior del orificio papilar en 38 casos, localización parcial del poro papilar en 23 y estenosis del orificio papilar en 16 casos. Diez pacientes tuvieron divertículo periampular, 7 pacientes tuvieron conducto biliar normal. Ninguno de los pacientes experimentó pancreatitis. Tres pacientes tuvieron sangrado precoz, una paciente presento sangrado tardío. Un paciente (2%) tuvo fiebre y fue hospitalizado. Conclusiones: En casos de canulación biliar difícil el precorte tipo fistulotomía es seguro y eficaz.
Background: Difficult biliary cannulation is a risk factor for post-ERCP pancreatitis. In these cases, precutting is the most used technique. Objective: To demonstrate that precut fistulotomy is safe and effective. Materials and methods: Data from May 2016 to May 2018 were reviewed. Difficult cannulation was defined as: impacted lithiasis, inadvertent cannulation of the pancreatic duct on three occasions and inability to achieve deep biliary cannulation in 3 minutes. The outcome measures were successful biliary cannulation and post-ERCP Pancreatitis. Results: Precut fistulotomy was performed in 96 cases (67 women, 29 men). The success rate of biliary cannulation was 95.8% (92/96). Eighty patients had risk factors for post-ERCP pancreatitis: 29 had 1 risk factor, 26 had 2 risk factors, 19 had 3 risk factors, and 6 had four risk factors. Ampullary risk factors of difficult cannulation: impacted stone in the papilla: 9 cases, papilla bulging: 10 cases, lower location of the hole papillary 38 cases, partial location of the papillary pore 23 and papillary orifice stenosis 16 cases. Ten patients had periampullary diverticulum, 7 patients had normal bile duct. None of the patients experienced Pancreatitis. Three patients had early bleeding, one patient had late bleeding. One patient (2%) had a fever and was hospitalized. Conclusions: In cases of difficult biliary cannulation, the precut fistulotomy is safe and effective.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Pancreatite/prevenção & controle , Ampola Hepatopancreática/cirurgia , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/métodos , Ductos Pancreáticos , Pancreatite/etiologia , Fatores de Tempo , Ampola Hepatopancreática/diagnóstico por imagem , Ductos Biliares , Cateterismo/efeitos adversos , Cateterismo/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Colangiopancreatografia Retrógrada Endoscópica/métodosRESUMO
BACKGROUND: Difficult biliary cannulation is a risk factor for post-ERCP pancreatitis. In these cases, precutting is the most used technique. OBJECTIVE: To demonstrate that precut fistulotomy is safe and effective. MATERIALS AND METHODS: Data from May 2016 to May 2018 were reviewed. Difficult cannulation was defined as: impacted lithiasis, inadvertent cannulation of the pancreatic duct on three occasions and inability to achieve deep biliary cannulation in 3 minutes. The outcome measures were successful biliary cannulation and post-ERCP Pancreatitis. RESULTS: Precut fistulotomy was performed in 96 cases (67 women, 29 men). The success rate of biliary cannulation was 95.8% (92/96). Eighty patients had risk factors for post-ERCP pancreatitis: 29 had 1 risk factor, 26 had 2 risk factors, 19 had 3 risk factors, and 6 had four risk factors. Ampullary risk factors of difficult cannulation: impacted stone in the papilla: 9 cases, papilla bulging: 10 cases, lower location of the hole papillary 38 cases, partial location of the papillary pore 23 and papillary orifice stenosis 16 cases. Ten patients had periampullary diverticulum, 7 patients had normal bile duct. None of the patients experienced Pancreatitis. Three patients had early bleeding, one patient had late bleeding. One patient (2%) had a fever and was hospitalized. CONCLUSIONS: In cases of difficult biliary cannulation, the precut fistulotomy is safe and effective.