{"id":19465,"date":"2024-10-15T07:30:00","date_gmt":"2024-10-15T07:30:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=19465"},"modified":"2024-10-15T01:11:49","modified_gmt":"2024-10-15T01:11:49","slug":"mucosectomia-por-imersao-underwater-com-auxilio-de-cap-um-alternativa-para-casos-dificeis","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mucosectomia-por-imersao-underwater-com-auxilio-de-cap-um-alternativa-para-casos-dificeis\/","title":{"rendered":"Mucosectomia por imers\u00e3o (underwater) com aux\u00edlio de cap \u2013 um alternativa para casos dif\u00edceis"},"content":{"rendered":"\n

Paciente masculino, 45 anos, previamente h\u00edgido, foi submetido a colonoscopia em outro servi\u00e7o que identificou um p\u00f3lipo s\u00e9ssil de 6 mm de di\u00e2metro, 0-Is pela classifica\u00e7\u00e3o de Paris, com superf\u00edcie lisa e amarelada, localizado em reto m\u00e9dio. Na ocasi\u00e3o foi realizada ressec\u00e7\u00e3o parcial da les\u00e3o com al\u00e7a a frio. Resultado anatomopatol\u00f3gico e imunohistoqu\u00edmico evidenciaram tumor neuroend\u00f3crino bem diferenciado (grau 1 \u2013 Ki67<2%), com margens comprometidas. <\/p>\n\n\n\n

Paciente veio encaminhado para realizar nova colonoscopia na tentativa de ressec\u00e7\u00e3o completa da les\u00e3o. Durante o procedimento foi observada uma diminuta les\u00e3o amarelada no reto, discretamente elevada, correspondente \u00e0 \u00e1rea de polipectomia pr\u00e9via com presen\u00e7a de les\u00e3o residual (Figuras 1, 2 e 3). Realizada tentativa de mucosectomia pela t\u00e9cnica de imers\u00e3o (\u201cunderwater\u201d), n\u00e3o havendo pega adequada com a al\u00e7a para ressec\u00e7\u00e3o. Foi optado, ent\u00e3o, pela realiza\u00e7\u00e3o da mucosectomia por imers\u00e3o assistida por cap, que consiste na imers\u00e3o do espa\u00e7o intraluminal com \u00e1gua, seguido por suc\u00e7\u00e3o da les\u00e3o com aux\u00edlio de cap endosc\u00f3pico, afim de formar um pseudop\u00f3lipo, e assim facilitar a apreens\u00e3o e ressec\u00e7\u00e3o da les\u00e3o (Figura 4). Com o uso dessa t\u00e9cnica foi poss\u00edvel apreender a les\u00e3o residual com a al\u00e7a e realizar sua ressec\u00e7\u00e3o completa (Figuras 5 e 6). O resultado anatomopatol\u00f3gico confirmou a presen\u00e7a de tumor neuroend\u00f3crino bem diferenciado (grau 1 \u2013 Ki67<2%), com margens laterais e profunda livres.<\/p>\n\n\n

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Figura 1: aspecto endosc\u00f3pico da les\u00e3o residual em reto distal<\/figcaption><\/figure>\n<\/div>\n\n
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Figura 2: aspecto endosc\u00f3pico da les\u00e3o residual em reto distal<\/figcaption><\/figure>\n<\/div>\n\n
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Figura 3: aspecto endosc\u00f3pico da les\u00e3o residual em reto distal com aux\u00edlio de NBI<\/figcaption><\/figure>\n<\/div>\n\n
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Figura 4: aspira\u00e7\u00e3o da les\u00e3o com aux\u00edlio de cap para forma\u00e7\u00e3o de pseudop\u00f3lipo<\/figcaption><\/figure>\n<\/div>\n\n
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Figura 5: apreens\u00e3o do pseudop\u00f3lipo com al\u00e7a de polipectomia<\/figcaption><\/figure>\n<\/div>\n\n
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Figura 6: aspecto p\u00f3s ressec\u00e7\u00e3o endosc\u00f3pica<\/figcaption><\/figure>\n<\/div>\n\n\n

