RESUMO
BACKGROUND AND STUDY AIMS: There is no consensus about the optimal alternative procedure in cases of failed cannulation of the common bile duct (CBD). The alternatives are usually considered to be high-risk procedures. This study describes endoscopic dissection of the distal biliary tract (EDBT) as a new technique in cases of difficult cannulation of the CBD. PATIENTS AND METHODS: Out of a total of 1057 patients in whom cannulation was attempted, deep cannulation failed in 49 patients, and 48 of those underwent EDBT. The procedure consists of cutting the mucosa, and the partial isolation of the distal part of the biliary tract using catheters, a needle-knife papillotome, and thin forceps. Access to the biliary tract was achieved with an endoscopic needle or forceps with or without electrocoagulation. RESULTS: EDBT was successful in all cases. In 46 patients EDBT was followed by standard sphincterotomy. Four patients developed clinical pancreatitis and hyperamylasemia occurred in 11 cases. Perforation, uncontrolled bleeding, and other complications did not occur in this series. CONCLUSIONS: EDBT is feasible, safe and constitutes a potential alternative for cannulation of the CBD. The endoscopic visualization of the wall structure and duodenal layers during the maneuvers at the papilla probably accounts for the absence of major complications.
Assuntos
Ampola Hepatopancreática/cirurgia , Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Esfinterotomia Endoscópica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco/cirurgia , Dissecação/métodos , Eletrocoagulação , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias , Segurança , Resultado do TratamentoRESUMO
The authors emphasize the colonoscopy's importance and report their experience with the procedure in a general hospital. In a nearly 4 year period, 300 patients were submitted to the procedure, and the main indication was digestive bleeding, followed by alterations of bowels movements. The bowel preparation was done with mannitol ingestion except when contraindicated. The most frequent pathology were polyps and diverticular disease. Fifty three polypectomies were done in 22 patients.