{"id":19578,"date":"2026-04-08T17:31:57","date_gmt":"2026-04-08T17:31:57","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/es\/?p=19578"},"modified":"2026-04-08T19:19:16","modified_gmt":"2026-04-08T19:19:16","slug":"esfincterotomia-transpancreatica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/esfincterotomia-transpancreatica\/","title":{"rendered":"Esfinterotom\u00eda transpancre\u00e1tica"},"content":{"rendered":"\n

La canulaci\u00f3n biliar es un paso fundamental para el \u00e9xito de la CPRE, y el acceso biliar dif\u00edcil se asocia con mayores tasas de fracaso y eventos adversos, seg\u00fan la literatura1<\/sup>.<\/p>\n\n\n\n

En casos de fracaso en el acceso a las v\u00edas biliares mediante la t\u00e9cnica convencional, se pueden emplear m\u00e9todos alternativos de acceso a la CPRE, como la f\u00edstula suprapapilar, la cateterizaci\u00f3n con doble gu\u00eda, la esfinterotom\u00eda transpancre\u00e1tica (ETP), el precorte y diferentes t\u00e9cnicas de acceso Rendez-Vous2<\/sup>.<\/p>\n\n\n\n

La ETP, descrita por Goff en 19953<\/sup>, se ha considerado recientemente un m\u00e9todo de acceso importante en casos de cateterizaci\u00f3n inadvertida del conducto pancre\u00e1tico principal.<\/p>\n\n\n\n

La t\u00e9cnica consiste en, tras la cateterizaci\u00f3n del conducto pancre\u00e1tico principal, dirigir el papil\u00f3tomo hacia el eje de las v\u00edas biliares a las 11 en punto y realizar la esfinterotom\u00eda (Figura 1).<\/p>\n\n\n

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Figura 1: Ilustraci\u00f3n de la t\u00e9cnica de esfinterotom\u00eda transpancre\u00e1tica.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n


A continuaci\u00f3n, se recomienda la colocaci\u00f3n de un stent pancre\u00e1tico, seguido de la cateterizaci\u00f3n de las v\u00edas biliares (Figura 2).<\/p>\n\n\n

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Figura 2: Esfinterotom\u00eda transpancre\u00e1tica seguida de colocaci\u00f3n de stent pancre\u00e1tico.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n

Una de las ventajas potenciales del m\u00e9todo es que el acceso se gu\u00eda por la presencia de la gu\u00eda met\u00e1lica, a diferencia de una f\u00edstula suprapapilar, lo que puede beneficiar a los endoscopistas en formaci\u00f3n4<\/sup>.<\/p>\n\n\n\n

En los \u00faltimos a\u00f1os, se han realizado nuevos estudios que eval\u00faan las tasas de \u00e9xito de la CPRE, as\u00ed como la incidencia de eventos adversos relacionados. Haga clic para obtener m\u00e1s informaci\u00f3n sobre las estrategias para prevenir la pancreatitis post-CPRE.<\/p>\n\n\n\n

Dos estudios retrospectivos destacan por su gran tama\u00f1o muestral de pacientes sometidos a CPRE5,6<\/sup>. El primero compar\u00f3 un grupo control con acceso convencional exitoso, ETP, doble gu\u00eda y precorte con estilete; las tasas de \u00e9xito fueron del 94,9%, 87,2%, 74,5% y 69,6%, respectivamente. No se observaron diferencias significativas en los eventos adversos entre el grupo control y el grupo ETP; en este \u00faltimo, la tasa de pancreatitis fue del 1,1% y la de hemorragia del 0,3%. El segundo estudio citado evalu\u00f3 a pacientes sometidos a ETP en comparaci\u00f3n con aquellos con acceso biliar convencional. La tasa de \u00e9xito t\u00e9cnico de la ETP fue del 95,9%, la incidencia de pancreatitis en este grupo fue del 2,8%, y la tasa de hemorragia fue significativamente mayor en comparaci\u00f3n con el acceso convencional (10,9%, p=0,005), si bien el riesgo de hemorragia se atribuy\u00f3 a intentos previos de acceso con precorte.<\/p>\n\n\n\n

En un ensayo cl\u00ednico multic\u00e9ntrico aleatorizado que compar\u00f3 la ETP y la doble gu\u00eda en el acceso biliar dif\u00edcil7<\/sup>, Kyl\u00e4np\u00e4\u00e4 y colaboradores demostraron la superioridad de la ETP para lograr el acceso biliar (84,6 % frente a 69,7 %; p = 0,01), sin diferencias en la tasa de pancreatitis (13,5 % frente a 16,2 %).<\/p>\n\n\n\n

