ABSTRACT
Acute pancreatitis is a constant management challenge, especially with peripancreatic collection that are one of the most common complications; after the first surgical attempts that had high mortality, there had to be a new approach based in decades of acquired knowledge in physiopathology added to the development of endoscopic intervention techniques and the evolution of endoscopic devices help to establish less invasive and conservative management. This review allows us to know the last advances in the management of acute pancreatitis, pancreatic pseudocyst and walled off necrosis, determined the right time for the management to become more invasive, even considering surgery at a final stage. It also reviews the different types of drainage of peripancreatic collections and the accessories currently in use.
La Pancreatitis Aguda nos plantea un reto constante en su manejo teniendo a las colecciones líquidas peri pancreáticas como una de las complicaciones más frecuente ; inicialmente de manejo quirúrgico con una alta mortalidad, fue necesario replantear este enfoque en base a los conocimientos adquiridos durante décadas sobre su fisiopatología, que sumado al desarrollo de las técnicas de intervención endoscópica y evolución de los dispositivos endoscópicos permitió establecer manejos menos invasivos y conservadores. Esta revisión nos permite conocer los últimos avances en el manejo de la pancreatitis aguda, seudoquiste pancreático y necrosis encapsulada; determinando en que momento nuestro manejo debe tornarse más invasivo hasta llegar a la cirugía. Haciendo una revisión en los diferentes tipos de drenaje de las colecciones peri pancreáticas y los diferentes accesorios utilizados hasta el momento.
Subject(s)
Humans , Pancreatic Pseudocyst/therapy , Pancreatitis/therapy , Drainage/methods , Acute Disease , Cholangiopancreatography, Endoscopic Retrograde , Combined Modality Therapy , Endosonography , Conservative Treatment/methodsABSTRACT
La endomicroscopia confocal láser basada en probes (Cellvizio de Mauna Kea Technologies, París) es una nueva tecnología que permite, durante cualquier procedimiento endoscópico, realizar análisis histológicos en tiempo real (biopsia óptica), mejorando el diagnóstico y ayudando a definir el tratamiento de múltiples patologías digestivas. Es de resaltar, para nuestro medio, su utilidad en patologías de difícil diagnóstico como son las estenosis biliares indeterminadas y las neoplasias quísticas pancreáticas, cuyo diagnóstico temprano y exacto es muy difícil con las técnicas actualmente disponibles, y que es necesario para definir la realización o la exclusión de tratamientos quirúrgicos de alta morbimortalidad y alto costo, como por ejemplo, la cirugía de Whipple. En esta revisión se muestran los aportes actuales de esta tecnología, ya disponible en nuestro medio, para el diagnóstico y estudio de las patologías digestivas.
Probe based confocal laser endomicroscopy (Cellvizio Mauna Kea, Paris) is a new technology that allows performance of histological analysis (optical biopsy) during any endoscopic procedure. This improves diagnosis and helps define the treatment needed for multiple digestive diseases. Its utility for diseases that are difficult to diagnose such as indeterminate biliary strictures and pancreatic cystic neoplasms is noteworthy. Early and accurate diagnoses can be very difficult with currently available techniques, but they are exactly what are needed to determine whether or not expensive surgical treatments with great potential morbidity, for example the Whipple procedure, need to be performed. This review looks at the contribution that this technology can make in our country where it is now available for the diagnosis and study of digestive diseases.
Subject(s)
Humans , Gastrointestinal Neoplasms , Mass Screening , Microscopy, ConfocalABSTRACT
Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.