RESUMO
INTRODUCTION: Difficult cannulation in cases of endoscopic retrograde cholangiopancreatography (ERCP) could be associated with several factors, including: type of major papilla, however, there are limited data regarding this possible association. OBJECTIVES: To determine the association between the type of papilla and difficult biliary cannulation. MATERIALS AND METHODS: A retrospective cross-sectional analytical study was conducted in patients over 18 years old who underwent ERCP on papilla naive, from July 2019 to April 2021, in a private institution. Unsuccessful cannulations were excluded. The papilla was classified based on Haraldsson classification. The crude association and adjusted for possible confounders between the type of papilla and difficult cannulation was evaluated. Relative risks (RR) and 95% confidence intervals were calculated. RESULTS: 188 patients were included. The mean age was 55 years, 66% female. The most frequent indication was choledocholithiasis with 88.5%. The most frequent type of major duodenal papilla was type 1 (32%), followed by type 3 (27%), type 2 (25%) and type 4 (16%). Type 2, 3, 4 papillae showed a significant relationship with difficult cannulation compared to type 1 (p<0.001, p<0.001 and p=0.008 respectively). The indication other than choledocholithiasis also showed a significant relationship with difficult cannulation (p<0.001). In the adjusted analysis, the RR for difficult cannulation compared to type 1 papilla was: 2.51 (95% CI 1.23-5.94) for type 2 papilla, 3.72 (95% CI 1.79-7.71) for papilla type 3 and 3.41 (95% CI 1.54-7.71) for type 4. Theindication other than choledocholithiasis was also associated with a higher risk of difficult cannulation with a RR of 2.36 (95% CI 1.57-3.56). The fistulotomy type precut was used more frequently in the type 3 papilla (46%), while the use of cannula was more frequent in the type 4 papilla (29.6%). CONCLUSIONS: Papilla types 2, 3 and 4 are associated with a higher risk of difficult cannulation. This should be considered when performing ERCP in order to reduce the risk of complications.
Assuntos
Ampola Hepatopancreática , Adolescente , Ampola Hepatopancreática/diagnóstico por imagem , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esfinterotomia EndoscópicaRESUMO
OBJECTIVE: To identify clinical, endoscopic and histological characteristics and their relationship with Helicobacter pylori (Hp) in patients treated with the diagnosis of dyspepsia in our hospital during 2010. MATERIALS AND METHODS: We conducted a cross sectional and retrospective study in the population attending our hospital during 2010, a sample of 300 patients was studied. We evaluated clinical, histological and endoscopic findings. An instrument of data collection was made. We used the statistical package SPSS 15.0. RESULTS: It was found that the majority were female (63%), while the mean age at diagnosis was 42 years, mostly from SJL district (30%) of these Andean origin (50 %) was the highest percentage. Only 19% showed signs of alarm, low weight characterize this group (14%), the endoscopic findings most commonly found were antral erythema (74.7%), followed by erosions (32.9%) and nodules (22%). Hp infection was found in 93%, mild dysplasia was present in 2.7% and atrophy in only 14.7%. The 98.5% of patients with nodularity on endoscopy had Hp infection. CONCLUSIONS: The most frequent dyspeptic symptoms were epigastric pain followed by abdominal distension, the female gender was present more often, the warning signs were rare, antral erythema was the feature most found in endoscopies. Hp infection was significantly associated with some features such as endoscopic antral nodularity and erythema as well as had relation to the activity of gastritis.
Assuntos
Dispepsia/diagnóstico , Endoscopia Gastrointestinal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dispepsia/patologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Retrospectivos , Adulto JovemRESUMO
RESUMEN Introducción : La canulación difícil en casos de colangiopancreatografía retrógrada endoscópica (CPRE) podría asociarse a diversos factores incluyendo el tipo de papila mayor, sin embargo, existen datos limitados con respecto a esta posible asociación. Objetivos : Determinar la asociación entre el tipo de papila y la canulación biliar difícil. Materiales y métodos : Se realizó un estudio retrospectivo transversal analítico en pacientes mayores de 18 años en quienes se realizó CPRE en papila virgen, de julio 2019 a abril 2021, en una institución privada. Se excluyeron las canulaciones frustras. La papila fue clasificada en base a la clasificación de Haraldsson. Se evaluó la asociación cruda y ajustada a posibles confusores entre el tipo de papila y canulación difícil. Se calcularon los riesgos relativo (RR) e intervalos de confianza al 95%. Resultados : Se incluyeron 188 pacientes. La edad media fue 55 años, el 66% de sexo femenino. La indicación más frecuente fue coledocolitiasis con 88,5%. El tipo de papila duodenal mayor más frecuente fue el tipo 1 (32%), seguido de tipo 3 (27%), tipo 2 (25%) y tipo 4 (16%). Las papilas tipo 2, 3, 4 presentaron una relación significativa con canulación difícil comparadas con la tipo 1 (p<0,001, p<0,001 y p=0,008 respectivamente). La indicación diferente a coledocolitiasis también mostró una relación significativa con canulación difícil (p<0,001). En el análisis ajustado, El RR para canulación difícil en comparación con la papila tipo 1 fue: de 2,51 (IC 95% 1,23-5,94) para la papila tipo 2, 3,72 (IC 95% 1,79-7,71) para la papila tipo 3 y 3,41 (IC 95% 1,54-7,71) para la tipo 4. La indicación distinta a la coledocolitiasis también se asoció a un mayor riesgo de canulación difícil con un RR de 2.36 (IC95% 1,57-3,56). El precorte tipo fistulotomía fue usado con mayor frecuencia en la papila tipo 3 (46%) mientras que el uso de canulótomo fue más frecuente en la papila tipo 4 (29,6%). Conclusiones : Los tipos de papila 2, 3 y 4, están asociados a mayor riesgo de canulación difícil. Ello debe ser considerado al momento de realizar la CPRE a fin de reducir el riesgo de complicaciones.
