RESUMO
Objetivo: Describir la experiencia clínica con la técnica de dilatación de la esfinterotomía papilar con balones de gran diámetro en pacientes con coledocolitiasis de difícil extracción. Materiales y métodos: Estudio retrospectivo, diseño descriptivo. Serie de Casos. Se analizaron las historias clínicas de 18 pacientes que fueron sometidos a colangiopancreatografía retrograda endoscópica (CPRE) más dilatación papilar con balón de gran diámetro (DPBGD) por presentar coledocolitiasis de gran tamaño (≥15 mm), desproporción de diámetro entre cálculo y colédoco distal y/o papila yuxtadiverticular. Se emplearon balones dilatadores CRETM entre 12 y 20mm de diámetro. Se consignaron datos como éxito del procedimiento, uso de litotricia; así como complicaciones durante el procedimiento. Resultados: La edad promedio fue 66,1 años. Hubo predominio del género femenino (66,7%). El tamaño promedio de los cálculos en vía biliar fue de 16,7 mm. Las indicaciones de DPBGD fueron: coledocolitiasis gigante (12 pacientes, 66,7%), discordancia entre el diámetro del cálculo y el colédoco distal (6 pacientes, 33,3%). El diámetro de los balones de dilatación más frecuentemente empleados fueron: 15 mm (8 pacientes, 44,4%), 18 mm (5 pacientes, 27,8%), 12 mm (3 pacientes, 16,7%) y 20 mm (2 pacientes, 11,1%). Se consiguió la extracción completa de los cálculos en 15 pacientes (83,3%). Se precisó litotricia en 4 pacientes (22,2%). Hubo 3 pacientes en los que la extracción con balón fue frustra, realizándose manejo quirúrgico. Se reportó 1 caso de pancreatitis aguda leve (5,5%). Conclusiones: Los resultados demuestran que la dilatación con balón es una alternativa segura y eficaz en el manejo de los cálculos en vía biliar de difícil extracción
Objective: The aim of this study was to report the initial experience of the combined use of biliary sphincterotomy plus balloon dilatation of the papilla for management of large stones. Materials and methods: Design: Retrospective, descriptive. This study included 18 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2012 and April 2014. Patients had multiple large stones, tapered distal common bile duct, previous sphincterotomy, or peri/ intradiverticular papilla. CRE™ dilatation balloons with diameters ranging from 12 to 20 mm were used. Data were recorded as successful procedure, use of lithotripsy and complications during the procedure. Results: The average age was 66.1 years. There was a predominance of the female gender (66.7%). The average size of the bile duct stones was 16.7 mm. The main indications were: giant choledocholithiasis (12 patients, 66.7%) and tapered distal common bile duct (6 patients, 33.3%). The dilatation balloons diameter used were: 15 mm (8 patients, 44.4%), 18 mm (5 patients, 27.8%), 12 mm (3 patients, 16.7%) and 20 mm (2 patients, 11.1%). Complete stone clearance was achieved in 15 patients (83.3%). Lithotripsy was performed in 4 patients (22.2%). There were 3 patients in whom the removal with balloon was unsuccessful, performed surgical management. It was reported 1 case of mild acute pancreatitis (5.5%). Conclusions: The results show that endoscopic papillary large balloon dilation after sphincterotomy is a safe and effective technique for treatment of difficult bile duct stones
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esfinterotomia Endoscópica , Coledocolitíase/terapia , Dilatação/métodos , Litotripsia , Estudos Retrospectivos , Colangiopancreatografia Retrógrada Endoscópica , Resultado do Tratamento , Terapia Combinada , Coledocolitíase/diagnóstico por imagem , Dilatação/instrumentaçãoRESUMO
OBJECTIVE: The aim of this study was to report the initial experience of the combined use of biliary sphincterotomy plus balloon dilatation of the papilla for management of large stones. MATERIALS AND METHODS: Design: Retrospective, descriptive. This study included 18 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2012 and April 2014. Patients had multiple large stones, tapered distal common bile duct, previous sphincterotomy, or peri/ intradiverticular papilla. CRE™ dilatation balloons with diameters ranging from 12 to 20 mm were used. Data were recorded as successful procedure, use of lithotripsy and complications during the procedure. RESULTS: The average age was 66.1 years. There was a predominance of the female gender (66.7%). The average size of the bile duct stones was 16.7 mm. The main indications were: giant choledocholithiasis (12 patients, 66.7%) and tapered distal common bile duct (6 patients, 33.3%). The dilatation balloons diameter used were: 15 mm (8 patients, 44.4%), 18 mm (5 patients, 27.8%), 12 mm (3 patients, 16.7%) and 20 mm (2 patients, 11.1%). Complete stone clearance was achieved in 15 patients (83.3%). Lithotripsy was performed in 4 patients (22.2%). There were 3 patients in whom the removal with balloon was unsuccessful, performed surgical management. It was reported 1 case of mild acute pancreatitis (5.5%). CONCLUSIONS: The results show that endoscopic papillary large balloon dilation after sphincterotomy is a safe and effective technique for treatment of difficult bile duct stones.
