{"id":5617,"date":"2019-07-22T20:42:38","date_gmt":"2019-07-22T20:42:38","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/classificacao\/publish-39\/"},"modified":"2021-08-10T01:13:38","modified_gmt":"2021-08-10T01:13:38","slug":"stapfer-perfuracao-pos-cpre","status":"publish","type":"classificacao","link":"https:\/\/endoscopiaterapeutica.net\/pt\/classificacao\/stapfer-perfuracao-pos-cpre\/","title":{"rendered":"STAPFER \u2013 PERFURA\u00c7\u00c3O P\u00d3S-CPRE"},"content":{"rendered":"

 <\/p>\n

A classifica\u00e7\u00e3o de Stapfer \u00e9 a mais utilizada para perfura\u00e7\u00e3o ap\u00f3s CPRE e baseia-se no mecanismo, localiza\u00e7\u00e3o anat\u00f4mica e gravidade da les\u00e3o.<\/p>\n

 <\/p>\n

\n\n\n\n\n\n\n
Tipo<\/td>\nLes\u00e3o<\/td>\n<\/tr>\n
I<\/td>\nPerfura\u00e7\u00e3o da parede intestinal livre<\/td>\n<\/tr>\n
II<\/td>\nPerfura\u00e7\u00e3o periampular (retroperit\u00f4neo)<\/td>\n<\/tr>\n
III<\/td>\nPerfura\u00e7\u00e3o do ducto pancre\u00e1tico ou biliar<\/td>\n<\/tr>\n
IV<\/td>\nAr no retroperit\u00f4nio em exame de imagem (sem perfura\u00e7\u00e3o evidente)<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

 <\/p>\n

\"\"<\/a>

Imagem retirada do artigo: Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232:191.<\/p><\/div>\n

 <\/p>\n

A perfura\u00e7\u00e3o p\u00f3s-CPRE ocorre em 0,5% dos casos.<\/p>\n

 <\/p>\n

Os tipos de perfura\u00e7\u00e3o apresentam mecanismos diferentes:<\/p>\n

I \u2013 relacionada ao endosc\u00f3pio;<\/p>\n

II \u2013 relacionada \u00e0 esfincterotomia e manipula\u00e7\u00e3o periampular;<\/p>\n

III \u2013 relacionada \u00e0 instrumenta\u00e7\u00e3o da via biliar;<\/p>\n

IV – relacionada \u00e0 insufla\u00e7\u00e3o excessiva junto a papila.<\/p>\n

 <\/p>\n

 <\/p>\n

O tratamento inicial depende do tipo de perfura\u00e7\u00e3o:<\/p>\n

I \u2013 eminentemente cir\u00fargico (pode tentar tratamento endosc\u00f3pico);<\/p>\n

II \u2013 tratamento endosc\u00f3pico (pr\u00f3tese met\u00e1lica autoexpans\u00edvel totalmente recoberta);<\/p>\n

III \u2013 tratamento endosc\u00f3pico (pr\u00f3tese biliar ou pancre\u00e1tica) e observa\u00e7\u00e3o;<\/p>\n

IV \u2013 observa\u00e7\u00e3o nos assintom\u00e1ticos.<\/p>\n

 <\/p>\n

\"\"<\/a>

Les\u00e3o tipo IV. Ar no retroperit\u00f4nio, sem perfura\u00e7\u00e3o evidente pelo exame de endoscopia.<\/p><\/div>\n

 <\/p>\n

 <\/p>\n

Refer\u00eancias: <\/strong><\/p>\n

    \n
  • Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232:191.<\/li>\n
  • ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc. 2017 Jan;85(1):32-47.<\/li>\n<\/ul>\n

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

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