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UNIVERSIDAD NACIONAL MAYOR DESAN MARCOS

UNIVERSIDAD DEL PER, DECANA DEAMRICA

FACULTAD DE MEDICINAE.A.P. DE TECNOLOGA MDICA

Trascendencia de la aplicacin de laColangiopancreatogra!a Retrograda

Endoscpica con g"!a #"oroscpica enpacientes con patolog!a de $!as %iliares &

pancre'ticas()

Curso: Radioo!"a #asada $% $&id$%'ias

Es(udia%($:)$ri*+o Pi$ro )u%ior Go%a$s A%(-%

C-di!o://011

Li*a + ,er-./01

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Trascendencia de la aplicacin de la Colangiopancreatogra!a

Retrograda Endoscpica con g"!a #"oroscpica en pacientes con

patolog!a de $!as %iliares & pancre'ticas

La Coa%!io2a%'r$a(o!ra3"a R$(r-!rada E%dos'-2i'a 4CPRE5 $s $2ro'$di6i$%(o d$ $$''i-% a'(ua $% a 2a(oo!"a #iio2a%'r$7(i'a,2ri%'i2a6$%($ $% 'asos d$ o#s(ru''i-% #iiar 8 'oa%!i(is, 9u!a%do u% roi62or(a%($ $% $ (ra(a6i$%(o d$ as $s($%osis #$%i!%as 8 6ai!%as d$ $s(as&"as. E% $ 'aso d$ a 2a(oo!"a #iiar o#s(ru'(i&a s$ $s(i6a u$ a CPRE $su% 2ro'$di6i$%(o d$ $&aua'i-% ;(i $% 67s d$ u(i'o 'o6o u%a &$%(a9a d$ a CPRE so#r$os o(ros 6>(odos 6$%'io%ados, au% ($%i$%do $% 'u$%(a $% 2a"s$s 'o6o os%u$s(ros os a(os 'os(os 8 a''$si#iidad ($'%o-!i'a u$ 3r$'u$%($6$%($i6i(a% su uso.

E% 'ua%(o a a CPRE ($ra2>u(i'a, as 2u#i'a'io%$s d$ 2ro'$di6i$%(os 'ada&$ 67s $?i(osos 'o%du9$ro% +a'ia u% a62io uso d$ a 6is6a $% $ 76#i(o6u%dia, '$r'a d$ //,/// i%($r&$%'io%$s so% r$aiadas a%ua6$%($ $% os

Es(ados U%idos.

La CPRE 'o6#i%ada 'o% a $s@%($ro(o6"a #iiar $s u%a d$ as i%($r&$%'io%$s67s so@s(i'adas d$ a $%dos'o2ia !as(roi%($s(i%a 8 $s(7 aso'iada a u%a(asa d$ 'o62i'a'io%$s u$ d$#$ s$r (o6ada $% 'u$%(a, $% ra-% dir$'(a asu 6or(aidad u$ &a d$sd$ /.= +as(a ,=.

E% a 6a8or"a d$ 2a"s$s a(i%oa6$ri'a%os, a CPRE 'o%s(i(u8$ $ 2ri6$r 2aso$% $ (ra(a6i$%(o $%dos'-2i'o d$ os '7'uos #iiar$s, d$ as %$o2asias#iio2a%'r$7(i'as 8 6u'+as o(ras 2a(oo!"as #iio2a%'r$7(i'as $s(a r$aidads$ &$ r$B$9ada $% $ P$r;.

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A'(ua6$%($, s$ 'o%sid$ra u$ a CPRE (i$%$ u% a62io a#a%i'o d$i%di'a'io%$s, 2$ro a 2ri%'i2a d$ $s(as, $% (odo 6o6$%(o, 2ara r$aiar $s($2ro'$di6i$%(o $s a 'o$do'oi(iasis.

