RESUMEN
Ultrasound-guided biliary drainage is a new and effective method for relieving obstructive lesions of the biliary tract. In the hands of experienced operators, ultrasound-guided diversion of the mid portion of the common bile duct and the duodenal bulb is a feasible strategy for the relief of jaundice secondary to distal obstruction (distal bile duct tumors, pancreatic head cancer, or major duodenal papillary tumor), with low morbidity and mortality rates. The technical aspects of the procedure and its indications are reviewed herein, emphasizing its performance in institutions equipped with experienced personnel adhering to strict study protocols.
Asunto(s)
Coledocostomía/métodos , Colestasis/cirugía , Endosonografía , Colestasis/etiología , HumanosRESUMEN
Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.
Asunto(s)
Colestasis/diagnóstico por imagen , Colestasis/cirugía , Drenaje/instrumentación , Endosonografía , Migración de Cuerpo Extraño/etiología , Implantación de Prótesis/métodos , Stents/efectos adversos , Anciano , Humanos , Masculino , Diseño de PrótesisRESUMEN
A 65 year-old male was admitted to the University hospital with obstructive jaundice. Endoscopic examination revealed a grossly abnormal major ampulla, situated at the edge of a large duodenal diverticulum. Biopsy of the ampulla was positive for villous adenoma. We describe the technique utilized to successfully perform an end-bloc endoscopic resection of a major ampulla on a diverticulum.
Asunto(s)
Adenoma Velloso/cirugía , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Endoscopía del Sistema Digestivo , Adenoma Velloso/complicaciones , Anciano , Neoplasias del Conducto Colédoco/complicaciones , Divertículo/complicaciones , Enfermedades Duodenales/complicaciones , Endoscopía del Sistema Digestivo/métodos , Humanos , MasculinoRESUMEN
Plasmacytoma presents more frequently in middle age men with aerodigestive tract involvement, especially in the head and the neck. Gastrointestinal tract involvement is uncommon, but the organ most commonly involved is the stomach. We report the first case in the literature in which final diagnosis was made by fine- needle aspiration biopsy guided by endoscopic ultrasound with adequate sample for pathologic analysis. The treatment of this entity is systemic chemotherapy but its effectiveness is limited. Plasmacytoma should be taken into account in differential diagnosis of pancreatic masses.
Asunto(s)
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Neoplasias Pancreáticas/diagnóstico , Plasmacitoma/diagnóstico , Adulto , Quimioradioterapia , Resultado Fatal , Humanos , Masculino , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Plasmacitoma/patología , Plasmacitoma/terapia , Tomografía Computarizada por Rayos XRESUMEN
Bile duct injury is a known complication of cholecystectomy. While minor injuries can be treated endoscopically, successful endoscopic management of complete ligation of the common hepatic duct (CHD) has not been described. Our aim was to report a novel technique for endoscopic recanalization of accidently ligated CHD. We demonstrated a 75 year old woman presented with a small bile leak and complete ligation of the CHD after open cholecystectomy subjected to successful biliary endoscopic recanalization. Cholangiogram demonstrated resolution of the bile leak and minimal residual narrowing of the CHD. Endoscopic intervention following biliary needle puncture access may avoid surgery in patients with CHD ligation or complex stenosis.
Asunto(s)
Colecistectomía , Endoscopía del Sistema Digestivo , Conducto Hepático Común/lesiones , Complicaciones Intraoperatorias/cirugía , Anciano , Catéteres , Diseño de Equipo , Femenino , Humanos , LigaduraAsunto(s)
Drenaje/métodos , Endosonografía , Migración de Cuerpo Extraño/complicaciones , Absceso Hepático/terapia , Stents/efectos adversos , Ultrasonografía Intervencional , Anciano , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/etiología , RadiografíaRESUMEN
Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
Asunto(s)
Enfermedad de Chagas/cirugía , Acalasia del Esófago/cirugía , Esófago/patología , Brasil , Cateterismo/métodos , Enfermedad de Chagas/mortalidad , Enfermedad de Chagas/terapia , Acalasia del Esófago/mortalidad , Acalasia del Esófago/terapia , Esofagectomía/métodos , Esofagoplastia/métodos , Esofagoscopía/métodos , Esófago/cirugía , Femenino , Humanos , Inyecciones Intralesiones , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fármacos Neuromusculares/uso terapéutico , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. METHODS: Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. RESULTS: Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). CONCLUSION: The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.
