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Dilata o Papilar com Bal o de Grande Diametro Precedida de Esfincterotomia para Remo o de Cálculos da Via Biliar Principal: Casuística de Um Ano Papillary Large-Balloon Dilation Preceded by Sphincterotomy for Removal of Bile Ducts Stones: One Year Experience

Keywords: Dilata o papilar com bal o , esfincterotomia endoscópica , cálculos da via biliar principal , Papillary balloon dilation , endoscopic sphincterotomy , bile duct stones

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INTRODU O: A associa o de dilata o da papila de Vater com bal o TTS-CRE (through the scope-controlled radial expansion) com esfincterotomia (ETE) tem sido usada para remo o de cálculos de grandes dimens es da via biliar principal (VBP). OBJECTIVOS: Apresenta o da casuística do nosso Servi o durante doze meses, em que se procedeu a ETE seguida de dilata o papilar com bal o para remo o de cálculos da VBP. Pretendeu-se avaliar a eficácia na remo o dos cálculos, a necessidade de litotrí-cia mecanica e a ocorrência de complica es. MéTODOS: Entre Outubro de 2009 e Setembro de 2010 foi realizada dilata o papilar com bal o precedida de ETE em 25 doentes. Os doentes incluídos apresentavam no colangiograma por colangiopancreatografia retrógrada endoscópica (CPRE) cálculos na VBP com dimens o superior ou igual a 10mm. Usaram-se bal es TTS-CRE de 12 a 20mm de diametro. RESULTADOS: Dos 25 doentes, 12 (48%) eram do sexo feminino. A média de idades foi de 73 anos e 65% dos doentes apresentavam dois ou mais cálculos. O tamanho médio dos cálculos foi de 15mm. Seis doentes apresentavam litíase residual do colé-doco com ETE prévia. Em 100% dos casos foi conseguida remo o completa dos cálculos numa única sess o. N o houve necessidade de litotrícia mecanica. N o se registaram complica es. CONCLUS O: A associa o dos dois métodos mostrou-se eficaz, rápida e segura na remo o de cálculos de grandes dimens es da VBP. INTRODUCTION: Papillary balloon dilation with TTS-CRE balloon (through the scope-controlled radial expansion) in association with sphincterotomy (EST) has been used for removal of large bile duct stones. OBJECTIVES: We present the 12 month experience of our Department wherein we performed a EST followed by papillary balloon dilation for removal of bile duct stones. Efficacy, need for mechanical lithotripsy and occurrence of complications were evaluated. METHODS: Papillary balloon dilation preceded by EST was performed in 25 patients from October 2009 to September 2010. Patients included in the present study had bile duct stones with a diameter greater than or equal to 10mm detected on cholangiogram obtained during endoscopic retrograde cho-langiopancreatography (ERCP). We used TTS-CRE balloons with 12 to 20mm. RESULTS: Of the 25 patients, 12 (48%) were female. Average age was 73 years and 65% of patients had two or more stones. The average size of the stones was 15mm. Six patients had residual bile duct stones with prior EST. In 100% of cases complete removal of the bile duct stones was achieved in a single session. There was no need for mechanical lit

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