Co% $ (i$62o, $ 2ro'$di6i$%(o +a $&ou'io%ado %o(a#$6$%($, si%

$6#ar!o s$ d$#$ r$'a'ar u$ $s 'os(oso 8 (i$%$ 'o62i'a'io%$s o $&$%(osad&$rsos. U%a 'uidadosa +is(oria 8 $?76$%$s d$ a#ora(orio u$ i%'u8$%+is(oria, 2ru$#as d$ 3u%'i-% +$27(i'a $ i67!$%$s so% %$'$sarios 2arar$d$@%ir $ ro d$ a CPRE. E?is($% %u6$rosos $s(udios $% a i($ra(ura 8 $a%7isis 'uidadoso d$ os 6is6os 2u$d$ $&i(ar $?2ora'io%$s i%%$'$sarias.

Todos as 2asos d$ $s(a (>'%i'a so2or(a% u%a (asa d$ r$su(ados %od$s$ados su2$rior a a d$ r$s(o d$ as $%dos'o2ias 4s$da'i-%, dia!%-s(i'o 8a'(ua'io%$s ($ra2>u(i'as5 8 'ada u%a d$ as a''io%$s i%di&idua$s d$ a6is6a $s(7 a'o62aada d$ su 2ro2ia 'or($ d$ $3$'(os ad&$rsos $s2$'"@'os,u$ rara &$ s$ soa2a% 'o% os d$ o(ros 2asos 8 $% 6u'+as o'asio%$s $s(7%i!adas a 'ara'($r"s(i'as i%di&idua$s d$ os 2a'i$%($s. Au%u$ a 2ro2iaCPRE su2o%$ u% $s3u$ro 6$'7%i'o, u"6i'o, +idros(7(i'o, $%i67(i'o,6i'ro#io-!i'o 8 (>r6i'o 2ara a 2a2ia, s$ a 'o%sid$ra 'o6o u%2ro'$di6i$%(o $%dos'-2i'o r$a(i&a6$%($ s$!uro, asu6i$%do su 2o($%'iad$ 2ro&o'ar 'o62i'a'io%$s !ra&$s 8 2o($%'ia6$%($ 6or(a$s.

A%($s s$ 2od"a d$'ir u$ as 'o%(rai%di'a'io%$s 'a($!-ri'as 2ara a CPRE,$ra% a s$2sis #iiar 8 a 2a%'r$a(i(is a!uda, 2$ro +o8 $% d"a, s$ 'o%o'$ u$$ 2ro'$di6i$%(o %o r$su(a u%a 'o%(rai%di'a'i-%, 2or $ 'o%(rario, a CPRE$s #$%$@'iosa $% 'aso d$ $s(as 2a(oo!"as. Soa6$%($ $% $ 'aso d$ u%a

2a%'r$a(i(is a!uda a 'ausa d$ a'o+o, s$ a d$($r6i%ar"a 'o6o u%a !ra&$'o%(rai%di'a'i-%.

La Buoros'o2"a s$ u(iia $% u% %;6$ro d$ di3$r$%($s 2ru$#as u$ so%!$%$ra6$%($ 6$%os i%&asi&as u$ os 6>(odos uir;r!i'os (radi'io%a$s,'o6o $s $ 'aso d$ a CPRE ($ra2>u(i'a. La Buoros'o2ia 2u$d$ r$aiars$'o6o 2a'i$%($ i%($r%o o 2ro'$di6i$%(o a6#ua(orio. Es(o $s(7 d$($r6i%ado2or $ (i2o d$ 2ru$#a Buoros'-2i'a a r$aiar 8 as +a#iidad$s %$'$sarias2ara 'o62$(ar a 2ru$#a. La s$!uridad d$ 2a'i$%($ $s d$ su6ai62or(a%'ia 2ara u$ $ radi-o!o r$ai'$ u%a Buoros'o2"a, as" 'o6o os3a#ri'a%($s d$ $s(as 67ui%as. Por o (a%(o, a Buoros'o2"a d$2$%d$ 6u'+od$ a +a#iidad d$ o2$rador d$ $s($ $ui2o radio-!i'o 8 $s $%($%di#$ ai62or(a%'ia u$ (o6a u% 2ro3$sio%a 'a2a'i(ado 2ara r$aiar $s(a a#or. 45

