Manejo del cálculo difícil en la vía biliar: Serie de casos

  • martin Gómez Zuleta
  • Oscar Gutiérrez
  • Mario Jaramillo
Palabras clave: Coledocolitiasis, cálculo difícil, litotripsia, colangioscopia, Spyglass®

Resumen

El 85% a 90% de los cálculos de la vía biliar son manejados de forma exitosa con la técnica endoscópica es- tándar, que incluye esfinterotomía endoscópica combinada con canastilla y/o catéter con balón. Sin embargo, cuando los cálculos son múltiples, de gran tamaño, de localización o forma inusual, o existen alteraciones anatómicas de la vía biliar se hacen refractarios al manejo estándar, lo que obliga la realización de otras modalidades terapéuticas. Los cálculos de gran tamaño o impactados generalmente son manejados con técnicas de fragmentación como la litotripsia mecánica y en casos fallidos con litotripsia electrohidráulica (LEH) o litotripsia láser (LL) guiado por colangioscopia convencional o más recientemente por un sistema de colangioscopia directa llamado Spyglass®. También se puede usar el sistema de dilatación endoscópica papilar con balón grande, que ha demostrado ser útil en el manejo de cálculos grandes y múltiples. En casos con anatomía alterada con dificultad para acceder a la papila, el abordaje preferido para la técnica de frag- mentación es el percutáneo transhepático. En pacientes ancianos y con pobre estado general la colocación de una prótesis biliar es la técnica de elección definitiva mientras mejoran las condiciones del paciente para un tratamiento endoscópico posterior. 

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Biografía del autor/a

martin Gómez Zuleta
  1. Profesor asociado de Gastroenterología, Facultad de Medicina, Universidad Nacional. Gastroenterólogo Hospital El Tunal. Gastroenterólogo UGEC. Bogotá, Colombia 

Oscar Gutiérrez
  1. specialista Adscrito a Gastroenterología y Endoscopia Digestiva en Colsanitas y Clínica del Occidente. Profesor Titular (r). Universidad Nacional de Colombia. Bogotá, Colombia 

Mario Jaramillo
  1. Internista, residente de Gastroenterología de último año. Universidad Nacional de Colombia. Bogotá, Colombia 

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Publicado
2016-10-28
Cómo citar
Gómez Zuleta martin, Gutiérrez, O., & Jaramillo, M. (2016). Manejo del cálculo difícil en la vía biliar: Serie de casos. Revista Colombiana De Gastroenterología, 30(4), 461-468. https://doi.org/10.22516/25007440.10
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