RESUMO
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the surgical treatment of choice for morbid obesity. Several therapeutic options to remove common bile duct (CBD) stones have been proposed in these patients. Laparoscopy-assisted transgastric ERCP (LATERCP) has a high success rate. However, the procedure is not fully standardized and some technical variations have been proposed. We introduce two cases in which laparoscopic transgastric ERCP has been used to treat choledocholithiasis after LRYGB (AU)
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Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica , Laparoscopia , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Derivação Gástrica/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/tendênciasRESUMO
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the surgical treatment of choice for morbid obesity. Several therapeutic options to remove common bile duct (CBD) stones have been proposed in these patients. Laparoscopy-assisted transgastric ERCP (LATERCP) has a high success rate. However, the procedure is not fully standardized and some technical variations have been proposed. We introduce two cases in which laparoscopic transgastric ERCP has been used to treat choledocholithiasis after LRYGB.
Assuntos
Cirurgia Bariátrica , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Esfinterotomia EndoscópicaRESUMO
BACKGROUND AND AIM: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. METHODS: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. RESULTS: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. CONCLUSIONS: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.
Assuntos
Adenoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/efeitos adversos , HumanosRESUMO
Background and aim: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention (AU)
No disponible
Assuntos
Humanos , Masculino , Feminino , Adenocarcinoma Papilar/cirurgia , Adenocarcinoma Papilar , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Ampola Hepatopancreática , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endoscopia/métodos , Endoscopia/normas , Endoscopia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias dos Ductos Biliares , Ductos Biliares/patologia , Ductos BiliaresRESUMO
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Assuntos
Humanos , Masculino , Criança , Stents Farmacológicos/tendências , Stents Farmacológicos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/cirurgia , Icterícia Obstrutiva , Stents/efeitos adversos , Stents Metálicos Autoexpansíveis/efeitos adversos , Stents Metálicos Autoexpansíveis , Endoscopia/métodos , Endoscopia , Colangite/complicações , Colangite/cirurgia , Colangite , CorrosãoRESUMO
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