Intervencionismo endoscópico en la pancreatitis crónica

  • Rodrigo Castaño Llano Universidad Pontificia Bolivariana, Universidad de Antioquia, Clínica de las Américas. Medellín, Colombia.
  • Everson L Artifon Universidad de Sao Paulo (FMUSP)
Palabras clave: pancreatitis crónica, colangiografía endoscópica, cálculos pancreáticos, estenosis pancreática, pseudoquiste pancreático, bloqueo de plexo celiaco

Resumen

La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.

Biografía del autor/a

Rodrigo Castaño Llano, Universidad Pontificia Bolivariana, Universidad de Antioquia, Clínica de las Américas. Medellín, Colombia.
Cirujano gastrointestinal y endoscopista. Jefe de postgrado de cirugía general, Universidad Pontificia Bolivariana; Profesor titular Grupo de gastrohepatología de la Universidad de Antioquia; Cirugía y endoscopia en Instituto de cancerología en Clínica de las Américas. Medellín
Everson L Artifon, Universidad de Sao Paulo (FMUSP)
Profesor del departamento de cirugía de la Facultad de medicina de la Universidad de Sao Paulo, Coordinador de la unidad de endoscopia biliopancreática, FMUSP, Vicepresidente de SIED (2017-2018)

Citas

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Publicado
2019-04-01
Sección
Revisión de tema