{"id":20319,"date":"2025-08-12T07:00:00","date_gmt":"2025-08-12T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=20319"},"modified":"2025-06-29T19:44:00","modified_gmt":"2025-06-29T19:44:00","slug":"papilectomia-endoscopica-pos-transplante-hepatico","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/papilectomia-endoscopica-pos-transplante-hepatico\/","title":{"rendered":"Papilectomia endosc\u00f3pica p\u00f3s-transplante hep\u00e1tico"},"content":{"rendered":"\n

Paciente do sexo feminino, 51 anos, com antecedente de transplante hep\u00e1tico em outubro de 2023 devido a cirrose hep\u00e1tica de etiologia alc\u00f3olica. A partir de dezembro de 2023, passa a apresentar colestase bioqu\u00edmica persistente e assintom\u00e1tica, a despeito de n\u00edveis adequados de imunossupress\u00e3o: BT 2,52; BD 1,83; GGT 544,31 (VR<38); FAL 373 (VR<116).  <\/p>\n\n\n\n

Foi submetida a resson\u00e2ncia magn\u00e9tica de abdome (RNM) com colangiorresson\u00e2ncia (colangioRNM), que n\u00e3o evidenciou altera\u00e7\u00e3o vascular da art\u00e9ria hep\u00e1tica, apenas despropor\u00e7\u00e3o entre as vias biliares do doador e receptor, sem estenose definida, por\u00e9m com discreta dilata\u00e7\u00e3o de vias intra-hep\u00e1ticas.<\/p>\n\n\n

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Imagem 1: ColangioRNM mostrando despropor\u00e7\u00e3o entre as vias biliares do doador e receptor<\/em>.<\/figcaption><\/figure>\n<\/div>\n\n\n


Tendo em vista quadro cl\u00ednico associado a dilata\u00e7\u00e3o de vias biliares, foi indicada colangiopancreatografia endosc\u00f3pica retr\u00f3grada (CPRE) para tratamento de poss\u00edvel estenose da anastomose biliar. Ao se posicionar o duodenosc\u00f3pio na segunda por\u00e7\u00e3o duodenal, identificada les\u00e3o polip\u00f3ide suspeita para adenoma de papila duodenal maior, sendo realizadas bi\u00f3psias.<\/p>\n\n\n\n

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Imagem 2: Vis\u00e3o endosc\u00f3pica<\/em><\/figcaption><\/figure>\n\n\n\n
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Imagem 3: Vis\u00e3o endosc\u00f3pica<\/em><\/figcaption><\/figure>\n\n\n\n
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Imagem 4: Vis\u00e3o endosc\u00f3pica<\/em><\/figcaption><\/figure>\n<\/figure>\n\n\n\n


Diante da confirma\u00e7\u00e3o histol\u00f3gica de adenoma tubular com displasia de baixo grau, optado pelo estadiamento local atrav\u00e9s de ultrassom endosc\u00f3pico (EUS), evidenciando les\u00e3o restrita a mucosa (sem sinais de acometimento de camada muscular) medindo 12×9 mm, com dilata\u00e7\u00e3o de col\u00e9doco at\u00e9 9 mm e aus\u00eancia de extens\u00e3o intraductal.<\/p>\n\n\n\n

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Imagem 5: vis\u00e3o ecoendosc\u00f3pica<\/em><\/figcaption><\/figure>\n\n\n\n
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Imagem 6: vis\u00e3o ecoendosc\u00f3pica<\/figcaption><\/figure>\n\n\n\n
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Imagem 7: vis\u00e3o ecoendosc\u00f3pica<\/figcaption><\/figure>\n<\/figure>\n\n\n\n


Dessa forma, indicada papilectomia endosc\u00f3pica e realizada ressec\u00e7\u00e3o em monobloco, em modo endocut Q, sem inje\u00e7\u00e3o de submucosa. N\u00e3o foi realizada esfincterotomia ou passagem de pr\u00f3tese biliar ou pancre\u00e1tica. Observou-se pequeno sangramento imediato no leito de ressec\u00e7\u00e3o, controlado com inje\u00e7\u00e3o de adrenalina. N\u00e3o h\u00e1 les\u00e3o residual no leito. Paciente evoluiu bem, assintom\u00e1tica e sem intercorr\u00eancias ap\u00f3s o procedimento.<\/p>\n\n\n\n

