{"id":4400,"date":"2016-11-14T08:00:33","date_gmt":"2016-11-14T08:00:33","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/papel-da-endoscopia-no-manejo-das-colecoes-fluidas-peripancreaticas\/"},"modified":"2023-03-13T17:22:28","modified_gmt":"2023-03-13T17:22:28","slug":"papel-da-endoscopia-no-manejo-das-colecoes-fluidas-peripancreaticas","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/papel-da-endoscopia-no-manejo-das-colecoes-fluidas-peripancreaticas\/","title":{"rendered":"Guia Atualizado do Tratamento das Cole\u00e7\u00f5es Flu\u00eddas Peripancre\u00e1ticas"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"4400\" class=\"elementor elementor-4400\">\n\t\t\t\t\t\t<section class=\"penci-section penci-disSticky penci-structure-10 elementor-section elementor-top-section elementor-element elementor-element-69f43e45 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"69f43e45\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"penci-ercol-100 penci-ercol-order-1 penci-sticky-ct    elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-579db970\" data-id=\"579db970\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-279a6219 elementor-widget elementor-widget-text-editor\" data-id=\"279a6219\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6 style=\"text-align: justify;\">Introdu\u00e7\u00e3o &#8211; Terminologia:<\/h6>\n<p style=\"text-align: justify;\">De acordo com a Classifica\u00e7\u00e3o de Atlanta Revisada (1), as cole\u00e7\u00f5es flu\u00eddas peripancre\u00e1ticas (CFPs) s\u00e3o agrupadas de acordo com:<\/p>\n\n<ul>\n \t<li style=\"text-align: justify;\">Tempo: 4 semanas<\/li>\n \t<li style=\"text-align: justify;\">Presen\u00e7a de componentes necr\u00f3ticos\/s\u00f3lidos<\/li>\n<\/ul>\n&nbsp;\n\n<div id=\"attachment_7092\" style=\"width: 1470px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Atlanta.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-7092\" class=\"wp-image-7092 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Atlanta.png\" alt=\"Classifica\u00e7\u00e3o Revisada de Atlanta. (1)\" width=\"1460\" height=\"247\" \/><\/a><p id=\"caption-attachment-7092\" class=\"wp-caption-text\">Classifica\u00e7\u00e3o Revisada de Atlanta. (1)<\/p><\/div>\n<p style=\"text-align: justify;\">Esta nova classifica\u00e7\u00e3o \u00e9 importante pois o tratamento e o manejo\u00a0variam de acordo com o tipo de cole\u00e7\u00e3o.<\/p>\n<p style=\"text-align: justify;\">As CFPs s\u00e3o complica\u00e7\u00f5es frequentes da\u00a0pancreatite aguda ou cr\u00f4nica. Estima-se que 5% a 15% dos epis\u00f3dios de pancreatite s\u00e3o complicados com o desenvolvimento de pseudocistos. Entretanto a maioria das CFPs ir\u00e3o resolver-se espontaneamente.<\/p>\n\n<h6 style=\"text-align: justify;\">Indica\u00e7\u00f5es de Tratamento:<\/h6>\n<p style=\"text-align: justify;\">Considerar o tratamento para cole\u00e7\u00f5es cr\u00f4nicas (&gt; 4 semanas) e sintom\u00e1ticas.<\/p>\n<p style=\"text-align: justify;\">Poss\u00edveis sintomas e complica\u00e7\u00f5es:<\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>Dor abdominal<\/li>\n \t<li>Obstru\u00e7\u00e3o gastrointestinal<\/li>\n \t<li>Compress\u00e3o vascular<\/li>\n \t<li>Obstru\u00e7\u00e3o biliar<\/li>\n \t<li>Infec\u00e7\u00e3o<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">A drenagem das cole\u00e7\u00f5es\u00a0deve ser feita ap\u00f3s 4 semanas para permitir a matura\u00e7\u00e3o e o encapsulamento da les\u00e3o, com potencial redu\u00e7\u00e3o das complica\u00e7\u00f5es quando a drenagem for realizada.