Utilidad de la colangiopancreatografía retrógrada endoscópica en el manejo de la neoplasia bibliopancreatica según supervivencia
Fecha
2022
Autores
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Introducción: La colangio pancreatografía retrograda endoscópica (CPRE o ERCP) es una
técnica endoscópica avanzada con potencial terapéutico de la enfermedad neoplásica
obstructiva biliopancreática fundamentado en la recanalización de la vía biliar con el uso
de stents o prótesis. Objetivo: Determinar la utilidad de la CPRE en relación al manejo
terapéutico de la ictericia obstructiva neoplásica bilio pancreáticas y la supervivencia del
paciente. Materiales y métodos: El universo comprendió 199 pacientes con impresión
diagnóstica sospechosa de ictericia obstructiva generada por neoplasias en el Instituto
Oncológico Nacional SOLCA Guayaquil entre el 01 de agosto del 2017 al 31 de agosto del
2021. La muestra seleccionada consistió en 89 pacientes con enfermedad neoplásica
obstructiva biliopancreática confirmada mediante estudios de imágenes y laboratorios, a
los que se les realizó CPRE terapéutica. El estudio es de tipo correlacional, retrospectivo y
no experimental. Resultados: el grupo etario más afectado fueron los mayores de 70 años
(38,2%). Relación hombre mujer 1:1,54. Las neoplasias más frecuentes fueron las de vía
biliar intra/extrahepática (33,71%), de los cuales el COLANGIOCARCINOMA en
estadios avanzados (T4N1M1) fue el más frecuente (96,66%). Se realizó citología por
cepillado siendo positivo para malignidad en 20 casos (52,63%) con una sensibilidad del
61% (VPP: 80%). También se realizó micro histología con SPYBITE siendo 3 biopsias
positivas para malignidad (21,43%) con una sensibilidad del 0,75% (VPP: 23%).
Conclusiones: La CPRE demostró utilidad en el manejo de la neoplasia biliopancreática al
evidenciarse una reducción significativa de la BT media de 13,25 mg/dl pre ERCP a una
media de 6,4 mg/dl post ERCP (p=0,001), con una baja tasa de complicaciones (7,08%) y
una supervivencia predominante en los usuarios de SEMS con media de 307,55 días (Chicuadrado
de Pearson: 9,284 / p= 0,002
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP or CPRE) is an advanced endoscopic technique with therapeutic potential for biliopancreatic obstructive neoplastic disease based on the recanalization of the bile duct with the use of stents or prostheses. Objective: To determine the usefulness of ERCP in relation to the therapeutic management of biliopancreatic neoplastic obstructive jaundice and patient survival. Materials and methods: The universe comprised 199 patients with a diagnostic impression suspicious for obstructive jaundice generated by neoplasms at the National Cancer Institute SOLCA Guayaquil between August 1, 2017 and August 31, 2021. The selected sample consisted of 89 patients with neoplastic disease. Biliopancreatic obstructive disease confirmed by imaging and laboratory studies, who underwent therapeutic ERCP. The study is correlational, retrospective and non-experimental. Results: the most affected age group were those older than 70 years (38.2%). Male to female ratio 1:1.54. The most frequent neoplasms were those of the intra/extrahepatic bile duct (33.71%), of which CHOLANGIOCARCINOMA in advanced stages (T4N1M1) was the most frequent (96.66%). Brush cytology was performed and was positive for malignancy in 20 cases (52.63%) with a sensitivity of 61% (PPV: 80%). Micro histology was also performed with SPYBITE, with 3 biopsies being positive for malignancy (21.43%) with a sensitivity of 0.75% (PPV: 23%). Conclusions: ERCP demonstrated usefulness in the management of biliopancreatic neoplasia, showing a significant reduction in the mean BT from 13.25 mg/dl pre-ERCP to a mean of 6.4 mg/dl post-ERCP (p=0.001), with a low rate of complications (7.08%) and a predominant survival in SEMS users with a mean of 307.55 days (Pearson Chi-square: 9.284 / p= 0.002).
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP or CPRE) is an advanced endoscopic technique with therapeutic potential for biliopancreatic obstructive neoplastic disease based on the recanalization of the bile duct with the use of stents or prostheses. Objective: To determine the usefulness of ERCP in relation to the therapeutic management of biliopancreatic neoplastic obstructive jaundice and patient survival. Materials and methods: The universe comprised 199 patients with a diagnostic impression suspicious for obstructive jaundice generated by neoplasms at the National Cancer Institute SOLCA Guayaquil between August 1, 2017 and August 31, 2021. The selected sample consisted of 89 patients with neoplastic disease. Biliopancreatic obstructive disease confirmed by imaging and laboratory studies, who underwent therapeutic ERCP. The study is correlational, retrospective and non-experimental. Results: the most affected age group were those older than 70 years (38.2%). Male to female ratio 1:1.54. The most frequent neoplasms were those of the intra/extrahepatic bile duct (33.71%), of which CHOLANGIOCARCINOMA in advanced stages (T4N1M1) was the most frequent (96.66%). Brush cytology was performed and was positive for malignancy in 20 cases (52.63%) with a sensitivity of 61% (PPV: 80%). Micro histology was also performed with SPYBITE, with 3 biopsies being positive for malignancy (21.43%) with a sensitivity of 0.75% (PPV: 23%). Conclusions: ERCP demonstrated usefulness in the management of biliopancreatic neoplasia, showing a significant reduction in the mean BT from 13.25 mg/dl pre-ERCP to a mean of 6.4 mg/dl post-ERCP (p=0.001), with a low rate of complications (7.08%) and a predominant survival in SEMS users with a mean of 307.55 days (Pearson Chi-square: 9.284 / p= 0.002).
Descripción
PDF
Palabras clave
ENDOSCOSPIA, AMPOLLA HEPATOPANCREATICA, NEOPLASIAS, HOSPITAL SALCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR