<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-6483</journal-id>
<journal-title><![CDATA[Endoscopia]]></journal-title>
<abbrev-journal-title><![CDATA[Endoscopia]]></abbrev-journal-title>
<issn>2444-6483</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Endoscopia Gastrointestinal A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-64832019000600065</article-id>
<article-id pub-id-type="doi">10.24875/end.m19000052</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Uso de ASA subaponeurótica de acceso biliar para la dilatación endoscópica percutánea de estenosis de hepaticoyeyunoanastomosis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santillán-Lomelí]]></surname>
<given-names><![CDATA[Ivette]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cuendis-Velázquez]]></surname>
<given-names><![CDATA[Adolfo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bada-Yllán]]></surname>
<given-names><![CDATA[Orlando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez-Parra]]></surname>
<given-names><![CDATA[Andrés Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Delano-Alonso]]></surname>
<given-names><![CDATA[Roberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrera-Esquivel]]></surname>
<given-names><![CDATA[José de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreno-Portillo]]></surname>
<given-names><![CDATA[Mucio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valenzuela-Salazar]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Angulo]]></surname>
<given-names><![CDATA[Jaime Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General Dr. &#8221;Manuel Gea González&#8221; División de Endoscopía Gastrointestinal ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<fpage>65</fpage>
<lpage>71</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-64832019000600065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-64832019000600065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-64832019000600065&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen La construcción de una hepaticoyeyunoanastomosis es un método quirúrgico de bypass frecuentemente realizado para la resolución de condiciones patológicas de los conductos biliares extrahepáticos, la cual permite el drenaje biliar hacia el intestino delgado. (1,2) Existen varias complicaciones que se pueden presentar asociadas a estas técnicas como son la fuga biliar y fístula biliar (complicaciones tempranas); dentro de las complicaciones a largo plazo de este tipo de anastomosis se encuentra la estenosis, la cual puede llevar a múltiples hospitalizaciones y procedimientos para su resolución. (3,4). Anteriormente el gran problema de las estenosis posteriores a derivaciones biliodigestivas era que ameritaban varias cirugías mayores para su manejo. Por lo cual, la posibilidad de desarrollar un procedimiento que permitiera intervenciones terapéuticas repetidas sin la necesidad de someter al paciente a este tipo de procedimientos mayores ha sido, cada vez más necesario.(5) Este nuevo abordaje que se ha implementado ya en 82 casos de reconstrucción de vía biliar por mínima invasión en nuestro hospital, permitió en los siguientes casos que presentaron estenosis postquirúrgica, una ruta de acceso simple hacia la vía biliar, a través del cual se puede realizar terapéutica endoscópica. Primer caso paciente 27 años con lesión de vía biliar Strasberg E4, se realiza hepaticoyeyunoanastomosis con asa subaponeurótica con formación de neoconfluencia y a los 18 meses postquirúrgicos se detecta ictericia asintomática y dilatación de vía biliar por colangiorresonancia. A través de asa subaponeurótica se realiza dilatación endoscópica con éxito. Sin embargo, a los 20 meses posteriores a la dilatación presenta nuevamente ictericia por lo que se realiza segunda dilatación endoscópica con éxito. Segundo caso paciente de 51 años con diagnóstico de lesión de vía bliar Strasberg E3 se realiza hepaticoyeyunoanastomosis con asa subaponeurótica. Durante su seguimiento postquirúrgico presente ictericia asintomática a los 24 meses y se evidencia dilatación de vía biliar por colangiorresonancia. Se realiza dilatación endoscópica a través de asa subaponeurótica con éxito. Ha permanecido en vigilancia por 36 meses sin recidiva. La técnica de hepaticoyeyunoanastomosis con asa subaponeurótica permite el fácil acceso y por mínima invasión a anastomosis biliodigestiva para su rehabilitación en caso de estenosis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary The construction of an hepaticojejunostomy is a surgical method of bypass used for the resolution of pathological conditions of the extrahepatic bile ducts, which allows biliary drainage into the small intestine. (1,2) There are several complications that can occur in this technique, such as bile leak and biliary fistula (early complications); one of the long-term complications, is stenosis, which can lead to multiple hospitalizations and major procedures for its resolution. (3,4) Previously, the great problem of stenosis after biliodigestive bypasses was that several major surgeries were needed to manage it. Therefore, it is increasingly necessary to develope new techniques with less morbidity. (5) This new approach has already been implemented in 82 cases of biliary reconstruction, through an access loop direct to the bile duct, through which endoscopic therapy can be performed. First patient case, 27 years old with Strasberg E4 biliary lesion, hepatoejejunostomy was performed with subaponeurotic loop and formation of neoconfluence, 18 months after surgery, asymptomatic jaundice and bile duct dilatation were detected by cholangioresonance. A successful endoscopic dilation was performed through it. However, at 20 months after the dilation it occurs again. It was necessesary to perform another endoscopic dilation through the subaponeurotic loop, being a succesful treatment after 20 months follow up. Second patient case, a 51 year old patient with Strasberg E3 biliary lesión, we performed hepaticojejunostomy with subaponeurotic loop. During postoperative follow-up, asymptomatic jaundice was documented at 24 months and dilatation of the biliary tract by cholangioresonance was evidenced. An endoscopic dilation was performed through the subaponeurotic loop with success. He has remained under surveillance for 36 months without recurrence. The technique of hepaticojejunostomy with a subaponeurotic loop, allows easy access and minimal invasive procedures to the biliodigestive anastomosis for its rehabilitation in case of stenosis.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Dilatación]]></kwd>
<kwd lng="es"><![CDATA[Endoscopia]]></kwd>
<kwd lng="es"><![CDATA[Estenosis]]></kwd>
<kwd lng="es"><![CDATA[Hepaticoyeyunoanastomosis]]></kwd>
<kwd lng="en"><![CDATA[Dilation]]></kwd>
<kwd lng="en"><![CDATA[Endoscopy]]></kwd>
<kwd lng="en"><![CDATA[Stenosis]]></kwd>
<kwd lng="en"><![CDATA[Hepaticojejunostomy]]></kwd>
</kwd-group>
</article-meta>
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