Conceptos Categóricos

LAS TECNICAS DE RESCATE EN LA CANULACION BILIAR DIFICIL

LAS TECNICAS DE RESCATE EN LA CANULACION BILIAR DIFICIL

(especial para SIIC © Derechos reservados)
La colangiopancreatografía retrógrada endoscópica es la técnica de elección en el tratamiento de diferentes enfermedades biliopancreáticas. La canulación selectiva del conducto deseado (biliar o pancreático) es el punto clave inicial del objetivo terapéutico  
Autor:
Jesús Espinel-diez
Columnista Experto de SIIC

Institución:
Hospital de León


Artículos publicados por Jesús Espinel-diez
Coautor
María Eugenia Pinedo Ramos* 
Médica, Hospital de León, León, España*
Recepción del artículo
30 de Mayo, 2017
Aprobación
1 de Diciembre, 2017
Primera edición
11 de Diciembre, 2017
Segunda edición, ampliada y corregida
6 de Marzo, 2018

Resumen
La colangiopancreatografía retrógrada endoscópica (CPRE) es la técnica de elección para el tratamiento de diferentes enfermedades biliopancreáticas. La canulación selectiva del conducto deseado (biliar o pancreático) es el punto clave inicial del objetivo terapéutico. Actualmente, la forma más utilizada para conseguir el acceso a la vía biliar, y que podemos denominar "técnica estándar", es la que emplea un esfinterótomo asociado con una guía hidrófila. Cuando dicha canulación estándar falla, existen diferentes alternativas que nos permitirán conseguir la canulación en un alto porcentaje de pacientes. En situaciones de canulación difícil, las técnicas de rescate a utilizar pueden estar condicionadas, entre otras, por el perfil de riesgo de complicaciones del paciente, por la experiencia o las preferencias del endoscopista y por haber conseguido o no previamente la canulación del conducto pancreático. Si se consiguió la canulación del conducto pancreático puede intentarse la técnica de doble guía, la esfinterotomía transpancreática y el precorte de aguja sobre prótesis pancreática. Si no se consiguió la canulación del conducto pancreático, probablemente la mejor opción sea una fistulotomía. Es conveniente conocer, en el contexto de una canulación difícil, cuándo hay que decidir la finalización de la prueba, principalmente si no existe una urgencia de drenaje de la vía biliar para el paciente. En estos casos debemos considerar repetir el procedimiento unos días más tarde. Si la urgencia del paciente es evidente, puede intentarse el acceso de la vía biliar asistido por técnicas alternativas.

Palabras clave
pancreatitis aguda, colangiopancreatografía retrógrada endoscópica, esfinterotomía transpancreática, esfinterotomía de aguja, canulación dificil


Artículo completo

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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the technique of choice in treating different biliopancreatic diseases. Selective cannulation of the desired duct (biliary or pancreatic) is the initial key point of the therapeutic goal. Currently, the most used method to obtain access to the bile duct is what we can call "standard technique", which uses the sphincterotome associated with a hydrophilic guide. When such standard cannulation fails, there are different alternatives that will allow us to achieve cannulation in a high percentage of patients. In situations of difficult cannulation the rescue techniques may be conditioned by the risk profile of the patient's complications, by the experience and/or preferences of the endoscopist, or by whether or not he has previously been able to cannulate the pancreatic duct. If cannulation of the pancreatic duct is achieved, the double guide technique, and needle precut on pancreatic prosthesis can be attempted. If cannulation of the pancreatic duct is not achieved, fistulotomy is probably the best option. In the case of a difficult cannulation, it is important to know when to decide the end of the test, especially if there is no urgency to drain the bile duct. In these cases we should consider repeating the procedure a few days later. If the patient's urgency is evident, access to the bile duct assisted by alternative techniques can be attempted.

Key words
acute pancreatitis, endoscopic retrograde cholangiopancreatography, transpancreatic sphincterotomy, needle knife sphincterotomy, difficult cannulation


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Imágenes, Gastroenterología
Relacionadas: Anestesiología, Medicina Interna



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Jesús Espinel Diez, Santos Olivera 30, León, España
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