Colangiografía retrógrada realizada con enteroscopia asistida por balón simple en pacientes con anatomía alterada por cirugía en una clínica privada nivel III / Retrograde cholangiography performed with simple balloon-assisted enteroscopy in patients with altered anatomy by surgery in a private level III clinic

RESUMEN Objetivo : Evaluar la utilidad de la colangiografía retrógrada realizada con enteroscopia asistida por balón simple para el manejo de la patología de la via biliar en pacientes con anatomía alterada por cirugía en la Clínica Anglo Americana. Materiales y métodos : El presente es un estudio descriptivo retrospectivo donde se evalúan a todos los pacientes con anatomía alterada que acudieron por problemas de la via biliar para realizarse una colangiografía retrógrada asistida por enteroscopia con balón simple en la Clínica Anglo Americana durante el periodo de enero del 2014 a enero del 2020. Resultados : Realizamos 10 estudios de colangiografía retrógrada asistida por enteroscopia con balón simple. La canulación de la vía biliar fue exitosa en el 80% de nuestros casos, en dos casos no se pudo localizar la via biliar. Los hallazgos de la colangiografía retrógrada fueron litiasis de via biliar en 7 casos, estenosis de la anastomosis biliodigestiva en 5 casos y un ampuloma. Los procedimientos terapeúticos más frecuentes fueron dilatación con balón progresivo CRE de la anastomosis bilioentérica y extracción de litos con canastilla de Dormia. No se presentaron complicaciones asociadas al procedimiento. Conclusión : La colangiografía retrógrada asistida por enteroscopia con balón simple es un método seguro y eficaz para resolver la patología biliar en nuestros pacientes con anatomía alterada.

ABSTRACT Objective : To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. Materials and methods : This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. Results : We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. Conclusion : Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.

Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis

Background: Endoscopic sphincterotomy [EST] combined with balloon catheters and/or baskets are the routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large common bile duct [CBD] stones are treated conventionally with mechanical lithotripsy, large balloon papillary dilation after endoscopic sphincterotomy [ELPBD] represents the onset of an era in large CBD stone extraction and the management of [impaction]. That is because it seems effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones

Methods: Randomized prospective comparative study was conducted on seventy four patients with CBD stone[s], subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD[s]

The enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in the great majority of patients

Results: Complete extraction CBD stones among the patients of groupl; EPLBD was effective for clearance of [92.5%] of CBD stones in patients with the stone sized < 1cm and in [83%] of patients with stone size > 1cm, [overall clearance rate=87%]

Overall adverse effects of patients of groupl was [29%] as mild self-limiting post ERCP pain occurred in [9.6%] and mild intra- procedure bleeding occurred in [9.6%], whereas more serious complication as melena which occurred in [3.2%], and mild pancreatitis occurred in [6.4%]. Whereas complete CBD stones clearance among the patients of group 2; EST was effective in [96%] of patients with the stone sized < 1 cm, while stone clearance occurred in [56%] in patient with stone size> 1cm, [overall clearance rate=79%]. Overall adverse effects of patients of group 2 was [18.5%] as mild self-limiting post ERCP pain occurred in [7%] and mild intra-procedure bleeding occurred in [4.6%], whereas more serious complications as mild pancreatitis developed in [4.6%], and post ERCP cholangitis in [2.3%] The comparison between the two groups regarding the extraction of CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients whose the CBD stone size < 1 cm. Whereas the clearance rate of CBD stones in the patients with stone size > 1cm among the group 1 was [83%] which better than among the group 2 which was [56%] with nearly statistical difference [P value=0.07]

Conclusion: Conventional EST is an effective method for removal of common bile duct stones < 1 cm in diameter whereas the use of large papillary balloon dilation after endoscopic sphincterotomy improve the clearance rate of bile duct stones> 1cm which is difficult to be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones

Cápsula endoscópica: quando indicar seu uso? / Endoscopic capsule: when to indicate its use?

Muito do diagnóstico e tratamento das patologias do intestino delgado tem sido discutido e estudado na última década, desde a introdução da cápsula endoscópica na prática médica. Esta importante inovação tecnológica possibilitou o rompimento da última fronteira endoscópica do trato digestivo, permitindo o acesso endoscópico a toda a extensão do intestino delgado, o qual, devido a suas peculiaridades anatômicas e extensão, permanecia acessível somente à enteroscopia intraoperatória.

Both diagnosis and treatment of small intestine pathology has been discussed and studied in last decade since the introduction of endoscocopy capsule in medical practice. This important technological innovation allowed to break the last endoscopy borderline of digestive tract permitting endoscopy access for all extent of small intestine which due its anatomical peculiarities and extent remained accessible only to intraoperative enteroscopy.

Enteroscopía como método diagnóstico para neoplasias de intestino delgado / Enteroscopy as a diagnostic method for neoplasms of small intestine

Las neoplasias del tubo digestivo constituyen un verdadero reto para el médico. Hasta hace unos años el estudio de la patología del intestino delgado se realizaba a través de métodos no invasivos de visión indirecta (tránsito intestinal, tomografía computarizada axial, resonancia magnética nuclear o gammagrafía) o métodos invasivos de visión directa que exploraban la totalidad de intestino delgado a través de cirugías abdominales (enteroscopía intraoperatoria). Con el inicio de la enteroscopía por pulsión los tumores benignos o malignos localizados entre la 2° porción del duodeno y la válvula ileocecal, han dejado de ser diagnósticos apegados a procedimientos con baja sensibilidad o una elevada tasa de complicaciones. La facilidad con la cual la enteroscopía puede realizar un diagnóstico histopatológico a través de la toma de muestras o la realización de un tratamiento terapéutico lo vuelven una herramienta útil para el médico y la búsqueda de tumores del intestino delgado. El presente caso corresponde a un paciente masculino, de 64 años, conocido por una enfermedad diverticular, quien presenta síntomas constitucionales que hacen sospechar una neoplasia del tracto digestivo; se realiza una endoscopia de tubo digestivo superior la cual es normal, luego una Tomografía Axial Computarizada Abdominal que muestra una lesión a nivel de la 4° porción del duodeno en la que no puede establecerse su origen intra o extra-luminal, hasta que se realiza una enteroscopía como un método diagnóstico.