{"id":18720,"date":"2025-06-20T05:57:46","date_gmt":"2025-06-20T05:57:46","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/es\/?p=18720"},"modified":"2025-06-20T05:57:49","modified_gmt":"2025-06-20T05:57:49","slug":"cpre-en-pacientes-pediatricos","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/es\/articulos-comentados\/cpre-en-pacientes-pediatricos\/","title":{"rendered":"CPRE en pacientes pedi\u00e1tricos"},"content":{"rendered":"\n

La colangiopancreatograf\u00eda retr\u00f3grada endosc\u00f3pica (CPRE) es uno de los procedimientos m\u00e1s desafiantes dentro de la endoscopia. No solo por la dificultad t\u00e9cnica, sino por la variedad de patolog\u00edas, variaciones anat\u00f3micas y principalmente por las complicaciones graves involucradas, incluso la muerte.<\/p>\n\n\n\n

Entre los desaf\u00edos encontrados est\u00e1 la CPRE en pacientes pedi\u00e1tricos. Muchas dudas rodean el tema debido a la poca frecuencia con la que se indica este procedimiento en este grupo etario.<\/p>\n\n\n\n

Ramin Nikman y cols (1). realizaron una mini revisi\u00f3n de la literatura basada en un caso cl\u00ednico de colangitis desencadenada por coledocolitiasis, resuelta por CPRE con \u00e9xito. A continuaci\u00f3n comentaremos las principales peculiaridades de la CPRE en ni\u00f1os basada en la revisi\u00f3n de estos autores.<\/p>\n\n\n\n

La litiasis biliar es rara en ni\u00f1os con prevalencia variando de 0,13% a 0,3%, sin embargo, su prevalencia aumenta en la adolescencia y en ni\u00f1os con obesidad, pudiendo llegar a 6,1%. La causa m\u00e1s frecuente son las enfermedades hemol\u00edticas (20%-30%), otras causas son las anomal\u00edas cong\u00e9nitas, obesidad, nutrici\u00f3n parenteral total, quistes de col\u00e9doco y prematuridad.<\/p>\n\n\n\n

La indicaci\u00f3n de la CPRE en ni\u00f1os es menor que en el adulto (3.3% y 4% de acuerdo con Felux y cols. y Lou y cols.) no solo por la poca frecuencia de las patolog\u00edas pancreatobiliares, sino tambi\u00e9n por limitaciones t\u00e9cnicas que disminuyen su indicaci\u00f3n. Una de ellas es la limitaci\u00f3n del tama\u00f1o del aparato. Los duodenoscopios convencionales solo pueden ser utilizados en ni\u00f1os con m\u00e1s de 10 kg de forma general, limitando la aplicaci\u00f3n de esta alternativa terap\u00e9utica.<\/p>\n\n\n\n

Una evaluaci\u00f3n detallada con ex\u00e1menes de imagen es fundamental para una indicaci\u00f3n correcta de la CPRE. En el caso presentado en este art\u00edculo, se realiz\u00f3 una ecograf\u00eda del abdomen superior, demostrando una ves\u00edcula hiperdistendida con engrosamiento de su pared, adem\u00e1s de dilataci\u00f3n del hepatocol\u00e9doco ocasionada por un c\u00e1lculo en su segmento intrapancre\u00e1tico. La colangiorresonancia confirm\u00f3 el diagn\u00f3stico y caracteriz\u00f3 una ves\u00edcula biliar localizada a la izquierda del ligamento redondo, anomal\u00eda rara que puede estar asociada a ausencia del segmento IV y a malformaci\u00f3n de las ramificaciones de la vena porta. La ves\u00edcula biliar a la izquierda del ligamento redondo es una anomal\u00eda rara variando de 0,1% a 1,2%.<\/p>\n\n\n\n

En otro art\u00edculo, Fumihiro Terasaki describe en detalle estas alteraciones anat\u00f3micas y las clasifica, concluyendo que en estos casos de anomal\u00eda de implantaci\u00f3n del ligamento redondo hay un cambio significativo del volumen de los segmentos III y IV del h\u00edgado.<\/p>\n\n\n\n