La Buoros'o2"a (o6a 6u'+a i62or(a%'ia 'o6o !u"a dura%($ as CPREs, 8 $%$s(a i%&$s(i!a'i-%, s$ (o6a% 2or s$2arado 2oru$ s$ r$aia% $% a!u%os'asos $s(as i%($r&$%'io%$s si% !u"a Buoros'-2i'a 42or $9$62o, $% $ 'asod$ !$s(a%($s 'o% 2a(oo!"a #iio2a%'r$7(i'a5. Si% $s(a !u"a, $ 2$rso%a d$saud r$aiar"a a i%($r&$%'i-% 'asi a 'i$!as a 2ar(ir d$ a 'a%ua'i-%,2u$s(o u$ u$!o %o s$ 2u$d$ o#s$r&ar si%o $s 'o% a a8uda d$ os $ui2osBuoros'-2i'os.

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E% $s($ 2ro'$di6i$%(o, $ T$'%-o!o M>di'o $% Radioo!"a 'u62$ u% ro d$'oa#ora'i-% $% $ 6a%$9o d$ 2a'i$%($, $s2$'ia6$%($ a (ra&>s d$ os$?76$%$s Buoros'-2i'os d$s(i%ados a dia!%-s(i'o d$ 2a(oo!"as $% as &"as#iioH2a%'r$7(i'as.

E% $s(a i6a!$% s$ 2u$d$ o#s$r&aru%a o#s(ru''i-% a %i&$ d$ 'o>do'odis(a, si$%do $&id$%'ia d$ a$?is($%'ia d$ u% '7'uo #iiar, $s($i(o, 2u$d$ (o6ar dis(i%(as 3or6as 8

(a6aos.

La 2a(oo!"a #iio2a%'r$7(i'a $s 3r$'u$%($ 6o(i&o d$ 'o%su(a $% a$s2$'iaidad d$ !as(ro$%($roo!"a. E% os (i$62os a'(ua$s $s(a 7r$a d$'u$r2o +u6a%o $s $?2orada 2or di&$rsas i67!$%$s 4US, TAC, RM5. E usod$ $as si% u%a ad$'uada ori$%(a'i-% 2u$d$ r$su(ar d$ a(o 'os(o 8 r$(ardodia!%-s(i'o.

La CPRE $s $ 2ro'$di6i$%(o d$ $$''i-% a'(ua d$ (ra(a6i$%(o $% as2a(oo!"as #iio2a%'r$7(i'as, 2ri%'i2a6$%($ $% 'asos d$ o#s(ru''i-% #iiar 8'oa%!i(is, 9u!a%do u% ro i62or(a%($ $% $ (ra(a6i$%(o d$ as $s($%osis#$%i!%as 8 6ai!%as d$ $s(as &"as.

A d$6os(rar a $@'a'ia d$ a CPRE 'o% $s@%($ro(o6"a $%dos'-2i'a 4EE5, s$2u$d$ !$%$raiar 8 a62iar 'ada &$ 67s $s($ s$r&i'io $% #$%$@'io d$ a2o#a'i-%. Es(o, 2$r6i(ir7 r$aiar 2ro'$di6i$%(os ($ra2>u(i'os 67sra'io%a$s 8 $3$'(i&os o u$ d$($r6i%ar7 u%a 6a8or 'aidad $% a a($%'i-%d$ os 2a'i$%($s $% aras d$ $$&ar $ %i&$ d$ saud.

