Uso de gadolinio como contraste en CPRE en pacientes con reacciones adversas a contrastes yodados / Use of gadolinium as contrast agent in endoscopic retrograde cholangiopancreatography in patients with iodine allergy

RESUMEN

Introducción Para la realización de colangiopancreatografía retrógrada endoscópica (CPRE) es necesario el uso de contrastes radiológicos, utilizándose habitualmente contrastes yodados. La pauta de actuación ante pacientes que han sufrido reacciones adversas a contrastes yodados y que van a recibir una CPRE es controvertida. Objetivo Evaluar la seguridad y eficacia de un contraste basado en gadolinio en pacientes con reacciones alérgicas previas a contrastes yodados durante la realización de CPRE. Material y métodos Se utilizó gadobutrol como agente de contraste, un compuesto basado en el gadolinio, sin utilizar profilaxis previa. Se realizaron 13 procedimientos en 11 pacientes con antecedentes de reacciones adversas previas a contrastes yodados. Resultados Las CPRE fueron completadas satisfactoriamente en todos los casos, obteniéndose 13 colangiogramas y un pancreatograma. La calidad de imagen obtenida fue buena, equiparable a la obtenida con los contrastes yodados utilizados habitualmente, y permitiendo realizar el diagnóstico y la terapéutica endoscópica sin suponer una limitación. No se encontraron efectos adversos relacionados con el contraste y tampoco complicaciones post-CPRE. Conclusiones El gadobutrol, un contraste basado en gadolinio, es una alternativa segura y eficaz en pacientes alérgicos a contrastes yodados(AU)

ABSTRACT

Introduction Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP. Objective To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP. Material and methods Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis. Results In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications. Conclusions Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients (AU)