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Imagem 8: vis\u00e3o da ressec\u00e7\u00e3o endosc\u00f3pica<\/figcaption><\/figure>\n\n\n\n
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Imagem 9: vis\u00e3o p\u00f3s-ressec\u00e7\u00e3o endosc\u00f3pica<\/figcaption><\/figure>\n<\/figure>\n\n\n\n


O anatomopatol\u00f3gico confirma bi\u00f3psia pr\u00e9via, com margens laterais e profundas livres de les\u00e3o (R0). Houve resolu\u00e7\u00e3o da colestase ap\u00f3s o procedimento: BT 0,98; BD 0,42; GGT 105; FAL 153. Paciente permaneceu sem les\u00f5es suspeitas no leito nos exames de seguimento, com bi\u00f3psia ap\u00f3s 1 ano exibindo apenas processo infamat\u00f3rio reacional.<\/p>\n\n\n

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Imagem 10: vis\u00e3o endosc\u00f3pica de controle<\/figcaption><\/figure>\n<\/div>\n\n\n

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

A neoplasia da ampola de Vater \u00e9 uma entidade rara, mais comum em homens e idosos, embora o diagn\u00f3stico abaixo dos 45 anos venha em ascens\u00e3o nos \u00faltimos anos. Diante do diagn\u00f3stico em pacientes jovens, deve-se suspeitar de s\u00edndrome gen\u00e9tica sobrejacente, sendo a PAF (Polipose Adenomatosa Familiar) a principal envolvida1,2<\/sup>. Seguindo a cadeia de carcinog\u00eanese adenoma-carcinoma, as les\u00f5es podem se originar da mucosa duodenal ou pancreatobiliar e os tipos mais diagnosticados s\u00e3o o adenoma, displasia intraepitelial e adenocarcinoma, sendo que o adenoma do tipo intestinal corresponde a mas de 95% das les\u00f5es benignas3<\/sup>.<\/p>\n\n\n\n

A maioria das les\u00f5es \u00e9 assintom\u00e1tica e costuma ser identificada incidentalmente durante exames endosc\u00f3picos por outras indica\u00e7\u00f5es. \u00c9 poss\u00edvel, no entanto, se apresentarem com icter\u00edcia (16.6%), dor abdominal (14.4%), pancreatite (4.1%) e colangite (1%)4<\/sup>.<\/p>\n\n\n\n

Tendo em vista a vis\u00e3o parcial da papila duodenal maior obtida atrav\u00e9s do endosc\u00f3pio de vis\u00e3o frontal, sugere-se que a adequada avalia\u00e7\u00e3o seja realizada com o duodenosc\u00f3pio ou endosc\u00f3pio convencional associado ao uso de cap. Embora n\u00e3o exista uma classifica\u00e7\u00e3o validada para avalia\u00e7\u00e3o das les\u00f5es de papila, deve-se avaliar o tamanho, se h\u00e1 extens\u00e3o da les\u00e3o para al\u00e9m da papila, como as les\u00f5es de crescimento lateral (LSTp). Al\u00e9m disso, alguns aspectos identificados correlacionam-se com maior risco de invas\u00e3o da muscular como endurecimento, ulcera\u00e7\u00e3o, friabilidade, sangramento, depress\u00e3o e \u201cnonlifting sign\u201d4,5<\/sup>. O diagn\u00f3stico histol\u00f3gico deve ser realizado idealmente pela biopsia endosc\u00f3pica; em caso de falha diagn\u00f3stica, s\u00e3o alternativas a bi\u00f3psia por EUS ou bi\u00f3psia endosc\u00f3pica ap\u00f3s esfincterotomia, de prefer\u00eancia com intervalo de 10 dias entre os procedimentos4<\/sup>. Vale ressaltar que a presen\u00e7a de adenoma nas bi\u00f3psias endosc\u00f3picas n\u00e3o exclui a presen\u00e7a de adenocarcinoma, devido as altas taxas de falsos negativos e vari\u00e1vel concord\u00e2ncia entre as bi\u00f3psias endosc\u00f3picas e as pe\u00e7as de ressec\u00e7\u00e3o5<\/sup>.<\/p>\n\n\n\n

