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

	AUTOR	N	Cálculos Colédoco	Se%	Sp%	Precisión %
Edmundowicz Denis Keriven Amouyal Canto Total	(1992) (1993) (1994) (1994) (1995)	20 60 78 62 64 284	(20%) (42%) (32%) (37%) (30%) (32%)	75 92 100 97 84 90	100 100 89 100 95 97	95 97 95 98 92 95

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

	n	Sen	Esp	VPP	VPN
Edmundowicz 1992 Prat 1995	20 109	75% 75% 87% 93%	100% 100% 100% 97%	100% 100% 100% 98%	93% 93% 80% 88%	CPRE USE CPRE USE

• 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

		Estado T		Estado N
	N	EUS %	TAC %	EUS %	TAC %
Akasu Beynon 1988 Beynon 1988 Goldman Kramman Pappalardo Rifkin 1989 Rotte Ruf Strunk Waizer Total	41 44 46 32 29 14 81 25 49 10 48 419	80 91 – 81 93 93 67 84 88 70 77 84%	46 82 – 52 76 86 53 76 78 44 66 68%	78 – 87 – – 86 80 – – – – 84%	66 – 57 – – 57 72 – – – – 60

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Lecturas Recomendadas

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