ABSTRACT
En el transcurso de 2 años (1988-1990) se estudiaron 373 pacientes por ERCP para determinar la etiología de una colestasis. En 190 se encontraron cálculos en la vía biliar principal. Treinta y nueve fueron tratados quirúrgicamente y en 151 se efectuó EPE y diferentes técnicas de extracción. En 12 pacientes de este grupo de utilizó como tratamiento adicional ESWL para fragmentar cálculos que ho habían podido ser extraídos con canastilla o litotripsia mecánica. De los 12, 9 eran mujeres y 3 varones con un promedio de edad de 71 años (rango 32-90). Nueve estaban colecistectomizados y 3 tenían vesícula. La litiasis coledociana fue única en 4, y 5 tenían 2 cálculos. En los restantes se comprobaron 3 o más litos. El diámetro de los cálculos superó los 2,5 cm. en 11 pacientes. Sólo en 1 fue de 1 cm. Se efectuaron entre 1200 y 5000 disparos en cada sesión, con un promedio de 1400. En 8 pacientes (66%) la fragmentación permitió la evaluación completa, espontánea o instrumental. Se fracasó en 4 casos que recibieron una sola sesión de ESWL. Se registró hematobilia leve en 1 paciente y equimosis de piel y dolor en 2. En los 8 pacientes en los que se consiguió la eliminación total de los cálculos no hubo complicaciones alejadas. El empleo de ESWL resultó ser un recursos terapéutico útil en el tratamiento de cálculos coledocianos que no pudieron ser extraídos por EPE y maniobras instrumentales con canastilla y litotripsia mecánica (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Gallstones/therapy , Lithotripsy/methods , Prognosis , Aged, 80 and overABSTRACT
En el transcurso de 2 años (1988-1990) se estudiaron 373 pacientes por ERCP para determinar la etiología de una colestasis. En 190 se encontraron cálculos en la vía biliar principal. Treinta y nueve fueron tratados quirúrgicamente y en 151 se efectuó EPE y diferentes técnicas de extracción. En 12 pacientes de este grupo de utilizó como tratamiento adicional ESWL para fragmentar cálculos que ho habían podido ser extraídos con canastilla o litotripsia mecánica. De los 12, 9 eran mujeres y 3 varones con un promedio de edad de 71 años (rango 32-90). Nueve estaban colecistectomizados y 3 tenían vesícula. La litiasis coledociana fue única en 4, y 5 tenían 2 cálculos. En los restantes se comprobaron 3 o más litos. El diámetro de los cálculos superó los 2,5 cm. en 11 pacientes. Sólo en 1 fue de 1 cm. Se efectuaron entre 1200 y 5000 disparos en cada sesión, con un promedio de 1400. En 8 pacientes (66%) la fragmentación permitió la evaluación completa, espontánea o instrumental. Se fracasó en 4 casos que recibieron una sola sesión de ESWL. Se registró hematobilia leve en 1 paciente y equimosis de piel y dolor en 2. En los 8 pacientes en los que se consiguió la eliminación total de los cálculos no hubo complicaciones alejadas. El empleo de ESWL resultó ser un recursos terapéutico útil en el tratamiento de cálculos coledocianos que no pudieron ser extraídos por EPE y maniobras instrumentales con canastilla y litotripsia mecánica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gallstones/therapy , Lithotripsy , Aged, 80 and over , PrognosisABSTRACT
During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66%), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.
Subject(s)
Gallstones/therapy , Lithotripsy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , PrognosisABSTRACT
During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66
), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.
ABSTRACT
During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66
), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.
ABSTRACT
Los autores presentan su experiencia clinica em el tratamiento de la pancreatitis aguda de origen biliar, realizando esfinteropapilotomia endoscopica en urgencia para extraer calculos que obstruian el orificio ampular de la papila y/o el coledoco terminal, causa etiologica de la inflamacion aguda del pancreas. La serie comprende 4 pacientes portadores de pancreatitis aguda biliar tratados por este metodo, cuyos resultados inmediatos y alejados fueron satisfactorios
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Ampulla of Vater , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis , Pancreatitis , Surgical Procedures, OperativeABSTRACT
Los autores presentan su experiencia clinica em el tratamiento de la pancreatitis aguda de origen biliar, realizando esfinteropapilotomia endoscopica en urgencia para extraer calculos que obstruian el orificio ampular de la papila y/o el coledoco terminal, causa etiologica de la inflamacion aguda del pancreas. La serie comprende 4 pacientes portadores de pancreatitis aguda biliar tratados por este metodo, cuyos resultados inmediatos y alejados fueron satisfactorios
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Ampulla of Vater , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis , Pancreatitis , Surgical Procedures, OperativeABSTRACT
"Bulbitis" was classified by fiberoptic endoscopy in: superficial, erosive and pseudopolypoid. Endoscopic diagnosis of "bulbitis" is reliable, as good agreement was obtained in 100 cases tabulated according to histological grading. Erosive "bulbitis" implies a severe histopathological compromise.