ABSTRACT Introduction : Difficult cannulation in cases of endoscopic retrograde cholangiopancreatography (ERCP) could be associated with several factors, including: type of major papilla, however, there are limited data regarding this possible association. Objectives : To determine the association between the type of papilla and difficult biliary cannulation. Materials and methods : A retrospective cross-sectional analytical study was conducted in patients over 18 years old who underwent ERCP on papilla naive, from July 2019 to April 2021, in a private institution. Unsuccessful cannulations were excluded. The papilla was classified based on Haraldsson classification. The crude association and adjusted for possible confounders between the type of papilla and difficult cannulation was evaluated. Relative risks (RR) and 95% confidence intervals were calculated. Results : 188 patients were included. The mean age was 55 years, 66% female. The most frequent indication was choledocholithiasis with 88.5%. The most frequent type of major duodenal papilla was type 1 (32%), followed by type 3 (27%), type 2 (25%) and type 4 (16%). Type 2, 3, 4 papillae showed a significant relationship with difficult cannulation compared to type 1 (p<0.001, p<0.001 and p=0.008 respectively). The indication other than choledocholithiasis also showed a significant relationship with difficult cannulation (p<0.001). In the adjusted analysis, the RR for difficult cannulation compared to type 1 papilla was: 2.51 (95% CI 1.23-5.94) for type 2 papilla, 3.72 (95% CI 1.79-7.71) for papilla type 3 and 3.41 (95% CI 1.54-7.71) for type 4. The indication other than choledocholithiasis was also associated with a higher risk of difficult cannulation with a RR of 2.36 (95% CI 1.57-3.56). The fistulotomy type precut was used more frequently in the type 3 papilla (46%), while the use of cannula was more frequent in the type 4 papilla (29.6%). Conclusions : Papilla types 2, 3 and 4 are associated with a higher risk of difficult cannulation. This should be considered when performing ERCP in order to reduce the risk of complications.
RESUMO
Objetivo: Identificar las características clínicas, endoscópicas e histológicas así como su relación con Helicobacter pylori (Hp) en pacientes atendidos con el diagnóstico de dispepsia en nuestro hospital durante el año 2010. Materiales y métodos: Estudio descriptivo, transversal y retrospectivo en la población que acudía a nuestro hospital, en el año 2010, tamaño muestral de 300 pacientes. Se evaluaron variables clínicas, histológicas y endoscópicas. Se confeccionó un instrumento de recolección de datos. Utilizamos el paquete estadístico SPSS 15.0. Resultados: Del total, en su mayoría fueron mujeres (63%), la edad media de 42 años, procedentes del distrito de SJL (30%), 50% de origen andino. El 19% presentaba signos de alarma, la baja de peso caracterizó a este grupo (14%), en endoscopía, se observó eritema antral (74,7%), erosiones (32,9%) y nodularidad (22%). El 93% presentó infección por Hp, displasia leve en el 2,7% y atrofia en solo 14,7%.El 98,5% de los pacientes que presentó nodularidad tuvo infección por Hp. Conclusiones: Los síntomas dispépticos frecuentes fueron dolor epigástrico seguido de distensión abdominal, el género femenino lo presentó con mayor frecuencia, signos de alarma fueron poco frecuentes, eritema antral fue la característica más encontrada en las endoscopías. La gastritis crónica moderada fue el diagnóstico anátomo-patológico mas frecuente. La infección por Hp tuvo asociación significativa con nodularidad y eritema antral así como también con actividad de la gastritis.
Objective: To identify clinical, endoscopic and histological characteristics and their relationship with Helicobacter pylori (Hp) in patients treated with the diagnosis of dyspepsia in our hospital during 2010. Materials and methods: We conducted a cross sectional and retrospective study in the population attending our hospital during 2010, a sample of 300 patients was studied. We evaluated clinical, histological and endoscopic findings. An instrument of data collection was made. We used the statistical package SPSS 15.0. Results: It was found that the majority were female (63%), while the mean age at diagnosis was 42 years, mostly from SJL district (30%) of these Andean origin (50 %) was the highest percentage. Only 19% showed signs of alarm, low weight characterize this group (14%), the endoscopic findings most commonly found were antral erythema (74.7%), followed by erosions (32.9%) and nodules (22%). Hp infection was found in 93%, mild dysplasia was present in 2.7% and atrophy in only 14.7%. The 98.5% of patients with nodularity on endoscopy had Hp infection. Conclusions: The most frequent dyspeptic symptoms were epigastric pain followed by abdominal distension, the female gender was present more often, the warning signs were rare, antral erythema was the feature most found in endoscopies. Hp infection was significantly associated with some features such as endoscopic antral nodularity and erythema as well as had relation to the activity of gastritis.