{"id":13003,"date":"2022-08-09T07:00:00","date_gmt":"2022-08-09T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=13003"},"modified":"2022-08-05T00:22:13","modified_gmt":"2022-08-05T00:22:13","slug":"papila-duodenal-maior-precisamos-inspecionar-na-rotina","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/papila-duodenal-maior-precisamos-inspecionar-na-rotina\/","title":{"rendered":"PAPILA DUODENAL MAIOR: Precisamos inspecionar na rotina?"},"content":{"rendered":"\n<p>Todos sabemos que o endosc\u00f3pio \u201cstandard\u201d n\u00e3o favorece a visualiza\u00e7\u00e3o da parede medial da segunda por\u00e7\u00e3o do duodeno. Identificar e inspecionar detalhadamente a papila de Vater n\u00e3o costuma ser uma tarefa simples durante a endoscopia digestiva alta (EDA) de rotina. <em><strong>Ser\u00e1 que dever\u00edamos investir tempo na inspe\u00e7\u00e3o detalhada desta \u00e1rea frequentemente trabalhosa?<\/strong><\/em><\/p>\n\n\n\n<p>Para responder tal pergunta, precisamos refletir sobre as patologias clinicamente relevantes da papila. &nbsp;A principal delas \u00e9 o adenoma e sua degenera\u00e7\u00e3o maligna. Os p\u00f3lipos duodenais s\u00e3o les\u00f5es incomuns, encontrados em 0,3 a 4,6% das EDAS.(1) Dentre estes p\u00f3lipos, os adenomas representam apenas 7% das les\u00f5es, &nbsp;s\u00e3o localizados preferencialmente na segunda por\u00e7\u00e3o, podendo ou n\u00e3o envolver a papila maior.(2) Em uma m\u00e9dia extrapolada das estat\u00edsticas supracitadas, consideramos uma preval\u00eancia de aproximadamente 0,05 a 0,1% de adenomas ampulares nas EDAS.<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"542\" height=\"433\" data-id=\"13005\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/Fig-1.jpg\" alt=\"\" class=\"wp-image-13005\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/Fig-1.jpg?v=1659624757 542w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/Fig-1-300x240.jpg?v=1659624757 300w\" sizes=\"(max-width: 542px) 100vw, 542px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"542\" height=\"433\" data-id=\"13004\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-1.2.jpg\" alt=\"\" class=\"wp-image-13004\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-1.2.jpg?v=1659624757 542w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-1.2-300x240.jpg?v=1659624757 300w\" sizes=\"(max-width: 542px) 100vw, 542px\" \/><\/figure>\n<\/figure>\n\n\n\n<p class=\"has-small-font-size\">Figura 1 \u2013 Adenoma de papila<\/p>\n\n\n\n<p>A evid\u00eancia m\u00e9dica \u00e9 pobre para definir a import\u00e2ncia da inspe\u00e7\u00e3o de maneira rotineira. Mas uma incid\u00eancia de adenoma papilar em aproximadamente 1 caso para cada mil EDAs parece ser uma justificativa razo\u00e1vel para investimento de tempo na inspe\u00e7\u00e3o, mesmo que tangencial da papila. N\u00e3o podemos esquecer que a polipose adenomatosa familiar \u00e9 um cap\u00edtulo \u00e0 parte. A incid\u00eancia de adenomas duodenais pode chegar a 92% ao longo da vida, possuindo protocolo espec\u00edfico de rastreio e manejo.(3)<\/p>\n\n\n\n<p>O \u00faltimo guideline da ESGE sobre par\u00e2metros de qualidade em endoscopia digestiva alta, publicado em 2019, estabeleceu como prioridade de pesquisa a defini\u00e7\u00e3o da import\u00e2ncia da visualiza\u00e7\u00e3o da papila na endoscopia de rotina. (4) Em guideline subsequente sobre o manejo de tumores ampulares, publicado em 2021, <em>a <strong>ESGE recomenda que a papila seja inspecionada rotineiramente, apesar da evid\u00eancia limitada.<\/strong> (5).<\/em><\/p>\n\n\n\n<p>Em caso de suspeita cl\u00ednica (ex. amilase ou bilirrubinas, pancreatite idiop\u00e1tica, etc), ou aspecto endosc\u00f3pico suspeito, a inspe\u00e7\u00e3o detalhada da papila \u00e9 mandat\u00f3ria. Para tal finalidade, o <strong>duodenosc\u00f3pio<\/strong> deve ser o aparelho de primeira escolha.