Eficacia y seguridad del uso del needle knife en la canulación difícil de la vía biliar
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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EFICACIA Y SEGURIDAD DEL USO DEL NEEDLE KNIFE EN CANULACIÓN DIFÍCIL DE LA VÍA BILIAR Introducción: El acceso selectivo del conducto biliar común mediante la Colangio pancreatografia retrograda endoscópica es un requisito previo para las intervenciones endoscópicas terapéuticas biliares exitosas. El abordaje biliar con técnica convencional tiene un éxito de 80-90% con tasas de complicaciones de hasta 10%. Objetivo: Establecer la eficacia y seguridad del precorte con aguja Needle Knife vs. esfinterótomo e hilo guía en la canulación difícil de la vía biliar. Materiales y método: Estudio transversal, analítico, retrospectivo, correlacional, que comparó dos técnicas de abordaje al conducto biliar común: canulación convencional persistente y precorte. Se incluyeron pacientes sin esfinterotomía previa con criterios de canulación biliar difícil. Se realizó seguimiento de estos posterior al estudio para la detección de complicaciones. Resultados: Se revisaron 300 procedimientos, de los cuales 70 (6.66%) correspondieron a canulación difícil. En 48.6% se realizó precorte mientras que el resto de la población se continuó con canulación convencional persistente. El éxito total de la canulación con la técnica de precorte fue del 96%. No hubo diferencia estadísticamente significativa respecto a la edad, proporción de género, posición, tiempo hasta la canulación, duración del procedimiento o frecuencia de complicaciones entre el grupo precorte con Needle-Knife vs. canulación convencional. Conclusión: La esfinterotomía con aguja de precorte Needle Knife como sistema de acceso a la vía biliar es un procedimiento con una eficacia y seguridad similar a la técnica stándart con papilótomo e hilo guía en pacientes con criterios de canulación difícil, permitiendo completar con éxito la terapéutica biliopancreática.
EFFICACY AND SAFETY OF THE USE OF NEEDLE KNIFE IN DIFFICULT CANNULATION OF THE BILIAR DUCT Introduction: Selective access of the common bile duct (CBD) through ERCP is a requisite for successful biliary endoscopic therapeutic interventions. Biliary access with conventional technique is successful at 80-90% with complication rates of up to 10%. Aim: Establish the efficacy and safety of the Needle Knife precutt vs. sphincterotome and guidewire in the difficult cannulation of the bile duct. Methods: Cross-sectional, analytical, retrospective, correlational study that compared two access techniques to the bile duct: persistent conventional cannulation and precut. Patients without previous sphincterotomy with difficult biliary cannulation criteria were included. These were followed up after the study for the detection of complications Results: We reviewed 300 procedures, of which 70 (6.66%) corresponded to difficult cannulation. In 48.6% precut was performed while the rest of the population continued with persistent conventional cannulation. The overall success of pre-cutting cannulation was 96%. There was no statistically significant difference with respect to age, gender ratio, position, time to cannulation, duration of the procedure or frequency of complications between the pre-cut group with Needle-Knife vs. conventional cannulation. Conclusion: Sphincterotomy with precut needle Knife as access system to the bile duct is a procedure with an efficacy and safety similar to the stándart technique with papilotome and guidewire in patients with difficult cannulation, allowing to successfully complete the biliopancreatic therapy Key Words: Sphincterotomy, needle, precut, cannulation, bile duct, guide
EFFICACY AND SAFETY OF THE USE OF NEEDLE KNIFE IN DIFFICULT CANNULATION OF THE BILIAR DUCT Introduction: Selective access of the common bile duct (CBD) through ERCP is a requisite for successful biliary endoscopic therapeutic interventions. Biliary access with conventional technique is successful at 80-90% with complication rates of up to 10%. Aim: Establish the efficacy and safety of the Needle Knife precutt vs. sphincterotome and guidewire in the difficult cannulation of the bile duct. Methods: Cross-sectional, analytical, retrospective, correlational study that compared two access techniques to the bile duct: persistent conventional cannulation and precut. Patients without previous sphincterotomy with difficult biliary cannulation criteria were included. These were followed up after the study for the detection of complications Results: We reviewed 300 procedures, of which 70 (6.66%) corresponded to difficult cannulation. In 48.6% precut was performed while the rest of the population continued with persistent conventional cannulation. The overall success of pre-cutting cannulation was 96%. There was no statistically significant difference with respect to age, gender ratio, position, time to cannulation, duration of the procedure or frequency of complications between the pre-cut group with Needle-Knife vs. conventional cannulation. Conclusion: Sphincterotomy with precut needle Knife as access system to the bile duct is a procedure with an efficacy and safety similar to the stándart technique with papilotome and guidewire in patients with difficult cannulation, allowing to successfully complete the biliopancreatic therapy Key Words: Sphincterotomy, needle, precut, cannulation, bile duct, guide
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Pancreatografía, Endoscopía, Estudios retrospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Cateterismo, Aguja Needle Knife, Esfinterotomía, Conductos biliares