O estadiamento deve seguir a classifica\u00e7\u00e3o TNM e pode ser realizado por tomografia computadorizada (TC), colangioRNM, EUS e ultrassom intraductal. Nota-se a superioridade do EUS na avalia\u00e7\u00e3o do T (principalmente em les\u00f5es maiores do que 2 cm e T1) e da colangioRNM na avalia\u00e7\u00e3o do N. Ademais, a avalia\u00e7\u00e3o da extens\u00e3o intraductal da les\u00e3o se faz necess\u00e1ria para defini\u00e7\u00e3o do tratamento4<\/sup>.<\/p>\n\n\n\n

Segundo a recomenda\u00e7\u00e3o da ESGE, est\u00e1 indicada a papilectomia endosc\u00f3pica nas les\u00f5es at\u00e9 4 cm, com extens\u00e3o intraductal de at\u00e9 2cm e nas les\u00f5es malignas Tis\/T1aN0M0 (idealmente restritos a mucosa). Nos casos tecnicamente dif\u00edceis, como tamanho superior a 4 cm, divert\u00edculo duodenal ou extens\u00e3o intraductal>2cm pode ser considerado e discutido de forma individualizada a ampulectomia cir\u00fargica no caso de les\u00f5es superficiais ou duodenopancreatectomia nos casos de T\u22651 ou N+\/M+4<\/sup>. Existem trabalhos que mostram bons resultados na ressec\u00e7\u00e3o endosc\u00f3pica de neoplasias precoces (adenocarcinoma bem diferenciado at\u00e9 T1aN0M0), embora as taxas de acometimento linfonodal no T1 podem chegar a 45%4,6,7<\/sup>.<\/p>\n\n\n\n

Embora muitas t\u00e9cnicas tenham sido descritas at\u00e9 o momento e n\u00e3o haja consenso em alguns aspectos, a ESGE sugere a ressec\u00e7\u00e3o com al\u00e7a sem inje\u00e7\u00e3o de submucosa, utilizando-se modo Endocut de forma reduzir o risco de sangramento durante e ap\u00f3s o procedimento. Nos casos de LSTp, deve ser feita inje\u00e7\u00e3o de submucosa e ressec\u00e7\u00e3o por mucosectomia, apresentando um maior risco de sangramento associado. Nos casos de extens\u00e3o intraductal h\u00e1 maior risco de n\u00e3o obten\u00e7\u00e3o de R0 e necessidade de complementa\u00e7\u00e3o com tratamento cir\u00fargico, principalmente nas les\u00f5es com maior grau de displasia. Nestes casos, h\u00e1 possibilidade de abordagem da extens\u00e3o intraductal no momento da papilectomia atrav\u00e9s da abla\u00e7\u00e3o com cist\u00f3tomo guiada por fio guia ou abla\u00e7\u00e3o por radiofrequ\u00eancia (RFA)4<\/sup>.<\/p>\n\n\n\n

A esfincterotomia com passagem de pr\u00f3tese biliar \u00e9 considerada quando h\u00e1 esvaziamento lentificado, sangramento ou quando realizado tratamento de les\u00e3o intraductal. \u00c9 recomendada profilaxia de pancreatite com administra\u00e7\u00e3o de indometacina via retal e coloca\u00e7\u00e3o de pr\u00f3tese pancre\u00e1tica4<\/sup>. Embora exista tal recomenda\u00e7\u00e3o, alguns trabalhos recentes n\u00e3o demonstram redu\u00e7\u00e3o significativa na incid\u00eancia de pancreatite p\u00f3s-papilectomia endosc\u00f3pica com o uso da pr\u00f3tese pancre\u00e1tica8,9<\/sup>. Outras t\u00e9cnicas descritas incluem a colangiopancreatografia com esfincterotomia biliar e aloca\u00e7\u00e3o de fio guia no ducto pancre\u00e1tico precedendo a papilectomia com posterior coloca\u00e7\u00e3o de pr\u00f3teses10<\/sup>.<\/p>\n\n\n\n