Finalmente, un metaan\u00e1lisis que compar\u00f3 diferentes t\u00e9cnicas para acceder a la v\u00eda biliar dif\u00edcil8<\/sup>, favoreci\u00f3 la realizaci\u00f3n de la ETP sobre la persistencia con la t\u00e9cnica tradicional, la doble gu\u00eda, el precorte y la canulaci\u00f3n asistida con pr\u00f3tesis pancre\u00e1tica para el \u00e9xito del acceso biliar.<\/p>\n\n\n\n

Seg\u00fan los estudios evaluados, la esfinterotom\u00eda transpancre\u00e1tica ha demostrado ser un m\u00e9todo seguro y eficaz para la canulaci\u00f3n biliar en casos de fracaso del acceso convencional, y deber\u00eda ser una opci\u00f3n a considerar en el arsenal del endoscopista. Es importante destacar que la selecci\u00f3n de la t\u00e9cnica para el acceso biliar en caso de fracaso de la canulaci\u00f3n convencional debe tener en cuenta el aspecto endosc\u00f3pico de la papila, la patolog\u00eda subyacente, la presencia de cateterismo de la papila duodenal y la experiencia del endoscopista.<\/p>\n\n\n\n


Referencias<\/strong><\/h2>\n\n\n\n
    \n
  1. Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, Devi\u00e8re J, Dinis-Ribeiro M, Dumonceau JM, Giovannini M, Gyokeres T, Hafner M, Halttunen J, Hassan C, Lopes L, Papanikolaou IS, Tham TC, Tringali A, van Hooft J, Williams EJ. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 Jul;48(7):657-83.<\/li>\n\n\n\n
  2. Kouanda A, Bayudan A, Hussain A, Avila P, Kamal F, Hasan MK, Dai SC, Munroe C, Thiruvengadam N, Arain MA. Current state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study. Endosc Int Open. 2023 Jun 21;11(6):E588-E598.<\/li>\n\n\n\n
  3. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointestinal Endoscopy. 1995 41(5), 502\u2013505.<\/li>\n\n\n\n
  4. Su WC, Wang CC, Hsiao TH, Chen HD, Chen JH. The impact of transpancreatic precut sphincterotomy on the quality of ERCP in a low-volume setting. Gastrointest Endosc. 2024 May;99(5):747-755.<\/li>\n\n\n\n
  5. Barakat MT, Girotra M, Huang RJ, Choudhary A, Thosani NC, Kothari S, Sethi S, Banerjee S. Goff Septotomy Is a Safe and Effective Salvage Biliary Access Technique Following Failed Cannulation at ERCP. Dig Dis Sci. 2021 Mar;66(3):866-872.<\/li>\n\n\n\n
  6. Papaefthymiou A, Florou T, Koffas A, Kateri C, Pateras K, Fytsilis F, Chougias D, Bektsis T, Manolakis A, Kapsoritakis A, Potamianos S. Efficacy and safety of transpancreatic sphincterotomy in endoscopic retrograde cholangiopancreatography: a retrospective cohort study. Ann Gastroenterol. 2022 Nov-Dec;35(6):648-653.<\/li>\n\n\n\n
  7. Kyl\u00e4np\u00e4\u00e4 L, Koskensalo V, Saarela A, Ejstrud P, Udd M, Lindstr\u00f6m O, Rainio M, Tenca A, Halttunen J, Qvigstad G, Arnelo U, Fagerstr\u00f6m N, Hauge T, Aabakken L, Gr\u00f6nroos J. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial. Endoscopy. 2021 Oct;53(10):1011-1019.<\/li>\n\n\n\n
  8. Facciorusso A, Ramai D, Gkolfakis P, Khan SR, Papanikolaou IS, Triantafyllou K, Tringali A, Chandan S, Mohan BP, Adler DG. Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis. Gastrointest Endosc. 2022 Jan;95(1):60-71.e12.<\/li>\n<\/ol>\n\n\n\n


    Como citar este articulo<\/strong><\/h2>\n\n\n\n

    Logiudice FP, Penaloza CSQ. Esfinterotom\u00eda transpancre\u00e1tica. Endoscopia Terap\u00e9utica 2026, Vol I. Disponible en: https:\/\/endoscopiaterapeutica.net\/es\/temas-generales\/esfinterotomia-transpancreatica\/<\/a><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    La canulaci\u00f3n biliar es un paso fundamental para el \u00e9xito de la CPRE, y…<\/p>\n","protected":false},"author":6153,"featured_media":19580,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[751],"tipo":[155],"volume":[263],"class_list":["post-19578","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-temas-generales","ano-751","tipo-cpre","volume-volumen-i"],"yoast_head":"\nEsfinterotom\u00eda transpancre\u00e1tica • 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\/temas-generales\/esfincterotomia-transpancreatica\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" 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