ABSTRACT
Estudiamos manométricamente a 65 pacientes con sintomatología de esofagitis por reflujo gastroesofágico (ERGE), de ellos 36 tuvieron evidencia de reflujo endoscópicamente (21 masculinos y 15 femeninos). Las alteraciones encontradas en el cuerpo fueron ausencia de peristalsis efectiva en 20 por ciento y ondas no transmitidas en 75 por ciento con hipotomía y sin relajación apropiada 16 por ciento. Concluimos que no puede aseverarse si el reflujo es debido a las alteraciones o estas lo producen
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Endoscopy, Gastrointestinal/statistics & numerical data , Manometry/statistics & numerical data , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/physiopathology , Esophageal Motility Disorders/physiopathology , Esophagogastric Junction/physiopathologyABSTRACT
La esofagogastroduodenoscopia (EGD) ha demostrado ser un procedimiento seguro y útil. Su uso durante el embarazo no ha sido aceptado. El registro tococardiográfico de la frecuencia cardíaca fetal es un índice confiable del bienestar del producto, y sus alteraciones muestran el sufrimiento fetal. Se realizo un estudio prospectivo y logitudinal en 75 mujeres embarazadas, con sintomatología gastrointestinal superior, las cuales se sometieron a procedimiento endoscópico con monitoreo tococardiográfico. El promedio de edad fue de 26.6 años. 27 pacientes (49.3 por ciento) se encontraban entre la semana 20 y 27 de gestación 23 (30.6 por ciento) entre la semana 28 y 35). 15 pacientes (20 por ciento) entre la semana 36 y 42. Se registro bradicardía transitoria leve en 45 productos (60 por ciento), taquicardía transitoria en 15 (20 por ciento) y no se presentaron alteraciones 15 productos (20 por ciento). No se registro ninguna complicación durante el procedimiento ni durante el periodo de seguimiento hasta el momento del parto. Concluimos que el procedimiento de EGD realizado en las mujeres embarazadas es un procedimiento seguro y útil, y que no representa riesgo para la madre ni el producto.
Subject(s)
Humans , Female , Pregnancy , Adult , Echocardiography , Endoscopy, Digestive System , Fetal Distress/diagnosis , Fetal Monitoring , Pregnancy Trimester, Second , Risk Assessment , Security MeasuresABSTRACT
Oddi sphincter dysfunction is manifested as a biliary- or pancreatic-type pain syndrome. At present, imaging studies are not very trustworthy for the diagnosis of this dysfunction, because of which direct endoscopic manometry offers the gold standard for confirming or ratifying the problem, supported by the Milwaukee Biliary Classification. Currently, the endoscopic approach has become the most effective alternative used for this type of diagnosis. Among the techniques may be found the following: endoscopic sphincterotomy, balloon dilation, the placing of biliary endoprostheses, and the injection of botulinic toxin in the Oddi sphincter. In our modest and short experience with six patients, of which five corresponded to group I of the Milwaukee bile classification, the above patients were treated successfully with sphincterotomy. The other two patients belonged to group type III of the Milwaukee classification, and were treated with botulinic toxin until the moment of a satisfactory response, for a period of 8 months.
Subject(s)
Common Bile Duct Diseases/surgery , Sphincter of Oddi , Sphincterotomy, Endoscopic , Adult , Anti-Dyskinesia Agents/administration & dosage , Botulinum Toxins/administration & dosage , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Time FactorsABSTRACT
BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for patients with symptomatic gallstones. The management of choledocholithiasis in these patients remains controversial. Endoscopic retrograde cholangiopancreatography (ERCP) with ductal stone clearance prior to laparoscopic cholecystectomy is one of the options. OBJECTIVE: To evaluate the results of ERCP prior to laparoscopic cholecystectomy in patients with suspected ductal stones. METHODS: We performed a retrospective study from patients who underwent ERCP prior to laparoscopic cholecystectomy in a four years period. RESULTS: ERCP was successful in 86 out of 88 patients (97.7%). Common bile duct (CBD) stones were found in 34 patients (39.5%). Sixty two of 86 patients had symptomatic gallstones with abnormal liver function test and/or ultrasound. CBD stones were found in 25 of the 62 symptomatic patients (40.3%). Twenty four patients had acute biliary pancreatitis. CBD stones were found in nine of these patients (37.5%). All patients with CBD stones underwent stone extraction after endoscopic sphincterotomy (ES). Sixteen other patients underwent ES for suspected obstruction at the ampulla. Stone extraction was successful in 100% of patients. There were six patients with complications (6.9%). Four patients had pancreatitis (4.6%), one patient hemorrhage (1.1%) and one patient cholangitis (1.1%). Analysis using logistic regression model showed that CBD stones on ultrasonography was the only variable significantly associated with choledocholithiasis (P < 0.001). CONCLUSIONS: Preoperative ERCP is useful in the management of CBD stones prior to laparoscopic cholecystectomy.
