Jesús-Flores Alberto De, Guerrero-Martínez Gustavo A
Servicio de Cirugía General, Hospital Regional de Alta Especialidad, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México.
Cir Cir. 2019;87(4):423-427. doi: 10.24875/CIRU.19000683.
Choledocholithiasis is one of the main complications of cholelithiasis with a prevalence in the Mexican population of 14%. The management through the guide proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 can support the surgeon for the timely resolution of the pathology.
To determine that the guide proposed by ASGE for the management of choledocholithiasis in patients with "high risk" reduces the complications of this pathology.
A comparative, retrospective case-control study was conducted from January 1, 2015 to December 31, 2017. We included patients who were stratified at high risk of choledocholithiasis according to the ASGE guidelines. They were divided into 2 groups: the case group (diagnosis by ASGE guidelines) was submitted directly to endoscopic retrograde cholangiopancreatography (ERCP), the second group (no ASGE) followed the protocol of performing computed tomography, magnetic cholangioresonance, and finally ERCP.
Of 61 patients with choledocholithiasis, the following groups were compared: the appearance of cholangitis, the complications after ERCP, time of ERCP, days of hospital stay and mortality. Obtaining significant difference in: "complications post ERCP" group ASGE 3/35 (9%), group no ASGE 8/26 (30.7%) with OR of 0.2 (0.05 - 0.9 IC 95%) and a p = 0.03; "Cholangitis" group ASGE 2/35 (5.7%), group no ASGE 8/26 (30-7%) with ORP 0.13 (0.03-0.71 IC 95%) and p = 0.009.
In our setting, the use of the ASGE guideline reduces the presence of cholangitis and post-ERCP complications.
胆总管结石是胆石症的主要并发症之一，在墨西哥人群中的患病率为14%。2010年美国胃肠内镜学会（ASGE）提出的指南管理方法可为外科医生及时解决该病理问题提供支持。
确定ASGE提出的用于管理“高风险”患者胆总管结石的指南可减少该病理的并发症。
于2015年1月1日至2017年12月31日进行了一项比较性回顾性病例对照研究。我们纳入了根据ASGE指南被分层为胆总管结石高风险的患者。他们被分为两组：病例组（根据ASGE指南诊断）直接接受内镜逆行胰胆管造影（ERCP），第二组（非ASGE组）遵循进行计算机断层扫描、磁共振胆胰管造影，最后进行ERCP的方案。
在61例胆总管结石患者中，对以下几组进行了比较：胆管炎的发生情况、ERCP后的并发症、ERCP时间、住院天数和死亡率。在以下方面获得了显著差异：“ERCP后并发症”方面，ASGE组3/35（9%），非ASGE组8/26（30.7%），比值比为0.2（95%置信区间0. — 0.9），p = 0.03；“胆管炎”方面，ASGE组2/35（5.7%），非ASGE组8/26（30.7%），比值比为0.13（95%置信区间0.03 — 0.71），p = 0.009。
在我们的研究环境中，使用ASGE指南可减少胆管炎和ERCP后并发症的发生。