A ressec\u00e7\u00e3o \u00e9 considerada bem sucedida diante da aus\u00eancia de les\u00e3o residual no leito ap\u00f3s o procedimento, sendo a ressec\u00e7\u00e3o em monobloco \u00e9 o principal fator associado a obten\u00e7\u00e3o do R04,11<\/sup>. Os principais efeitos adversos da papilectomia endosc\u00f3pica s\u00e3o: pancreatite (11.9 %), sangramento (10.6 %), perfura\u00e7\u00e3o (3,1%) e colangite (2,7%)4,12<\/sup>. A taxa de mortalidade \u00e9 baixa (0,3%) e a estenose tardia pode ocorrer em 2,4% dos casos4<\/sup>.<\/p>\n\n\n\n

O seguimento deve ser realizado por duodenoscopia com bi\u00f3psias do leito e de \u00e1reas suspeitas em 3, 6 e 12 meses e anualmente por 3 a 5 anos. A presen\u00e7a de les\u00e3o residual benigna, que ocorre em cerca de 11%, ou recorrente pode ser tratada com eletrocoagula\u00e7\u00e3o por plasma de arg\u00f4nio ou mucosectomia, com bons resultados4<\/sup>. Em se tratando de adenomas espor\u00e1dicos, a taxa de recorr\u00eancia da les\u00e3o a longo prazo \u00e9 semelhante entre a papilectomia endosc\u00f3pica e a ampulectomia cir\u00fargica (15,7%x17,6%, com menores taxas de eventos adversos e maior seguran\u00e7a na primeira modalidade13<\/sup>.<\/p>\n\n\n\n

Veja mais sobre o assunto: PAPILA DUODENAL MAIOR: Precisamos inspecionar na rotina? \u2022 Endoscopia Terapeutica<\/a>.<\/p>\n\n\n\n