<\/p>\n\n<h6 style=\"text-align: justify;\">Tratamento endosc\u00f3pico<\/h6>\n<p style=\"text-align: justify;\">Recomendado como terapia de primeira linha (Grau A de recomenda\u00e7\u00e3o). (2)\nEnsaio-cl\u00ednico controlado e randomizado comparando o tratamento endosc\u00f3pico <em>vs<\/em> cir\u00fargico demonstrou:<\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>Sucesso t\u00e9cnico e taxa de complica\u00e7\u00f5es semelhantes;<\/li>\n \t<li>A terapia endosc\u00f3pica foi associada com menor tempo de interna\u00e7\u00e3o, menor custo e melhor qualidade de vida.<\/li>\n<\/ul>\n&nbsp;\n<p style=\"text-align: justify;\">Estudo retrospectivo comparando a drenagem endosc\u00f3pica <em>vs<\/em>\u00a0percut\u00e2nea favoreceu a endoscopia, pois esta \u00faltima esteve associada com (3):<\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>Maior taxa de sucesso no tratamento;<\/li>\n \t<li>Menores taxas de re-interven\u00e7\u00e3o;<\/li>\n \t<li>Menor tempo de interna\u00e7\u00e3o.<\/li>\n<\/ul>\n&nbsp;\n<p style=\"text-align: justify;\"><strong><em>Tipos de drenagem endosc\u00f3pica:<\/em><\/strong><\/p>\n\n<ol style=\"text-align: justify;\">\n \t<li>Drenagem transpapilar<\/li>\n \t<li>Drenagem transmural, que se divide em: <span style=\"text-decoration: underline;\">convencional e ecoguiada<\/span>.<\/li>\n<\/ol>\n&nbsp;\n<p style=\"text-align: justify;\"><strong>Drenagem Transpapilar:<\/strong><\/p>\n<p style=\"text-align: justify;\">Realizada atrav\u00e9s da CPRE com coloca\u00e7\u00e3o de pr\u00f3tese pl\u00e1stica transpapilar idealmente at\u00e9 o interior da cole\u00e7\u00e3o.<\/p>\n<p style=\"text-align: justify;\">Reservada para pequenas cole\u00e7\u00f5es (at\u00e9 6 cm), localizadas na cabe\u00e7a ou corpo proximal do p\u00e2ncreas, e que se comunicam com o ducto pancre\u00e1tico principal. (2)<\/p>\n\n\n<div id=\"attachment_7094\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/CPRE-transpapilar.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-7094\" class=\"wp-image-7094 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/CPRE-transpapilar.jpg\" alt=\"Pr\u00f3tese pl\u00e1stica para drenagem de pseudocisto na cabe\u00e7a do p\u00e2ncreas.\" width=\"374\" height=\"225\" \/><\/a><p id=\"caption-attachment-7094\" class=\"wp-caption-text\">Pr\u00f3tese pl\u00e1stica para drenagem de pseudocisto na cabe\u00e7a do p\u00e2ncreas.<\/p><\/div>\n\n<div id=\"attachment_7095\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/transpapilar.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-7095\" class=\"wp-image-7095\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/transpapilar.jpg\" alt=\"Pr\u00f3tese pl\u00e1stica transpapilar.\" width=\"374\" height=\"371\" \/><\/a><p id=\"caption-attachment-7095\" class=\"wp-caption-text\">Pr\u00f3tese pl\u00e1stica transpapilar.<\/p><\/div>\n<p style=\"text-align: justify;\"><strong>Drenagem Transmural Convencional:<\/strong><\/p>\n<p style=\"text-align: justify;\">Requer visualiza\u00e7\u00e3o endosc\u00f3pica do abaulamento causado pela CFP no trato gastrointestinal. Entretanto esta apresenta\u00e7\u00e3o com abaulamento \u00e9 descrita em\u00a0cerca de 42% a 48%\u00a0dos casos, o que limita a efic\u00e1cia e a seguran\u00e7a desta t\u00e9cnica em quase metade dos pacientes. (4)<\/p>\n\n\n<div id=\"attachment_7096\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/convencional.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7096\" class=\"wp-image-7096\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/convencional.jpg\" alt=\"Abaulamento do est\u00f4mago pela cole\u00e7\u00e3o pancre\u00e1tica.\" width=\"374\" height=\"298\" \/><\/a><p id=\"caption-attachment-7096\" class=\"wp-caption-text\">Abaulamento do est\u00f4mago pela cole\u00e7\u00e3o pancre\u00e1tica.<\/p><\/div>\n\n<div id=\"attachment_7097\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/eda-convencional.