Morbilidad postoperatoria por colangiografía endoscópica retrógrada con o sin papilotomía ulterior: serie de casos / Postoperative morbidity by endoscopic retrograde cholangiography with or without ulterior papillotomy: series of cases

La patología biliar litiásica es frecuente en nuestro país, con prevalencias entre 30% y 50%; y la ictericia obstructiva secundaria a coledocolitiasis (IOC), constituye un motivo de consulta frecuente en los servicios de urgencia. Por otra parte, la papilotomía endoscópica (PE) post colangiografía retrógrada endoscópica (CRE), constituye el tratamiento de elección en estos casos; sin embargo, es un procedimiento no exento de complicaciones. El objetivo de este estudio, es describir la MPO e identificar posibles factores de riesgo (FR) asociados a MPO, en pacientes con IOC, sometidos a PE. Serie de casos retrospectiva, de pacientes con IOC, a quienes se les realizó CRE y ulterior PE. La variable resultado fue desarrollo de MPO (hemorragia, perforación y pancreatitis). Otras variables de interés fueron canulación, dificultad de ésta, desarrollo de PE, uso de pre corte y mortalidad. La recolección de datos se realizó mediante una pauta ad-hoc, en la que se registraron las variables extraídas desde el protocolo operatorio y la ficha clínica. Se aplicó estadística descriptiva y analítica (Chi2 de Pearson y exacto de Fisher) para estimar fuerza de asociación. Se intervinieron 200 pacientes. La Media de edad fue de 60±18 años; 62% eran mujeres (n= 124). Se registró MPO en 32 casos (16,0%): Perforación (0,5%), pancreatitis (2,0%) y hemorragia (13,5%). La serie no registró mortalidad. No se logró objetivar asociación entre la variable "canulación difícil" y las variables hemorragia (p= 0,214); pancreatitis (p= 0,519); ni perforación (p= 1). Sin embargo, se verificó asociación entre el desarrollo de hemorragia y la realización de PE (p= 0,017). La hemorragia es la MPO más frecuente en esta serie; y la PE es un FR para el desarrollo de hemorragia.

Bileduct stones is prevalent in our country, with prevalences between 30% and 50%; and obstructive jaundice secondary to choledocholithiasis (OJC), is a frequent reason of consultation in emergency services. Furthermore, endoscopic papillotomy (EP) post ERCP is the treatment of choice in these cases; however, it is not free of complications (POM). The aim of this study is to describe POM and identify potential risk factors (RF) associated with POM in patients with OJC, underwent PE. Retrospective case series of patients with OJC, who underwent ERCP and subsequent PE. Outcome variable was the development of POM (bleeding, perforation, and pancreatitis). Other variables of interest were cannulation, difficulty of this, developing PE, using precut and mortality. Data collection was performed by an ad-hoc pattern in which the variables extracted from surgical protocols and clinical data were recorded. Descriptive and analytical statistics (Pearson Chi2 and Fisher's exact test) were applied to assess strength of association. 200 patients were operated. The mean age was 60±18 years; 62% were women (n = 124). MPO was recorded in 32 cases (16.0%): perforation (0.5%), pancreatitis (2.0%) and bleeding (13.5%). The series does not record mortality. It was not possible to objectify association between "difficult cannulation" and the variables bleeding (p= 0.214); pancreatitis (p= 0.519); and perforation (p= 1). However, association between bleeding and performing PE (p= 0.017) was observed. Hemorrhage is the most common cause of MPO in this series; and PE is a RF for the development of bleeding.

Efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in treatment of common bile duct calculi / 中国医师杂志

Objective To explore the therapeutic efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi in order to reduce the recent and long-term complications.Methods A total of 120 cases of patients with common bile duct calculi was grouped into three groups:endoscopic sphincterotomy joint balloon dilatation,endoscopic sphincterotomy (EST),and endoscopic papillo-sphincter balloon dilatation (EPBD).The operative efficacy of three groupsand the incidence of postoperative immediate and long-term complications were observed and compared.Results No difference was found in total stone-free rate among three groups.No significant difference was found in a stone-free rate and lithotripsy rate between endoscopic sphincterotomy joint balloon dilatation and EST groups (P ＞ 0.05),however,those parameters in the former two groups were better than EPBD group (P ＜ 0.05).The incidence of postoperative bleeding in the endoscopic sphincterotomy joint balloon dilatation group is lower than EST group.The incidence of postoperative pancreatitis in the endoscopic sphincterotomy joint balloon dilatation and EST groups was lower than the EPBD group(P ＜ 0.05).For the long-term complications,the incidence of reflux cholangitis in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST group (P ＜ 0.05).The recurrence rate of postoperative bile duct calculi in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST and EPBD groups.Conclusions For the endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi,its curative effect was the same as the EST,but better than EPBD; it had a lower incidence of immediate and long-term complications than EST and EPBD.