Refer\u00eancias<\/strong><\/h2>\n\n\n\n
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  1. Ramai D, Ofosu A, Singh J, John F, Reddy M, Adler DG. Demographics, tumor characteristics, treatment, and clinical outcomes of patients with ampullary cancer: A Surveillance, epidemiology, and end results (SEER) cohort study. Minerva Gastroenterologica e Dietologica. 2019 May;65(2). doi:10.23736\/s1121-421x.18.02543-6<\/li>\n\n\n\n
  2. Rostain F. Trends in incidence and management of cancer of the ampulla of Vater. World Journal of Gastroenterology. 2014;20(29):10144. doi:10.3748\/wjg.v20.i29.10144<\/li>\n\n\n\n
  3. Fischer H-P, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. Journal of Hepato-Biliary-Pancreatic Surgery. 2004 Oct;11(5):301\u20139. doi:10.1007\/s00534-004-0898-3<\/li>\n\n\n\n
  4. 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 Mar 16;53(04):429\u201348. doi:10.1055\/a-1397-3198<\/li>\n\n\n\n
  5. Li S-L, Li W, Yin J, Wang Z-K. Endoscopic papillectomy for ampullary adenomatous lesions: A literature review. World Journal of Gastrointestinal Oncology. 2021 Oct 15;13(10):1466\u201374. doi:10.4251\/wjgo.v13.i10.1466<\/li>\n\n\n\n
  6. Lee S, Hwang J, Ko S, So H, Oh D, Song T, et al. Long-term outcomes of endoscopic papillectomy for early-stage cancer in duodenal ampullary adenoma: Comparison with surgical treatment. Endoscopy. 2020 Apr; doi:10.1055\/s-0040-1704412<\/li>\n\n\n\n
  7. Napoleon B, Gincul R, Ponchon T, Berthiller J, Escourrou J, Canard J-M, et al. Endoscopic papillectomy for early ampullary tumors: Long-term results from a large multicenter prospective study. Endoscopy. 2014 Jan 29;46(02):127\u201334. doi:10.1055\/s-0034-1364875<\/li>\n\n\n\n
  8. Chandan S, Canakis A, Deliwala S, Frohlinger M, Khan SR, Mohan BP, et al. Prophylactic pancreatic duct stenting to reduce the risk of post-ampullectomy pancreatitis: A comprehensive review and meta-analysis of 1858 patients. Surgical Endoscopy. 2024 Jul 19;38(9):4798\u2013813. doi:10.1007\/s00464-024-11019-y<\/li>\n\n\n\n
  9. Jiang J, Lv F, Chen C, Jiang W. Effectiveness of endoscopic papillectomy with stent placement in pancreatic and bile ducts for treating duodenal papillary adenoma: A retrospective study. BMC Gastroenterology. 2024 Oct 24;24(1). doi:10.1186\/s12876-024-03466-7<\/li>\n\n\n\n
  10. Kim GE, Siddiqui UD. Endoscopic resection techniques for duodenal and ampullary adenomas. VideoGIE. 2023 Aug;8(8):330\u20135. doi:10.1016\/j.vgie.2023.05.006<\/li>\n\n\n\n
  11. Choi SJ, Lee HS, Kim J, Choe JW, Lee JM, Hyun JJ, et al. Clinical outcomes of Endoscopic Papillectomy of Ampullary Adenoma: A multi-center study. World Journal of Gastroenterology. 2022 May 7;28(17):1845\u201359. doi:10.3748\/wjg.v28.i17.1845<\/li>\n\n\n\n
  12. Sahar N, Krishnamoorthi R, Kozarek RA, Gluck M, Larsen M, Ross AS, et al. Long-term outcomes of endoscopic papillectomy for ampullary adenomas. Digestive Diseases and Sciences. 2019 Aug 28;65(1):260\u20138. doi:10.1007\/s10620-019-05812-2<\/li>\n\n\n\n
  13. Garg R, Thind K, Bhalla J, Simonson MT, Simons-Linares CR, Singh A, et al. Long-term recurrence after endoscopic versus surgical ampullectomy of sporadic ampullary adenomas: A systematic review and meta-analysis. Surgical Endoscopy. 2023 May 23;37(7):5022\u201344. doi:10.1007\/s00464-023-10083-0<\/li>\n<\/ol>\n\n\n\n

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

    Mateus I. Papilectomia endosc\u00f3pica p\u00f3s transplante hep\u00e1tico Endoscopia Terapeutica, 2025 Vol II. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/papilectomia-endoscopica-pos-transplante-hepatico\/<\/a><\/p>\n\n\n\n

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

    Paciente do sexo feminino, 51 anos, com antecedente de transplante hep\u00e1tico em outubro de…<\/p>\n","protected":false},"author":5910,"featured_media":20321,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[821,294,822],"ano":[783],"tipo":[155],"volume":[147],"class_list":["post-20319","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","tag-ampulectomia","tag-cpre","tag-papilectomia","ano-783","tipo-cpre","volume-volume-ii"],"yoast_head":"\nPapilectomia endosc\u00f3pica p\u00f3s-transplante hep\u00e1tico • Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"Papilectomia endosc\u00f3pica p\u00f3s-transplante hep\u00e1tico\" \/>\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\/casosclinicos\/papilectomia-endoscopica-pos-transplante-hepatico\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Papilectomia endosc\u00f3pica p\u00f3s-transplante hep\u00e1tico\" \/>\n<meta property=\"og:description\" content=\"Paciente do sexo feminino, 51 anos, com antecedente de transplante hep\u00e1tico em outubro de 2023 devido a cirrose hep\u00e1tica de etiologia alc\u00f3olica. 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