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7097\" class=\"wp-image-7097\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/eda-convencional.jpg\" alt=\"Drenagem convencional com m\u00faltiplas pr\u00f3teses.\" width=\"374\" height=\"339\" \/><\/a><p id=\"caption-attachment-7097\" class=\"wp-caption-text\">Drenagem convencional com m\u00faltiplas pr\u00f3teses.<\/p><\/div>\n<p style=\"text-align: justify;\"><strong>Drenagem Transmural Ecoguiada:<\/strong><\/p>\n<p style=\"text-align: justify;\">Devido ao uso da ecoendoscopia, esta t\u00e9cnica apresenta a capacidade de identificar e evitar estruturas vasculares entre a cole\u00e7\u00e3o e o l\u00famen g\u00e1strico\/enteral. Sendo fortemente indicada para os pacientes com cole\u00e7\u00f5es que n\u00e3o produzam abaulamento e nos pacientes com hipertens\u00e3o portal.\nApresenta taxa de sucesso de 94%, com taxa de complica\u00e7\u00e3o de 5% na drenagem de pseudocistos. (4)\nAtualmente, \u00e9 a t\u00e9cnica estabelecida\u00a0como a terapia de primeira linha na drenagem de\u00a0pseudocistos e de necroses pancre\u00e1ticas delimitadas (NPD), do ingl\u00eas <em>walled-off necrosis<\/em>.<\/p>\n<p style=\"text-align: justify;\">\u00c9 tradicionalmente realizada com a coloca\u00e7\u00e3o de pelo menos 2 pr\u00f3teses pl\u00e1sticas (menor chance de oclus\u00e3o comparado com apenas 1 pr\u00f3tese) com formato em duplo pigtail (menor chance de migra\u00e7\u00e3o comparado com as pr\u00f3teses retas).\nAs pr\u00f3teses\u00a0n\u00e3o devem ser retiradas antes da resolu\u00e7\u00e3o do cisto (determinada pela revolu\u00e7\u00e3o cl\u00ednica e radiol\u00f3gica), e tamb\u00e9m n\u00e3o antes de pelo menos 2 meses (Grau B de recomenda\u00e7\u00e3o). (2)<\/p>\n<p style=\"text-align: justify;\">Abaixo v\u00eddeo demonstrando a t\u00e9cnica (<strong>gentilmente cedido por Dr Madhu Sanaka<\/strong>):<\/p>\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-6bd9fa9e-25d7-4fc5-a2b8-b3c38e5d971c\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=6bd9fa9e-25d7-4fc5-a2b8-b3c38e5d971c\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n<p style=\"text-align: justify;\">Mais recentemente pr\u00f3teses met\u00e1licas auto-expans\u00edveis cobertas (PMAEc) passaram a ser utilizadas para durante a drenagem ecoguiada. As vantagens da utiliza\u00e7\u00e3o da PMAEc\u00a0s\u00e3o:<\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>Necessidade de apenas um \u00fanico stent, portanto, simplificando e encurtando o procedimento;<\/li>\n \t<li>O maior di\u00e2metro da pr\u00f3tese, possibilitando\u00a0uma drenagem mais r\u00e1pida, com menor risco de oclus\u00e3o;<\/li>\n \t<li>E o potencial para entrar na colec\u00e7\u00e3o repetidamente com um gastrosc\u00f3pio para a realiza\u00e7\u00e3o de necrosectomia.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Recentes publica\u00e7\u00f5es demonstraram melhores resultados para a drenagem de pseudocistos e NPDs com o uso de PMAEc,\u00a0quando comparadas com pr\u00f3teses pl\u00e1sticas, com benef\u00edcios em rela\u00e7\u00e3o (6-8):<\/p>\n\n<ul>\n \t<li style=\"text-align: justify;\">Tempo de procedimento mais curto;<\/li>\n \t<li style=\"text-align: justify;\">Maior taxa de resolu\u00e7\u00e3o;<\/li>\n \t<li style=\"text-align: justify;\">Menor taxa\u00a0de complica\u00e7\u00f5es.<\/li>\n<\/ul>\n&nbsp;\n\n<div id=\"attachment_7099\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2016\/11\/Screen-Shot-2016-11-12-at-11.05.10-PM.png\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7099\" class=\"wp-image-7099\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Screen-Shot-2016-11-12-at-11.05.10-PM.png\" alt=\"screen-shot-2016-11-12-at-11-05-10-pm\" width=\"374\" height=\"269\" \/><\/a><p id=\"caption-attachment-7099\" class=\"wp-caption-text\">Pr\u00f3tese met\u00e1lica coberta de 18 mm de di\u00e2metro para drenagem de cole\u00e7\u00e3o pancre\u00e1tica.