Discuss\u00e3o<\/strong><\/h2>\n\n\n\n

A mucosectomia underwater assistida por cap (CAP-UEMR) consiste na utiliza\u00e7\u00e3o de cap endosc\u00f3pico para suc\u00e7\u00e3o da les\u00e3o a ser ressecada sob imers\u00e3o em \u00e1gua, at\u00e9 que seja formado um \u201cpseudop\u00f3lipo\u201d pass\u00edvel de apreens\u00e3o e ressec\u00e7\u00e3o. Se a ressec\u00e7\u00e3o em monobloco n\u00e3o for poss\u00edvel, pode-se realizar novos \u201cpseudop\u00f3lipos\u201d e ressecar \u00e0 piece-meal, at\u00e9 que se alcance o resultado desejado, conforme ilustrado na figura abaixo:<\/p>\n\n\n

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Fonte:<\/strong> Ilustra\u00e7\u00e3o de Uchima Hugo et al. Endoscopy 2023.<\/p>\n\n\n\n

O estudo foi uma an\u00e1lise observacional retrospectiva de 83 procedimentos de ressec\u00e7\u00e3o endosc\u00f3pica pela t\u00e9cnica CAP-UEMR, realizados em dois centros entre setembro de 2020 e dezembro de 2021. O desfecho prim\u00e1rio foi o sucesso t\u00e9cnico, definido como ressec\u00e7\u00e3o completa macrosc\u00f3pica da les\u00e3o no \u00edndice CAP-UEMR. Os desfechos secund\u00e1rios foram as taxas de sangramento e perfura\u00e7\u00e3o. As 83 les\u00f5es tratadas tinham um tamanho m\u00e9dio de 20 mm. Foram inclu\u00eddas 64 les\u00f5es deprimidas ou planas (18 previamente manipuladas, 9 com acesso dif\u00edcil), 11 les\u00f5es do ap\u00eandice e 8 les\u00f5es da v\u00e1lvula ileocecal. Os resultados mostraram uma taxa de sucesso t\u00e9cnico de 100%, com ressec\u00e7\u00e3o macrosc\u00f3pica completa alcan\u00e7ada em todas as 83 les\u00f5es. Houve 7 casos de sangramento intraoperat\u00f3rio e 2 casos de sangramento tardio, todos tratados endoscopicamente. Nenhuma perfura\u00e7\u00e3o ou outras complica\u00e7\u00f5es ocorreram. Entre as 64 les\u00f5es com colonoscopia de acompanhamento, apenas 1 recorr\u00eancia foi detectada, que foi tratada endoscopicamente.<\/p>\n\n\n\n

Concluiu-se que a CAP-UEMR pode ser uma t\u00e9cnica segura e eficaz para facilitar a ressec\u00e7\u00e3o de les\u00f5es colorretais complexas. O estudo possui suas limita\u00e7\u00f5es, sendo as principais o poss\u00edvel vi\u00e9s de sele\u00e7\u00e3o e design retrospectivo e necessidade de estudos comparativos para determinar a efic\u00e1cia espec\u00edfica do CAP-UEMR em rela\u00e7\u00e3o a outras t\u00e9cnicas de ressec\u00e7\u00e3o.<\/p>\n\n\n\n

Refer\u00eancia<\/strong><\/h2>\n\n\n\n

Uchima H, Calm A, Mu\u00f1oz-Gonz\u00e1lez R, Caballero N, et al. Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions. Endoscopy. 2023 Nov;55(11):1045-1050. doi: 10.1055\/a-2115-7797. Epub 2023 Jun 22. PMID: 37348544.<\/p>\n\n\n\n

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

Retes FA. Camilo VF. Castro RFM. Mucosectomia por imers\u00e3o (underwater) com aux\u00edlio de cap \u2013 um alternativa para casos dif\u00edceis. Endoscopia Terapeutica, 2024 vol II. dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mucosectomia-por-imersao-underwater-com-auxilio-de-cap-um-alternativa-para-casos-dificeis\/ <\/a><\/p>\n\n\n\n

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

Paciente masculino, 45 anos, previamente h\u00edgido, foi submetido a colonoscopia em outro servi\u00e7o que…<\/p>\n","protected":false},"author":5650,"featured_media":19470,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[777],"ano":[742],"tipo":[156],"volume":[147],"class_list":["post-19465","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-mucosectomia","ano-742","tipo-colonoscopia","volume-volume-ii"],"yoast_head":"\nMucosectomia por imers\u00e3o (underwater) com aux\u00edlio de cap \u2013 um alternativa para casos dif\u00edceis • 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\" 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