Assuntos
Coledocolitíase/terapia , Dilatação/métodos , Esfinterotomia Endoscópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Terapia Combinada , Dilatação/instrumentação , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
La gastritis hemorrágica por radiación es una entidad rara. Nosotros presentamos un caso, en un paciente varón de 75 años, admitido por melena recurrente y anemia, a quien se le aplicó previamente radioterapia adyuvante por un hipernefroma. Este paciente requirió la transfusión de 10 unidades de paquete globular. La endoscopía inicial mostró múltiples telangiectasias difusas en antro con sangrado activo espontáneo, tratadas exitosamente con varias sesiones de probeta caliente.
The hemorrhagic radiation gastritis is rare. We describe a case, a 75-year-old man admitted for recurrent melena and progressive anemia, with history of adjuvant radiotherapy of hipernefroma. He required the transfusion with 10 units of packed red blood cells. The initial endoscopy revealed multiple telangiectasias spreading in the antrum, with active spontaneous bleeding, successfully treated with some sessions of heater probe.
Assuntos
Masculino , Humanos , Idoso , Gastrite/patologia , Gastrite/terapiaRESUMO
La Proctitis actínica es una complicación tardía de la radioterapia pélvica. El presente estudio describe la experiencia del empleo de probeta caliente en el manejo de pacientes con sangrado rectal causado por proctitis actínica refractaria a tratamiento médico. Material y métodos: El presente estudio es descriptivo prospectivo, el período de estudio fue Junio 2000-Abril 2001. Se incluyeron 30 pacientes, con sangrado rectal persistente, diario, que no mejoró con enemas de dexametasona o sucralfato. Se incluyeron pacientesque por lo menos tuvieron 2 sesiones. Se empleóuna probeta caliente de 2,8 mm marca Olympus modelo HPU, se aplicó a través de un Video -Colonoscopio marca Olympus modelo CF140L. Aplicándose la probeta firmemente contra la telangiectasia hasta su coagulación, tratando de abarcar la mayor área posible por sesión. Se aplicaban toques de 25 a 30 J cada uno, con 6 a 12 toques por sesión. Se empleó de 150 a 300 Joules/sesión, con 1 a 2 sesiones por mes. En cada sesión el paciente refería el grado de mejoría con una escala de 1 a 10 puntos y si habían recibido transfusiones. Se consideró pacientes de alta a aquellos en los que el sangrado rectal desapareció o fue mínimo con mejoría endoscópica. No se reportaron complicaciones. Resultados: Se incluyeron 30 pacientes. 28 fueron mujeres (93.3%). Todos refirieron mejoría en cada sesión con rangos de 3 a 10 (escala de 1 a 10). El puntaje promedio de mejoría por sesión para todos los pacientes fue: luego de la 1ra sesión: 5.8 puntos, luego de la 2da sesión: 6.7 puntos; la mayor puntuación fue luego de la 6ta sesión: 7.8 puntos, se obtuvo un promedio de 6.6 puntos de mejoría por sesión. El puntaje promedio de mejoría según el número total de sesiones por paciente fue 2 sesiones: 6,2 puntos, 3 sesiones: 6.5 puntos, con mayor puntuación los que tuvieron 5 y 7 sesiones con 7 y 7.7 puntos respectivamente.
Radiation proctitis is a late complication of pelvic radiation. The present study describes the experience of using heater probe in the management of patients with rectal bleeding caused by this entity that is unresponsive to medical local treatment. Material and methods: This is a prospective descriptive study at National Hospital "Edgardo Rebagliati Martins" of Lima Peru, between June 2000 and April 2001. We included 30 patients with persistent rectal bleeding, daily, that didn't improve with sucralphate or corticoid enemas. We included patients with at least 2 sessions. We used Olympus heater probe unit (2.8mm) and Olympus colonoscope CF140L. Heater probe was applied over bleeding vascular lesions, until complete coagulation was obtained, using 25 to 30 joules per application , 6 to 12 times until a total of 150 to 300 Joules was completed. The sessions were 2 per month and the patient completed a questionnaire. Symptoms improved (scale 1 to 10) an need for transfusion was recorded. Patients were discharged from follow up endoscopic improvement and no bleeding. Results: 30 patients were included, 28 females (93.3%). All reported clinical improvement at each session with score range 3 to 10 and mean 5.8 for the first session, 6.7 for the second. The major improvement was 7.8 for 6th session. Overall rate improvement was 6.6 per session. The mean rate applied to number of sessions per patient was 6.2 for 2 sessions, 6.5 for three sessions, 7 and 7.7 for 5 and 7 sessions. At the time of reporting results for this study, 9 (30%) patients were discharged, with a mean of 4.5 sessions. The benefit of treatment was noted in 29 patients (96.7%), lowering the grade of bleeding and requirements for transfusions. We didn't have complications. Conclusions: Heater probe is an effective and safe method for manageme of radiation proctitis inpatients not responding to conventional local treatment.