<\/p><\/div>\n<p style=\"text-align: justify;\">No entanto, uma importante preocupa\u00e7\u00e3o com o uso de PMAEc\u00a0\u00e9 o risco de migra\u00e7\u00e3o, levando alguns endoscopistas a colocarem uma pr\u00f3tese\u00a0pl\u00e1stica de duplo pigtail por dentro da pr\u00f3tese met\u00e1lica para sua ancoragem.<\/p>\n<p style=\"text-align: justify;\">Para diminuir o risco\u00a0de migra\u00e7\u00e3o das PMAEc, novas pr\u00f3teses\u00a0met\u00e1licas foram concebidas com bordas que possibilitam a aposi\u00e7\u00e3o de lumens (figuras abaixo). As vantagens desses pr\u00f3teses s\u00e3o:<\/p>\n\n<ul>\n \t<li style=\"text-align: justify;\">Possuem largas falanges\u00a0de ancoragem e evitam a necessidade de colocar uma pr\u00f3tese pl\u00e1stica de ancoragem;<\/li>\n \t<li style=\"text-align: justify;\">Apresentam\u00a0largo\u00a0di\u00e2metro interno (10 ou 15 mm), que\u00a0possibilita a realiza\u00e7\u00e3o\u00a0da necrosectomia endosc\u00f3pica atrav\u00e9s da pr\u00f3tese;<\/li>\n \t<li style=\"text-align: justify;\">Presen\u00e7a de caut\u00e9rio na ponta de sua agulha de pun\u00e7\u00e3o que possibilita a libera\u00e7\u00e3o da pr\u00f3tese sem a necessidade de uso de outros materiais.<\/li>\n<\/ul>\n&nbsp;\n\n<div id=\"attachment_7100\" style=\"width: 384px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/lams-2.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7100\" class=\"wp-image-7100\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/lams-2.jpg\" alt=\"Caut\u00e9rio na ponta da agulha - Hot Axios\u00ae.\" width=\"374\" height=\"353\" \/><\/a><p id=\"caption-attachment-7100\" class=\"wp-caption-text\">Caut\u00e9rio na ponta da agulha &#8211; Hot Axios\u00ae.<\/p><\/div>\n\n<div id=\"attachment_7101\" style=\"width: 214px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/lams.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-7101\" class=\"wp-image-7101 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/lams.jpg\" alt=\"lams\" width=\"204\" height=\"151\" \/><\/a><p id=\"caption-attachment-7101\" class=\"wp-caption-text\">Pr\u00f3tese met\u00e1lica para aposi\u00e7\u00e3o de lumens.<\/p><\/div>\n<p style=\"text-align: justify;\">Na literatura existe apenas um recente estudo retrospectivo comparando as\u00a0PMAEc com as pr\u00f3teses met\u00e1licas para aposi\u00e7\u00e3o de lumens (PMAL),\u00a0realizado por Siddiqui et al (9). Esta publica\u00e7\u00e3o, com pacientes submetidos \u00e0 drenagem endosc\u00f3pica da NPDs, demonstrou:<\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>N\u00e3o houve diferen\u00e7a quanto \u00e0s taxas de sucesso t\u00e9cnico e cl\u00ednico, e sucesso a longo prazo (necessidade de interven\u00e7\u00e3o ap\u00f3s 6 meses da remo\u00e7\u00e3o da pr\u00f3tese);<\/li>\n \t<li>Menor\u00a0n\u00famero necess\u00e1rio de procedimentos com o uso PMAL;<\/li>\n \t<li>Entretanto, houve uma maior taxa de complica\u00e7\u00f5es precoces com o uso das PMAL.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Os autores justificaram que as complica\u00e7\u00f5es precoces, com ocorr\u00eancia principalmente de perfura\u00e7\u00f5es, foram resultados da falha na libera\u00e7\u00e3o da pr\u00f3tese pelo operador, e n\u00e3o devido ao design da pr\u00f3tese. Essas complica\u00e7\u00f5es ocorreram principalmente no in\u00edcio do estudo e estiveram associadas com a curva de aprendizado do endoscopista. Com rela\u00e7\u00e3o \u00e0s complica\u00e7\u00f5es tardias, houve menor taxa de migra\u00e7\u00e3o com as\u00a0PMAL, como esperado pelo autores.