(5) Usando o gastrosc\u00f3pio \u201cstandard\u201d, a papila \u00e9 totalmente visualizada em apenas 24% das EDAs e vista parcialmente em 69%. Ou seja, na indisponibilidade de um duodenosc\u00f3pio, a avalia\u00e7\u00e3o apropriada da papila fica bastante comprometida. Esse problema pode ser facilmente solucionado com o uso de um <strong>cap transparente<\/strong> que permite a visualiza\u00e7\u00e3o completa da papila em at\u00e9 97% dos exames. (6)<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"542\" height=\"433\" data-id=\"13007\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2.jpg\" alt=\"\" class=\"wp-image-13007\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2.jpg?v=1659625012 542w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2-300x240.jpg?v=1659625012 300w\" sizes=\"(max-width: 542px) 100vw, 542px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"542\" height=\"433\" data-id=\"13006\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2.1.jpg\" alt=\"\" class=\"wp-image-13006\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2.1.jpg?v=1659625012 542w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2022\/08\/fig-2.1-300x240.jpg?v=1659625012 300w\" sizes=\"(max-width: 542px) 100vw, 542px\" \/><\/figure>\n<\/figure>\n\n\n\n<p class=\"has-small-font-size\">Figura 2 \u2013 Exposi\u00e7\u00e3o completa da papila com o uso de \u201ccap\u201d<\/p>\n\n\n\n<h2 class=\"has-pale-cyan-blue-background-color has-background wp-block-heading\">Respondendo \u00e0 pergunta inicial:<\/h2>\n\n\n\n<ol class=\"has-pale-ocean-gradient-background has-background wp-block-list\"><li>Devemos inspecionar a papila rotineiramente<\/li><li>Em casos suspeitos: usar o duodenosc\u00f3pio<\/li><li>O gastrosc\u00f3pio com &#8220;cap&#8221; \u00e9 uma excelente alternativa ao duodenosc\u00f3pio<\/li><\/ol>\n\n\n\n<p><\/p>\n\n\n\n<p>Falar sobre os aspectos endosc\u00f3picos da papila e o manejo das patologias, transcende o prop\u00f3sito deste post. Voc\u00ea gostaria de ver estes t\u00f3picos abordados no Endoscopia Terap\u00eautica? Deixe seu coment\u00e1rio!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<p>1. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Culver EL, McIntyre AS. Sporadic duodenal polyps: Classification, investigation, and management. Endoscopy. 2011;43(2):144\u201355.<\/p>\n\n\n\n<p>2. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Klein A, Bourke MJ. Duodenal and Papillary Adenomas [Internet]. Third Edition. Clinical Gastrointestinal Endoscopy. Elsevier Inc.; 2019. 374-381.e3 p. Available from: https:\/\/doi.org\/10.1016\/B978-0-323-41509-5.00034-7<\/p>\n\n\n\n<p>3. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Leerdam ME Van, Roos VH, Hooft JE Van, Dekker E, Jover R, Michal F, et al. Endoscopic management of polyposis syndromes\u202f: European Society of Gastrointestinal Endoscopy ( ESGE ) Guideline Authors. 2019;877\u201395.<\/p>\n\n\n\n<p>4. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Spada C, McNamara D, Despott EJ, Adler S, Cash BD, Fern\u00e1ndez-Uri\u00e9n I, et al. Performance measures for small-bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United Eur Gastroenterol J. 2019;7(5):614\u201341.<\/p>\n\n\n\n<p>5. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Vanbiervliet G, Strijker M, Arvanitakis M, Aelvoet A, Arnelo U, Beyna T, et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(4):429\u201348.<\/p>\n\n\n\n<p>6. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Abdelhafez M, Phillip V, Hapfelmeier A, Elnegouly M, Poszler A, Strobel K, et al. Cap Assisted Upper Endoscopy for Examination of the Major Duodenal Papilla\u202f: A Randomized , Blinded , Controlled Crossover Study ( CAPPA Study ). Nat Publ Gr [Internet]. 2017;(October 2016):1\u20139. Available from: http:\/\/dx.doi.org\/10.1038\/ajg.2017.47<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Todos sabemos que o endosc\u00f3pio \u201cstandard\u201d n\u00e3o favorece a visualiza\u00e7\u00e3o da parede medial da&hellip;<\/p>\n","protected":false},"author":2695,"featured_media":13005,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[309],"tipo":[153],"volume":[147],"class_list":["post-13003","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-309","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>PAPILA DUODENAL MAIOR: Precisamos inspecionar na rotina? &#8226; 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\/papila-duodenal-maior-precisamos-inspecionar-na-rotina\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PAPILA DUODENAL MAIOR: Precisamos inspecionar na rotina?\" \/>\n<meta property=\"og:description\" content=\"Todos sabemos que o endosc\u00f3pio \u201cstandard\u201d n\u00e3o favorece a visualiza\u00e7\u00e3o da parede medial da segunda por\u00e7\u00e3o do duodeno. 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