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      Principales patologías asociadas a la vía biliar y páncreas y la aplicación de la colangiopancreatografía retrógrada endoscópica (CPRE) en el diagnóstico y tratamiento de algunas de ellas

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          Abstract

          Resumen:Justificación:La colangiopancreatografia retrógrada endoscópica (CPRE) es una forma actual de tratamiento endoscópico de las diversas patologías asociadas a la vía biliar y pancreática. Este es uno de los métodos menos invasivos, el cual tiene la ventaja de simplificar distintas técnicas de tratamiento.Métodos:Se realizó una revisión bibliográfica exhaustiva en bases de datos confiables acerca de la CPRE y las principales patologías asociadas a dicha técnica.Resultados y Conclusiones:Aunque la CPRE puede ser utilizada con diferentes fines, su mayor uso consiste en diagnosticar y tratar coledocolitiasis. Dentro de sus complicaciones más frecuentes se encuentra la pancreatitis en un rango de 1,8% a 7,2%. Sin embargo, a pesar de las diferentes complicaciones que puede presentar, su uso es muy ventajoso según las características del lito y del riesgo que representa la utilización de otras técnicas para el paciente.

          Translated abstract

          Abstract:Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is an endoscopic treatment for diverse biliary duct and pancreas pathologies. It is one of the least invasive methods, since it has the advantage of simplifying different treatment techniques. Methods: We carried out a thorough review of the document available on ERCP and the main pathologies associated to it,Results and colusions: Although ERCP is useful for different situations, its main purpose is for the diagnosis and treatment of choledocholithiasis. Pancreatitis still the most frequent complication associated to ERCP, in a rate of 1,8% to 7,2%. Nevertheless, despite the different complications it may cause, its application is very advantageous depending on the characteristic of the litho and the risk that the use of other techniques represent for the patient.

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          Most cited references70

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          Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials.

          Data regarding the incidence and severity of post-ERCP pancreatitis (PEP) are primarily from nonrandomized studies.
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            New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines

            Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis were published in 2007 (TG07) and have been widely cited in the world literature. Because of new information that has been published since 2007, we organized the Tokyo Guidelines Revision Committee to conduct a multicenter analysis to develop the updated Tokyo Guidelines (TG13). Methods/materials We retrospectively analyzed 1,432 biliary disease cases where acute cholangitis was suspected. The cases were collected from multiple tertiary care centers in Japan. The ‘gold standard’ for acute cholangitis in this study was that one of the three following conditions was present: (1) purulent bile was observed; (2) clinical remission following bile duct drainage; or (3) remission was achieved by antibacterial therapy alone, in patients in whom the only site of infection was the biliary tree. Comparisons were made for the validity of each diagnostic criterion among TG13, TG07 and Charcot’s triad. Results The major changes in diagnostic criteria of TG07 were re-arrangement of the diagnostic items and exclusion of abdominal pain from the diagnostic list. The sensitivity improved from 82.8 % (TG07) to 91.8 % (TG13). While the specificity was similar to TG07, the false positive rate in cases of acute cholecystitis was reduced from 15.5 to 5.9 %. The sensitivity of Charcot’s triad was only 26.4 % but the specificity was 95.6 %. However, the false positive rate in cases of acute cholecystitis was 11.9 % and not negligible. As for severity grading, Grade II (moderate) acute cholangitis is defined as being associated with any two of the significant prognostic factors which were derived from evidence presented recently in the literature. The factors chosen allow severity assessment to be performed soon after diagnosis of acute cholangitis. Conclusion TG13 present a new standard for the diagnosis, severity grading, and management of acute cholangitis.
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              Risk factors for post-ERCP pancreatitis: A systematic review and meta-analysis.

              Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Prevention strategies targeting risk factors could be important to reduce the rate of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis (PEP) are still debated. This systematic review and meta-analysis was performed to identify risk factors for PEP.
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                Author and article information

                Contributors
                Role: ND
                Journal
                mlcr
                Medicina Legal de Costa Rica
                Med. leg. Costa Rica
                Asociación Costarricense de Medicina Forense
                1409-0015
                March 2016
                : 33
                : 1
                : 282-290
                Affiliations
                [1 ]
                Article
                S1409-00152016000100282
                803095d8-67ed-4897-ba45-d9165bb92851

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=1409-0015&lng=en
                Categories
                Anatomy & Morphology
                Medicine, Legal

                Social law,Anatomy & Physiology
                Colangiopancreatografía retrograda endoscópica,cálculos en la vía biliar,coledocolitiasis,colelitiasis esfinterotomía,colangitis,pancreatitis,Endoscopic Retrograde Cholangiopancreatography,bile duct stones,choledocholithiasis,cholelithiasis,sphinterectomy,cholangitis

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