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Endoscopia

versão On-line ISSN 2444-6483versão impressa ISSN 0188-9893

Resumo

RIVERA-VICENCIO, Yahaira Berenice; WALLER-GONZALEZ, Luis Ariel  e  SOTO-SOLIS, Rodrigo. Derivación biliodigestiva guiada por ultrasonido endoscópico, experiencia en el Centro Médico Nacional 20 de Noviembre, ISSSTE. Endoscopia [online]. 2019, vol.31, suppl.2, pp.221-226.  Epub 14-Fev-2022. ISSN 2444-6483.  https://doi.org/10.24875/end.m19000100.

Introduction:

Malignant diseases of the biliopancreatic junction with failed ERCP due to tumor size or infiltration which does not allow cannulation of the sphincter of Oddi, can be resolved by means of a biliodigestive derivation guided by endoscopic ultrasound (DBD-EUS). In 2001, Dr. Giovannini reported the first procedures in which he placed plastic prostheses. Several meta-analyzes reported a technical and clinical success rate between 90-94%, superior to the percutaneous procedure, but it is operator dependent. The derivations that can be performed are: Coleodeco-duodenum or antral, hepatic-gastro, Rendezvous approach, cholecysto-antral, cholecysto-duodenum. The procedure is palliative in neoplastic diseases; It can be useful in benign conditions such as: hepatojejunal anastomosis stenosis, in Roux-en-Y surgery, Billroth II, Whipple, percutaneous drainage failure and patients with high surgical risk. Complications occur in 17% and are; perforation, hemorrhage, stent obstruction, cholangitis and biliary leak.

Objective:

Evaluate technical and clinical success rates and complications of the biliodigestive derivation guided by EUS in the endoscopy service of the “CMN 20 de Noviembre” ISSSTE.

Material and methods:

Retrospective, longitudinal study. All patients over 18 years of age with a diagnosis of malignant biliary obstruction and failed ERCP were included in those who underwent EUS-guided biliodigestive derivation. In the period between April 2017 and May 2019. Patient background, laboratory and image studies were evaluated. Descriptive statistics were used to obtain the technical and clinical success rates and to calculate the rate of complications.

Results:

Eleven patients were included, 7 were women, median age was 64 years. Technical success was achieved in 100% of the procedures and clinical success in 81%. Complications presented in only one patient (9%) due to septic shock secondary to cholangitis.

Conclusions:

Both the technical and clinical aspects are comparable with reports from the medical literature, the usefulness of this procedure was demonstrated and we concluded that this method is an effective therapeutic measure which is operator dependent.

Palavras-chave : EUS-guided biliodigestive derivation; Technical success; Clinical success; Complications.

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