EUS en Patología Pancreática

Cálculos de Colédoco

En la actualidad el endoscopista cuenta con diferentes métodos diagnósticos para detectar cálculos biliares o cálculos de colédoco.

La visualización del colédoco por ultrasonido abdominal es limitada. La TAC permite valorar el árbol biliar pero ha demostrado limitaciones para detectar los cálculos del colédoco.

La CPRE ha sido el patrón de oro como método de alto valor diagnostico de coledocolitiasis, sin embargo, presenta riesgos importantes para los pacientes.

La EUS ha demostrado en los estudios que es una técnica sensible y específica para detectar coledocolitiasis demostrando un valor similar que los encontrados con la CPRE. Sin embargo la EUS permite ver la microlitiasis que la CPRE convencional no logra valorar adecuadamente.

Otra ventaja de la EUS es que no presenta riesgos diferentes de los de la endoscopia diagnóstica convencional (34-36). Tablas 8-9.

TABLA 8.
Valor diagnóstico de la EUS en coledocolitiasis

TABLA 9.
EUS en la litiasis de la VBP.
Resultados comparativos ERCP/EUS

• Embarazo con US negativo
• Alergia a medios de contraste
• ERCP fallida
• Trastorno de coagulación
• ERCP dudosa
• Microlitiasis

Valor de la EUS en Coledocolitiasis

• Procedimiento altamente sensible y específico
• Mejor que US y CT
• Semejante a CPRE
• Seguro
• No exposición a Rx
• No utiliza medio de contraste
• Si demuestra tumor permite determinar su extensión
• Elige paciente para esfinterotomía
• Estudio de Pancreatitis idiopática (Microlitiasis).

EUS y Cáncer Colorectal

De acuerdo los estudios comparativos realizados entre las diferentes técnicas diagnósticas, se concluye que la USE es la mejor para estadificación del cáncer rectal tanto en sensibilidad como en especificidad.

La EUS tiene notable importancia clínica en el cáncer por la variedad de opciones terapéuticas dependientes del estado tumoral.

La EUS detecta las recidivas locales siendo utilizada como técnica de vigilancia después de tratamiento (37-40). TABLA 10.

TABLA 10.
EUS vs. TAC en la determinación del estado
local del cáncer de recto

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Lecturas Recomendadas

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