La 2ri%'i2a 'ausa 2or a u$ s$ r$aia $s($ 2ro'$di6i$%(o, os '7'uos a%i&$ d$ as &"as #iiar$s, (i$%$ 3a'(or$s d$ 2r$s$%(a'i-% 'o6;% a s$?o3$6$%i%o, %;6$ro d$ $6#araos, o#$sidad, 2>rdida r72ida d$ 2$so,i%d"!$%as d$ a(i2a%o suda6$ri'a%o4C+i$, oi&ia, P$r;5, $('.

E dia!%-s(i'o d$ 'o$do'oi(iasis $s di3"'i. La $&aua'i-% '"%i'a 8 ar$aia'i-% d$ 2ru$#as #iou"6i'as s>ri'as 3r$'u$%($6$%($ %o so%su@'i$%($s 2ara r$aiar u% dia!%-s(i'o $?a'(o d$ 'o$do'oi(iasis, 8 $2a'i$%($ s$ so6$($ 'o% 3r$'u$%'ia a u%a CPRE u$ 2u$d$ s$r i%%$'$saria.

La Buoros'o2"a (o6a 6u'+a i62or(a%'ia 'o6o !u"a dura%($ as CPRE, 8 $%$s(a i%&$s(i!a'i-%, s$ (o6a% 2or s$2arado 2oru$ s$ r$aia% $% a!u%os

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'asos $s(as i%($r&$%'io%$s si% !u"a Buoros'-2i'a 42or $9$62o, $% $ 'asod$ !$s(a%($s 'o% 2a(oo!"a #iio2a%'r$7(i'a5. Si% $s(a !u"a, $ 2$rso%a d$saud r$aiar"a a i%($r&$%'i-% 'asi a 'i$!as a 2ar(ir d$ a 'a%ua'i-%,2u$s(o u$ u$!o %o s$ 2u$d$ o#s$r&ar si%o $s 'o% a a8uda d$ os $ui2osBuoros'-2i'os.

E T$'%-o!o M>di'o $% Radioo!"a %o d$#$ s$r a9$%o a os 'o%o'i6i$%(osso#r$ $s($ 2ro'$di6i$%(o 8 d$#$ 'o%o'$r 'orr$'(a6$%($ su 3u%'i-% ad$s$62$ar 2ara u$ $ a#orda9$ d$ 2a'i$%($ s$a -2(i6o. D$#$ r$'ordarsus 2ri%'i2ios a usar radia'io%$s io%ia%($s 8 os "6i($s u$ d$#$ a2i'ar a6o6$%(o d$ 6os(rar a i6a!$% radio-!i'a a 2$rso%a 6>di'o.

E% $s(a i%&$s(i!a'i-% 8 2or (odo o 6$%'io%ado a%($rior6$%($, s$ ui$r$'o%'uir a 6is6a i62or(a%'ia u$ +a (o6ado a CPRE !uiada 2orBuoros'o2"a $% $ dia!%-s(i'o 8 (ra(a6i$%(o d$ as 2a(oo!"as#iio2a%'r$7(i'as, 'o6o $% as i%&$s(i!a'io%$s 2r$&ias u$ +a% sido(o6adas 'o6o 6od$os. Las i%&$s(i!a'io%$s so#r$ as 2a(oo!"as#iio2a%'r$7(i'as 8 sus di3$r$%($s a#orda9$s, so% i62or(a%($s d$#ido a sua(a 2r$s$%'ia a %i&$ %a'io%a.

I*agen endoscpica 2"e nos *"estra el procedi*iento de la

es3nteroto*!a)

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4i%liogra!a

0) Colangiopancreatogra!a retrograda endoscpica en pacientes

con patolog!a %iliopancre'tica) E5periencia en 6.. casos) Dra) D!a7

A"rora & col) Ser$icio de 8astroenterolog!a) 9ospital Central

Uni$ersitario Antonio Mar!a ,ineda).//:

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.) Caracter!sticas de la Colangiopancreatogra!a retrgrada

endoscpica en "n centro de reerencia nacional) Re$)

gastroenterol) ,er- $).; n). Li*a a%r)