Resumen

GEMMATO, Ana María; ALAN, José Manuel  y  ANSELMI, Mario. Tasa de resolución endoscópica completa de cálculos de la vía biliar al primer intento: Experiencia de un centro terciario. Gen [online]. 2008, vol.62, n.3, pp.205-207. ISSN 0016-3503.

Introduction: Despite the technological progress of endoscopes and the existence of a variety of instrumental accessory available, the complete cleaning of the bile duct can not always be achieved in the initial procedure. Objectives: To analyze the experience of a center that specializes in endoscopic surgery, the success of the bile duct cleaning during the first attempt and causes of failure of this. Materials and methods: Between 01.01.04 and 12.30.04 272 patients undergoing an ERCP for the first time were prospectively studied during which the diagnosis of choledocholithiasis was confirmed. The average age was 59.1 μ 18, 189 (69.5%) were women. In 41 (15.1%) the presence of a juxtapapilar diverticulum was screened, 86 (31.6%) calculus measured more than 15mm in diameter and 93 patients (34.2%) presented a coledocus panlitiasis. Results: At the first session of RECP it was possible to extract all coledocus calculus in 227 patients (83.5%). In the 45 remaining (16.5%) the main causes of failure were the presence of large calculus that occupied the whole lumen of the bile duct, 20 (44.4%), 8 giant calculus (17.8%), 7 impacted calculus (15.6%) and discoagulopaty in 7 patients (15.6%). There was a 28.9% rate of concomitant cholangitis. The failure in the extraction of the calculus was associated with a higher age (57.1 μ 18.3 vs. 67.9 μ 14.1 years, P <0.0001), large calculus (10.7 μ 6.1 vs. 19.2 μ 9.4 mm) the presence of panlitiasis ( 29.6 vs. 55.6%, P <0.0001) and emergency procedures (26.9 vs. 42.2%, P <0.04). Conclusions: In a specialized endoscopic unit, the rate of extraction of calculations during the first attempt exceeds 82%. The failure in the extraction is associated with older patients with large and multiple calculus and when the procedure is performed as an emergency.