Los aparatos disponibles para CPRE en Brasil son todos terap\u00e9uticos con di\u00e1metro de la punta distal mayor que 13 mm. Olympus solo fabrica actualmente el modelo TJF-190 y TJF-170. Fujinon tiene los modelos ED-580T y ED-580XT. En estos casos tenemos una limitaci\u00f3n significativa de uso, siendo indicados solo para ni\u00f1os con peso superior a 10 kg. Felux J. utiliz\u00f3 el duodenoscopio convencional para adultos en ni\u00f1os con peso superior a 12,5 kg y un pedi\u00e1trico (Olympus PJF160) para ni\u00f1os menores (con hasta 6 meses de edad); ya Lou utilizando un duodenoscopio Olympus JF240, con 11,5 mm, realiz\u00f3 una CPRE con \u00e9xito en lactante de 3 meses (peso de 7,5 kg). Estos aparatos no est\u00e1n disponibles comercialmente en Brasil.<\/p>\n\n\n\n

En resumen la CPRE en ni\u00f1os es un procedimiento de elecci\u00f3n para tratamiento de patolog\u00edas biliares, principalmente la coledocolitiasis, pero con limitaci\u00f3n de tama\u00f1o de los aparatos disponibles. La evaluaci\u00f3n previa a trav\u00e9s de la colangiorresonancia es importante, a fin de evitar una CPRE puramente diagn\u00f3stica y de prever posibles anomal\u00edas anat\u00f3micas.<\/p>\n\n\n\n

Referencias<\/strong><\/h2>\n\n\n\n
    \n
  1. Stone removal in a 5-year-old child with extrahepatic biliary obstruction using ERCP: A case report and a mini-review. Niknam R, Mortazavi SMM, Jahromi MG, Davoodi M, Soheili M, Ataollahi M, Moshfeghinia R. Clin Case Rep. 2023 Jul 27;11(8): e7620. doi: 10.1002\/ccr3.7620. PMID: 37520769; PMCID: PMC10374985.<\/li>\n\n\n\n
  2. Felux J, Sturm E, Busch A, Zerabruck E, Graepler F, St\u00fcker D, Manger A, Kirschner HJ, Blumenstock G, Malek NP, Goetz M. ERCP in infants, children and adolescents is feasible and safe: results from a tertiary care center. United European Gastroenterol J. 2017 Nov;5(7):1024-1029. doi: 10.1177\/2050640616687868. Epub 2017 Jan 11. PMID: 29163969; PMCID: PMC5676540.<\/li>\n\n\n\n
  3. Terasaki F, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Ohgi K, Aramaki T, Uesaka K. Analysis of right-sided ligamentum teres: The novel anatomical findings and classification. J Hepatobiliary Pancreat Sci. 2021 Feb;28(2):221-230. doi: 10.1002\/jhbp.856. Epub 2020 Nov 17. PMID: 33135376.<\/li>\n\n\n\n
  4. Lou Q, Sun J, Zhang X, Shen H. Successful Therapeutic ERCP in a 99-Day-Old Child with Common Bile Duct Stones: A Case Report and Discussions on the Particularities of the ERCP in Children. Front Pediatr. 2020 Jul 28;8:435. doi: 10.3389\/fped.2020.00435. PMID: 32850548; PMCID: PMC7399065.<\/li>\n<\/ol>\n\n\n\n

    C\u00f3mo citar este art\u00edculo<\/strong><\/h2>\n\n\n\n

    Ide E. CPRE en pacientes pedi\u00e1tricos Endoscopia Terap\u00e9utica 2023, vol. 2. Disponible en: https:\/\/endoscopiaterapeutica.net\/es\/articulos-comentados\/<\/span>cpre-en-pacientes-pediatricos<\/span>\/<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    La colangiopancreatograf\u00eda retr\u00f3grada endosc\u00f3pica (CPRE) es uno de los procedimientos m\u00e1s desafiantes dentro de…<\/p>\n","protected":false},"author":5532,"featured_media":18715,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[142],"tags":[],"ano":[555],"tipo":[155],"volume":[147],"class_list":["post-18720","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articulos-comentados","ano-555","tipo-cpre","volume-volumen-ii"],"yoast_head":"\nCPRE en pacientes pedi\u00e1tricos • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/es\/articulos-comentados\/cpre-en-pacientes-pediatricos\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPRE en pacientes pedi\u00e1tricos\" \/>\n<meta property=\"og:description\" content=\"La colangiopancreatograf\u00eda retr\u00f3grada endosc\u00f3pica (CPRE) es uno de los procedimientos m\u00e1s desafiantes dentro de la endoscopia. 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