{"id":10747,"date":"2021-11-30T08:00:28","date_gmt":"2021-11-30T08:00:28","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=10747"},"modified":"2021-12-02T15:06:43","modified_gmt":"2021-12-02T15:06:43","slug":"podemos-considerar-a-ecoendoscopia-um-exame-seguro","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/podemos-considerar-a-ecoendoscopia-um-exame-seguro\/","title":{"rendered":"Podemos considerar a ecoendoscopia um exame seguro?"},"content":{"rendered":"

A ecoendoscopia \u00e9 um m\u00e9todo emergente e minimamente invasivo que dia a dia vem se aprimorando e adquirindo novas tecnologias e, com isso, ampliando suas finalidades diagn\u00f3sticas e terap\u00eauticas. No Brasil, deixou de ser exame restrito aos grandes hospitais das capitais, estando atualmente difundido por quase todo o pa\u00eds. No entanto, com o aumento da sua demanda, observam-se tamb\u00e9m maiores \u00edndices de eventos adversos. Mas, afinal, podemos consider\u00e1-la um m\u00e9todo seguro?<\/span><\/p>\n

A perfura\u00e7\u00e3o \u00e9 um dos eventos adversos mais temidos, pois na maioria das vezes requer tratamento cir\u00fargico. Os locais mais comumente acometidos s\u00e3o as \u00e1reas de maior angula\u00e7\u00e3o, como a hipofaringe, o duodeno (durante a passagem do aparelho do bulbo para a segunda por\u00e7\u00e3o) e a transi\u00e7\u00e3o do retossigmoide. O maior risco de perfura\u00e7\u00e3o em rela\u00e7\u00e3o \u00e0 endoscopia digestiva alta \u00e9 devido principalmente \u00e0s caracter\u00edsticas do aparelho: o ecoendosc\u00f3pio, al\u00e9m de calibroso, possui uma ponta pouco flex\u00edvel devido a um segmento r\u00edgido nos 4 cm distais, aumentando o desafio na introdu\u00e7\u00e3o do aparelho, principalmente se o paciente possuir altera\u00e7\u00f5es p\u00f3s-cir\u00fargicas, divert\u00edculos e estenoses associadas. Essa dificuldade se torna ainda mais acentuada pelo campo de vis\u00e3o restrito quando h\u00e1 necessidade de utiliza\u00e7\u00e3o do aparelho linear, dedicado \u00e0 realiza\u00e7\u00e3o das pun\u00e7\u00f5es ecoguiadas.<\/span><\/p>\n

Para minimizar o risco de perfura\u00e7\u00e3o, \u00e9 importante que o ecoendoscopista esteja familiarizado com o equipamento e conhe\u00e7a bem a anatomia. Pacientes submetidos a pun\u00e7\u00f5es ecoguiadas est\u00e3o at\u00e9 dez vezes mais propensos a eventos adversos, comparativamente \u00e0queles n\u00e3o puncionados, mesmo assim com incid\u00eancia em torno de 1-3%. Dor, infec\u00e7\u00f5es, pancreatite aguda e hemorragia s\u00e3o os eventos mais observados. Peritonite biliar e implante tumoral s\u00e3o extremamente raros, com poucos casos reportados na literatura, e a mortalidade relatada, estimada em 0,02%.<\/span><\/p>\n

O risco de infec\u00e7\u00e3o p\u00f3s-pun\u00e7\u00e3o pode ocorrer especialmente nas les\u00f5es de natureza c\u00edstica. Para tanto, recomendam-se alguns cuidados no intuito de diminuir esse evento, como realizar pun\u00e7\u00e3o \u00fanica, esvaziar, sempre que poss\u00edvel, completamente o conte\u00fado do cisto e administrar antibi\u00f3tico profil\u00e1tico.<\/span><\/p>\n

A possibilidade de pancreatite iatrog\u00eanica sempre deve ser considerada nas pun\u00e7\u00f5es pancre\u00e1ticas e ocorre em cerca de 2% dos casos, sendo a forma leve a mais frequentemente observada, estando os pacientes com hist\u00f3ria de pancreatite aguda recorrente e aqueles com doen\u00e7as pancre\u00e1ticas benignas sob maior risco. Para aumentar a seguran\u00e7a do procedimento, deve-se evitar transfixar o ducto pancre\u00e1tico, al\u00e9m de grandes segmentos de par\u00eanquima pancre\u00e1tico saud\u00e1vel com a agulha da pun\u00e7\u00e3o.<\/span><\/p>\n

Hemorragias leves e autolimitadas intraluminais s\u00e3o reportadas em at\u00e9 4% dos casos e usualmente n\u00e3o requerem interven\u00e7\u00e3o endosc\u00f3pica, cir\u00fargica ou transfus\u00f5es. Est\u00e3o sob maior risco os pacientes com les\u00f5es c\u00edsticas, bem vascularizadas (como tumores neuroend\u00f3crinos, les\u00f5es subepiteliais mesenquimais e algumas met\u00e1stases) ou aquelas pr\u00f3ximas aos grandes vasos, e portadores de hipertens\u00e3o portal. O uso do doppler para calcular o melhor trajeto da agulha e o questionamento sob uso de anticoagulantes e antiplaquet\u00e1rios s\u00e3o primordiais para diminuir o risco de hemorragia.<\/span><\/p>\n

Devido ao relativo baixo risco de eventos adversos, principalmente considerando casos fatais, podemos considerar a ecoendoscopia, com ou sem pun\u00e7\u00e3o, procedimento seguro, estando o sucesso da t\u00e9cnica diretamente relacionado ao treinamento adequado e experi\u00eancia do m\u00e9dico executante, al\u00e9m da pronta identifica\u00e7\u00e3o\/tratamento do evento adverso e apropriada sele\u00e7\u00e3o do paciente.<\/span><\/p>\n

\"Podemos

Pun\u00e7\u00e3o ecoguiada de cisto pancre\u00e1tico<\/p><\/div>\n

 <\/p>\n

\"Podemos

Material de pun\u00e7\u00e3o ecoguiada<\/p><\/div>\n

 <\/p>\n

Como citar este artigo<\/b><\/h2>\n

Ribeiro MSI. Podemos considerar a ecoendoscopia um exame seguro?. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: <\/span>https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/podemos-considerar-a-ecoendoscopia-um-exame-seguro\/<\/span><\/a><\/p>\n

Refer\u00eancias<\/b><\/h2>\n
    \n
  1. Jenssen C et al. World J Gastroenterol. 2012 Sep 14; 18(34): 4659\u20134676.<\/span><\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    A ecoendoscopia \u00e9 um m\u00e9todo emergente e minimamente invasivo que dia a dia vem…<\/p>\n","protected":false},"author":3701,"featured_media":10748,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[262],"tipo":[154],"volume":[147],"class_list":["post-10747","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-262","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"\nPodemos considerar a ecoendoscopia um exame seguro? • 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\/pt\/assuntosgerais\/podemos-considerar-a-ecoendoscopia-um-exame-seguro\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta 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