Dilatación de la papila de Vater con balón de gran diámetro para la extracción de coledocolitiasis

Abstract

Papillary dilation with a large balloon is an effective, safe, and easy technique for the retrieval of difficult common bile-duct stones. The procedure neither adds time to the exploration, nor increases complications, and obviates the need for mechanical lithotripsy in a majority of patients.

Endoscopic Papillary Large Balloon Dilation Combined with Guidewire-Assisted Precut Papillotomy for the Treatment of Choledocholithiasis in Patients with Billroth II Gastrectomy

“…Recently, endoscopic papillary large balloon dilation (EPLBD) combined with limited EST (EPLBD+EST) has been reported to be effective and safe for the removal of common bile duct (CBD) stones 5,13. Although this method has had promising results, EST is still a problematic procedure in patients with prior Billroth II gastrectomy.…”

Sedation with propofol controlled by endoscopists during percutaneous endoscopic gastrostomy

“…Sin embargo su ventana terapéutica es estrecha, obligando a un ajuste perfecto de las dosis para evitar provocar deterioro de la función cardiorrespiratoria; por dicho motivo y por el hecho de no disponer de un antídoto, el empleo de propofol por médicos no anestesistas ha suscitado controversia. No obstante, en los últimos años han sido muy numerosos los estudios publicados que demostraban una seguridad y efectividad aceptables cuando la sedación con propofol durante procedimientos endoscópicos era controlada directamente por endoscopistas o por enfermeras debidamente entrenadas, si bien es cierto que la mayoría de dichos estudios se llevaron cabo durante procedimientos de endoscopia básica y en pacientes de riesgo anestésico bajo, siendo escasos los trabajos referidos a endoscopia avanzada o en pacientes con riesgo anestési-co superior (16)(17)(18)(19)(20)(21)(22).…”

“…For this reason and because of not having an antidote, the non-anesthesiologist use of propofol by doctors has raised controversy. However, in recent years numerous studies have been published and they have demonstrated an acceptable safety and efficacy when propofol sedation during endoscopic procedures was controlled directly by endoscopists or by properly trained nurses, although most of these studies were carried out during basic endoscopic procedures, and in lower anesthetic risk patients, with few studies relating to advanced endoscopy or in patients with a higher anesthetic risk (16)(17)(18)(19)(20)(21)(22).…”

“…El debate ha sido zanjado parcialmente tras la aparición de varias guías de manejo clínico publicadas por diferentes sociedades científicas, que establecen las condiciones que debe cumplir el personal dedicado a la sedación tanto superficial como profunda y las situaciones en las que la misma debe ser llevada a cabo por anestesiólogos (4)(5)(6)(7)(8)(9)(10)(11)(12). No obstante, a pesar de la gran cantidad de trabajos publicados sobre sedación en endoscopia digestiva controlada por médicos no anestesistas o enfermeras entrenadas (13)(14)(15), apenas existen artículos que se refieran a su empleo durante procedimientos de endoscopia avanzada (2,(16)(17)(18)(19)(20). Es por ello que nos propusimos valorar de forma prospectiva la seguridad y calidad de la sedación con propofol controlada por endoscopista durante la práctica de gastrostomía percutánea endoscópica, procedimiento de cierta complejidad técnica y que se lleva a cabo habitualmente en pacientes de riesgo anestésico elevado, factores ambos que sitúan el procedimiento en la proximidad del límite generalmente aceptado para considerar necesaria la presencia de un médico anestesista.…”

“…The debate has been partially solved with the emergence of several clinical management guidelines published by various scientific societies, which set conditions to be fulfilled by staff dedicated to both conscious and deep sedation, and situations in which it must be carried out by anesthesiologists (4)(5)(6)(7)(8)(9)(10)(11)(12). However, despite the great number of published studies about sedation controlled by physicians or certified nurses, in gastrointestinal endoscopy (13)(14)(15), there are very few of them that value its use in advanced endoscopic procedures (2,(16)(17)(18)(19)(20). That is why we decided to prospectively evaluate the safety and quality of sedation with propofol controlled by endoscopists during the practice of percutaneous endoscopic gastrostomy, a procedure of some technical complexity and usually indicated in patients with anesthetic high risk, both of which put the procedure in the proximity of the generally accepted threshold necessary to consider the presence of an anesthesiologist.…”