{"id":19401,"date":"2024-09-10T07:30:00","date_gmt":"2024-09-10T07:30:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=19401"},"modified":"2024-09-10T03:09:18","modified_gmt":"2024-09-10T03:09:18","slug":"esfincterotomia-transpancreatica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/esfincterotomia-transpancreatica\/","title":{"rendered":"Esfincterotomia transpancre\u00e1tica"},"content":{"rendered":"\n

A canula\u00e7\u00e3o biliar \u00e9 etapa fundamental no sucesso da CPRE, sendo o acesso biliar dif\u00edcil associado a maiores taxas de falha na CPRE e eventos adversos documentados na literatura1<\/sup>.<\/p>\n\n\n\n

Na falha de acesso \u00e0 via biliar pela t\u00e9cnica convencional m\u00e9todos alternativos de acesso pela CPRE podem ser empregados, tais como a f\u00edstula suprapapilar, cateteriza\u00e7\u00e3o por duplo fio guia, esfincterotomia transpancre\u00e1tica (ETP), pr\u00e9-corte e diferentes t\u00e9cnicas de acesso por Rendez Vous2<\/sup>.<\/p>\n\n\n\n

A ETP, descrita por Goff em 1995 3<\/sup>, vem recentemente sendo discutida como importante m\u00e9todo de acesso, nos casos de cateteriza\u00e7\u00e3o inadvertida do DPP.<\/p>\n\n\n\n

A t\u00e9cnica consiste em, ap\u00f3s a cateteriza\u00e7\u00e3o do ducto pancre\u00e1tico principal, direcionar o papil\u00f3tomo para o eixo da via biliar \u00e0s 11h, realizando a esfincterotomia (Figura 1). <\/p>\n\n\n

\n
\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button>
Figura 1: ilustra\u00e7\u00e3o da t\u00e9cnica de esfincterotomia transpancre\u00e1tica.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n

Na sequ\u00eancia \u00e9 recomendada a passagem de uma pr\u00f3tese pancre\u00e1tica e em seguida procedida a cateteriza\u00e7\u00e3o da via biliar (Figura 2).<\/p>\n\n\n

\n
\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button>
Figura 2: esfincterectomia transpancre\u00e1tica seguida de passagem de pr\u00f3tese pancre\u00e1tica.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n

Uma das vantagens potenciais do m\u00e9todo \u00e9 o acesso ser direcionado pela presen\u00e7a do fio guia, em contrapartida \u00e0 f\u00edstula suprapapilar, podendo beneficiar endoscopistas em treinamento4<\/sup>.<\/p>\n\n\n\n

Nos \u00faltimos anos foram realizados novos trabalhos, avaliando as taxas de sucesso da ETP, assim como a ocorr\u00eancia de eventos adversos relacionados. Clique para saber mais sobre Estrat\u00e9gias de preven\u00e7\u00e3o de pancreatite p\u00f3s-CPRE<\/a>.<\/p>\n\n\n\n

Dois estudos retrospectivos se destacam pelas grandes amostras de pacientes submetidos \u00e0 CPRE5,6<\/sup>. O primeiro realizou compara\u00e7\u00e3o entre um grupo controle cujo acesso convencional obteve sucesso, ETP, duplo fio-guia e pr\u00e9-corte com estilete, as taxas de sucesso foram respectivamente 94,9% \/ 87,2% \/ 74,5% \/ 69.6%, n\u00e3o houve diferen\u00e7a significativa em eventos adversos entre o grupo controle e a ETP, nesta a taxa de pancreatite foi de 1,1% e a de sangramento 0,3%. O segundo trabalho citado avaliou pacientes submetidos \u00e0 ETP em compara\u00e7\u00e3o aos com acesso biliar convencional, o sucesso t\u00e9cnico da ETP foi de 95,9%, a ocorr\u00eancia de pancreatite nesse grupo de 2,8% e o desfecho de sangramento apresentou-se significativamente superior quando comparado ao acesso convencional (10,9%, P=0,005), atribuindo por\u00e9m o risco de sangramento a tentativas pr\u00e9vias de acesso por pr\u00e9-corte.<\/p>\n\n\n\n

Em ensaio cl\u00ednico randomizado multic\u00eantrico comparando ETP e duplo fio-guia em acesso biliar dif\u00edcil7<\/sup>, Kyl\u00e4np\u00e4\u00e4 e colaboradores demonstraram superioridade da ETP na realiza\u00e7\u00e3o de acesso biliar (84,6 % x 69,7 %; P = 0.01), sem diferen\u00e7a na taxa de pancreatite (13,5 % x 16,2 %).<\/p>\n\n\n\n

Por fim, a metan\u00e1lise comparando as diferentes t\u00e9cnicas de acesso \u00e0 via biliar dif\u00edcil8<\/sup>, favoreceu a realiza\u00e7\u00e3o de ETP em rela\u00e7\u00e3o \u00e0 persistir na tentativa com t\u00e9cnica tradicional, duplo fio guia, pr\u00e9-corte e canula\u00e7\u00e3o assistida por pr\u00f3tese pancre\u00e1tica para o desfecho de acesso bem sucedido \u00e0 via biliar.<\/p>\n\n\n\n

Com base nos trabalhos avaliados a esfincterotomia transpancre\u00e1tica se demonstra como m\u00e9todo seguro e eficaz para a canula\u00e7\u00e3o biliar em casos de falha do acesso convencional, devendo ser uma op\u00e7\u00e3o no arsenal do endoscopista. \u00c9 importante destacar que a sele\u00e7\u00e3o da t\u00e9cnica para o acesso biliar em caso de falha na canula\u00e7\u00e3o convencional deve considerar o aspecto endosc\u00f3pico da papila, patologia de base, ocorr\u00eancia de cateteriza\u00e7\u00e3o do DPP e a expertise do endoscopista.<\/p>\n\n\n\n

Refer\u00eancias<\/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 artigo<\/strong><\/h2>\n\n\n\n

    Logiudice FP. Esfincterotomia trans pancre\u00e1tica. Terapeutica Endoscopica, 2024 vol II. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/esfincterotomia-trans-pancreatica\/<\/a><\/p>\n\n\n\n

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

    A canula\u00e7\u00e3o biliar \u00e9 etapa fundamental no sucesso da CPRE, sendo o acesso biliar…<\/p>\n","protected":false},"author":5752,"featured_media":19405,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[294],"ano":[742],"tipo":[155],"volume":[147],"class_list":["post-19401","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-cpre","ano-742","tipo-cpre","volume-volume-ii"],"yoast_head":"\nEsfincterotomia transpancre\u00e1tica • Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"Esfincterotomia transpancre\u00e1tica\" \/>\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\/esfincterotomia-transpancreatica\/\" 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