{"id":3403,"date":"2015-05-11T10:00:04","date_gmt":"2015-05-11T10:00:04","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/artigo-comentado-endoscopic-treatment-of-duodenal-adenomas-in-fap\/"},"modified":"2022-06-17T15:43:33","modified_gmt":"2022-06-17T15:43:33","slug":"artigo-comentado-endoscopic-treatment-of-duodenal-adenomas-in-fap","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/artigo-comentado-endoscopic-treatment-of-duodenal-adenomas-in-fap\/","title":{"rendered":"Tratamento endosc\u00f3pico de adenomas duodenais em pacientes com PAF"},"content":{"rendered":"

O duodeno e a regi\u00e3o periampular s\u00e3o o principal s\u00edtio de desenvolvimento de adenomas em pacientes com PAF j\u00e1 submetidos a colectomia. O score de Spigelman \u00e9 muito utilizado para quantificar o acometimento duodenal e ajuda a definir conduta. Quando o paciente apresenta score IV, alguns autores recomendam a duodenopancreatectomia profil\u00e1tica, devido ao risco elevado de adenocarcinoma. No entanto, essa conduta \u00e9 controversa, visto a alta morbi-mortalidade desta cirurgia.<\/p>\n

\"Classifi<\/a>

Classifi ca\u00e7\u00e3o de Spigelman: nenhum p\u00f3lipo: est\u00e1gio 0; 1 a 4 pontos: est\u00e1gio I; 5 a 6 pontos:<\/em>
est\u00e1gio II; 7 a 8 pontos: est\u00e1gio III; 9 a 12 pontos: est\u00e1gio IV<\/em>.<\/p><\/div>\n

Os autores deste estudo, partiram do pressuposto que os pacientes com polipose duodenal no est\u00e1dio IV s\u00e3o pass\u00edveis de tratamento endosc\u00f3pico e podem ser poupados de cirurgia.<\/p>\n

\"Duodenoscopia<\/a>

Duodenoscopia com \u00edndigo-carmim revelando m\u00faltiplos pequenos adenomas duodenais<\/p><\/div>\n

 <\/p>\n

Neste estudo retrospectivo, os autores demonstraram que os pacientes com est\u00e1dio IV de Spigelman podem ser tratados endoscopicamente, sendo poss\u00edvel o downstaging em 95% dos casos. Trinta e cinco pacientes foram acompanhados com endoscopias peri\u00f3dicas durante um per\u00edodo m\u00e9dio de 9 anos (1-19 anos). A terap\u00eautica endosc\u00f3pica inclu\u00eda mucosectomia para as maiores les\u00f5es, e abla\u00e7\u00e3o com plasma de arg\u00f4nio para adenomas menores que 5 mm. Nenhum paciente nesta s\u00e9rie desenvolveu adenocarcinoma. Ocorreram 15 complica\u00e7\u00f5es em 245 procedimentos: sangramento (2.8%), pancreatite (2.8%) e perfura\u00e7\u00e3o necessitando de cirurgia em 1 caso (0.4%).<\/p>\n

A conduta endosc\u00f3pica parece ser uma op\u00e7\u00e3o atrativa nestas situa\u00e7\u00f5es e pode poupar o paciente de uma conduta mais agressiva como a gastroduodenopancreatectomia e, sobretudo, evitar o aparecimento de um adenocarcinoma de duodeno. Estudos prospectivos com seguimento a longo prazo ser\u00e3o bem-vindos para validar este m\u00e9todo e confirmar sua real efic\u00e1cia.<\/p>\n

 <\/p>\n

Veja o v\u00eddeo de ressec\u00e7\u00e3o endosc\u00f3pica de adenoma duodenal em paciente com PAF<\/a><\/p>\n

 <\/p>\n

Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis<\/strong><\/p>\n

Moussata D, Napoleon B, Lepilliez V, Klich A, Ecochard R, Lapalus MG, Nancey S, Cenni JC, Ponchon T, Chayvialle JA, Saurin JC.<\/em><\/p>\n

Gastrointest Endosc. 2014 Nov;80(5):817-25<\/em><\/p>\n

Link para o artigo<\/a><\/p>\n

 <\/p>\n

\n","protected":false},"excerpt":{"rendered":"

O duodeno e a regi\u00e3o periampular s\u00e3o o principal s\u00edtio de desenvolvimento de adenomas…<\/p>\n","protected":false},"author":712,"featured_media":3380,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[142],"tags":[],"ano":[282],"tipo":[153],"volume":[263],"class_list":["post-3403","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigoscomentados","ano-282","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nTratamento endosc\u00f3pico de adenomas duodenais em pacientes com PAF • 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\/artigoscomentados\/artigo-comentado-endoscopic-treatment-of-duodenal-adenomas-in-fap\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tratamento endosc\u00f3pico de adenomas duodenais em pacientes com PAF\" \/>\n<meta property=\"og:description\" content=\"O duodeno e a regi\u00e3o periampular s\u00e3o o principal s\u00edtio de desenvolvimento de adenomas em pacientes com PAF j\u00e1 submetidos a colectomia. 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