Search

Resumen Introduccion Presentamos nuestra experiencia en el tratamiento endoscopico del diverticulo de Zenker. Pacientes y metodo Tres pacientes con diverticulos de Zenker de tamano medio fueron sometidos a una cricofaringomiotomia endoscopica realizada con un esfinterotomo de aguja modificado a traves de un gastroscopio terapeutico. El procedimiento se realize en la unidad de endoscopia digestiva bajo sedacion consciente sin apoyo anestesico. Resultado La cricofaringomiotomia endoscopica se completo en una unica sesion sin complicaciones inmediatas ni tardias. En los 3 pacientes desaparecio completamente la disfagia y todos fueron dados de alta a las 48 h con indicacion de dieta solida. Tras 12,18 y 17 meses de seguimiento no ha reaparecido la disfagia ni otros sintomas atribuibles al diverticulode Zenker. Conclusion La cricofaringomiotomia mediante endoscopio flexible es un tratamiento simple, eficaz y seguro del diverticulo de Zenker que ahorra la cirugia abierta cervical y la anestesia general.

Warm Water Ampullary Washing: A Potential Needle-Knife Sphincterotomy Sparing Technique Emilio De la Morena, Elena Perez de Arellano, Yago Gonzalez-Lama, Esperanza Tomas-Moros Background: Needle-knife sphincterotomy (NKS) is an alternative endoscopic sphincterotomy (ES) technique used when selective biliary canulation (SBC) fails, but it is difficult to learn and is an independent risk factor for postERCP pancreatitis. Easier and safer canulation, NKS sparing, handlings are thus desirable. Objective: To report our preliminary results with a new canulation facilitating technique, the warm water ampullary washing (WAW). Method: WAW is performed when guide-wire assisted SBC fails and sphincter of Oddi spasm is one major presumptive cause of the failure. The ampoule is washed with 50 cc of tap water empirically titrated at 38-40 C using a canulotome inserted a few millimetres in the papillary orifice caring not to nail the tip to permit the duodenal reflux of the water and prevent pancreatic injection. After WAW a second SBC attempt is tried and if it fails again a NKS is performed. Results: Along one year 66 ES were indicated in 75 patients. Initially CSB and ES were performed in 54 (82%) and NKS in 5. WAW was tried in 7 and allowed CSB and ES in 4. Thus the final number of ES performed was 58 (88%) and the theoretic 12 (18%) NKS dropped to the real 8 (12%) (pZNS). The 4 WAW issues had healthy papillae (HP) (2 normal and 2 mild papillitis) whereas the 3 WAW failures had ill papillae (IP) (2 severe papillitis, 1 impacted stone). All 8 patients who required NKS had IP. Among the 3 WAW failures 1 mild pancreatitis was registered. Compared with 225 historical controls NKS dropped from 16% to 12% (pZNS). However NKS in IP patients rose from 7% to 12% (pZNS) and NKS in HP patients fell from 9% to 0 (pZ0.00002). Conclusion: With these results we hypothesise that WAW facilitates the SBC and allows ES in HP patients sparing NKS in them and limiting it to IP patients.