<\/p>\n<p style=\"text-align: justify;\">Abaixo v\u00eddeo demonstrando o uso da PMAL (<strong>gentilmente cedido por Dr Prabhleen Chahal<\/strong>):<\/p>\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-c2f0527c-bb05-4fc0-aab7-d3f73086b804\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=c2f0527c-bb05-4fc0-aab7-d3f73086b804\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n<p style=\"text-align: justify;\"><strong>Drenagem da necrose pancre\u00e1tica delimitada (NPD):<\/strong><\/p>\n\n<ul style=\"text-align: justify;\">\n \t<li>Dar\u00a0prefer\u00eancia para o uso de pr\u00f3teses\u00a0met\u00e1licas, pela necessidade da realiza\u00e7\u00e3o de necrosectomia;<\/li>\n \t<li>Considerar a associa\u00e7\u00e3o de dreno nasoc\u00edstico, uma vez que publica\u00e7\u00e3o demonstrou que pode produzir menor taxa de oclus\u00e3o das pr\u00f3teses e maior taxa de resolu\u00e7\u00e3o. (10)<\/li>\n \t<li>Considerar a t\u00e9cnica de m\u00faltiplos acessos transmurais, que pode estar associada com maior taxa de sucesso cl\u00ednico. (11)<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Link para caso de drenagem de CPF com necrosectomia: <strong><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/video\/drenagem-endoscopica-de-pseudocisto-de-pancreas-com-necrosectomia\/\" target=\"_blank\" rel=\"noopener\">aqui!<\/a><\/strong><\/h6>\n<p style=\"text-align: justify;\"><strong>Qual a necessidade da CPRE na drenagem das CFP?<\/strong><\/p>\n<p class=\"p1\" style=\"text-align: justify;\">Estudo retrospectivo multic\u00eantrico (12), com\u00a0375 pacientes (54% com NPD) submetidos a drenagem endosc\u00f3pica, comparou a drenagem transmural ecoguida isolada\u00a0<em>versus<\/em> drenagem combinada (transmural ecoguiada + transpapilar por CPRE), e observou que n\u00e3o houve\u00a0diferen\u00e7a na taxa de sucesso cl\u00ednico entre ambas a terapias.\nAssim, a CPRE tem sido reservada para casos selecionados, por exemplo para pacientes com suspeita de f\u00edstula pancre\u00e1tica ou cole\u00e7\u00f5es recorrentes. A CPRE em associa\u00e7\u00e3o com a drenagem transmural tem por objetivo a coloca\u00e7\u00e3o de uma pr\u00f3tese &#8220;em ponte&#8221; \u00a0para oclus\u00e3o do rompimento no ducto pancre\u00e1tico.<\/p>\n\n<h6><\/h6>\n<h6>Refer\u00eancias:<\/h6>\n<ol>\n \t<li>Banks PA, et al. Gut 2013, 62:102<\/li>\n \t<li>Dumonceau J-M, et al. Endoscopy 2012,\u00a044: 784<\/li>\n \t<li>Keane MG, et al. Surg Endosc 2016.<\/li>\n \t<li>Antillon MR, et al. Gastrointest Endosc 2006; 63: 797<\/li>\n \t<li>Sadik R, et al. Word J Gastroenterol 2012;\u00a017: 499<\/li>\n \t<li>Sharaiha RZ, et al. Gastrointest Endosc. 2015;1<\/li>\n \t<li>Mukai S, et al. Endoscopy 2015;47<\/li>\n \t<li>Lee BU, et al. Endoscopy. 2014;1078.<\/li>\n \t<li>Siddiqui AA, et al. Gastrointest Endosc. 2016;<\/li>\n \t<li>Siddiqui AA, et al. Gastrointest Endosc 2013.<\/li>\n \t<li>Varadalajulu S, et al. Gastrointest Endosc 2011.<\/li>\n \t<li>Yang D, et al. Gastrointest Endosc. 2016;83(4):720<\/li>\n<\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Introdu\u00e7\u00e3o &#8211; Terminologia: De acordo com a Classifica\u00e7\u00e3o de Atlanta Revisada (1), as cole\u00e7\u00f5es&hellip;<\/p>\n","protected":false},"author":3495,"featured_media":5137,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[281],"tipo":[155,154],"volume":[147],"class_list":["post-4400","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-281","tipo-cpre","tipo-ecoendoscopia","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>Guia Atualizado do Tratamento das Cole\u00e7\u00f5es Flu\u00eddas Peripancre\u00e1ticas &#8226; 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