Asunto(s)
Cateterismo , Obstrucción Duodenal/diagnóstico por imagen , Obstrucción Duodenal/terapia , Estenosis Pilórica/diagnóstico por imagen , Estenosis Pilórica/terapia , Cateterismo/métodos , Constricción Patológica , Obstrucción Duodenal/complicaciones , Obstrucción Duodenal/fisiopatología , Endoscopía Gastrointestinal , Femenino , Vaciamiento Gástrico , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/fisiopatología , Estenosis Pilórica/complicaciones , Estenosis Pilórica/fisiopatología , Cintigrafía/normas , Gastropatías/etiología , Gastropatías/fisiopatología , Tecnecio , Resultado del Tratamiento , Aumento de PesoAsunto(s)
Adenocarcinoma/patología , Biopsia con Aguja Fina , Endosonografía , Ganglios Linfáticos/patología , Neoplasias de la Próstata/patología , Abdomen , Adenocarcinoma/diagnóstico por imagen , Anciano , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática , Masculino , Neoplasias de la Próstata/diagnóstico por imagenAsunto(s)
Colecistectomía Laparoscópica/métodos , Endosonografía/métodos , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/cirugía , Ultrasonografía Intervencional/métodos , Medios de Contraste/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Femenino , Fluoroscopía , Estudios de Seguimiento , Cálculos Biliares/patología , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Endoscopía/métodos , Endosonografía/métodos , Neoplasias Ureterales/diagnóstico , Neoplasias Ureterales/cirugía , Ureterostomía/métodos , Adenocarcinoma/patología , Anciano , Biopsia , Cistoscopía , Femenino , Hematuria/etiología , Humanos , Estadificación de Neoplasias , Neoplasias Ureterales/complicaciones , Neoplasias Ureterales/patología , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/diagnósticoRESUMEN
A fistulizaçäo cirúrgico-endoscópica no contorno papilar superior é um procedimento destinado a facilitar a cateterizaçäo da porçäo terminal do ducto colédoco, pela impossibilidade do acesso habitual pelo óstio, tendo em vista a fibrose, tumores ou cálculo impacatado. Esse procedimento foi denominado por Schapira (19982) como fístulo-esfincterotomia endoscópica, embora tenha recebido outras denominações inapropriadas, como fistulotomia suprapapilar ou infundibulotomia. Tal intervençäo endoscópica viabiliza a catererizaçäo emcasos difíceis, ampliando o acesso ao colédoco terminal ao nível da ampola hepatopancreática. E difere do procedimento denominado pré-corte, porquanto o óstio da papila é poupado com o intuito de prevenir a pancreatite aguda. Essa intervençäo cirúrgico-endoscópica, com base anatômica, é denominada fístulo-papilotomia no Serviço de Endoscopia Digestiva do HC-FMUSP. No período de outubro de 1999 a dezembro de 2000, foram realizadas 451 papilotomias, sendo indicadas 65 (14,5por cento) fístulo-papilotomias, cuja indicaçäo miais frequente foi a coledocolitíase. Ocorreram nove (13,8por cento) complicações: pancreatite aguda em cinco (7,6por cento) casos, hemoragia em um (1,5por cento), colangite em dois (3por cento) e perfuraçäo retroduodenal em um (1.5por cento). Em todos esses casos houve resoluçäo espontânea através do tratamento conservador. Considerando-se o insucesso da cateterizaçäo do óstio da papila de forma convencional, a fístulo-papilotomia for a opçäo que demonstrou ser um procedimento viável e seguro