2. Descripción Presencia de piedras en la vesícula biliar. Se manifiesta principalmente por “cólico biliar.” Colecistitis aguda: resulta de la obstrucción del conducto cístico, con inflamación de la vesícula biliar. La coledocolitiasis, es la obstrucción del colédoco por algún lito.
3. Los litos son 75% de colesterol y 25% de pigmentos. Los litos de colesterol se asocian con: Obesidad, Diabetes, Género femenino, Fertilidad. Los litos de pigmento se asocian con: Anemias hemolíticas.
4. Epidemiología La incidencia aumenta con la edad (>40). 20% ˃40. 30% ˃70. Mujeres. Dif. Raciales (NHANES III): Mexicanas (26.7%) Blancas Afroamericanas (13.9%)
5. Diagnóstico Presentación Clínica: puede ser completamente asintomática (80%) o asociarse con colecistitis, coledocolitiasis, pancreatitis, colico biliar o raras veces ileo biliar.
6. Síntomas: Colelitiasis con colecistitis: Dolor en cuadrante superior derecho o epigastrio, que se irradia a la espalda, escápula u hombro derechos. Nausea y vómito. Colelitiasis con pancreatitis: Dolor abdominal transfictivo focal o difuso que puede irradiarse a la espalda. Nausea y vómito
7. Cólico biliar: Dolor posprandial en cuadrante superior derecho, por lo regular despues de alimentos grasosos. Dolor puede durar de minutos a horas. Intolerancia a alimentos grasosos. Nausea. Colecistitis con colangitis: Triada de Charcot: Dolor (cuadrante superior derecho). Ictericia. Fiebre.
8. Signos: Colelitiasis: Evidenciada mediante presencia de litos en la vesícula biliar por medio de ultrasonido o algún otro metodo de imagen. Signo de Murphy. Vesícula palpable (1/3 de pacientes). Ligera leucocitosis. Elevación de transaminasas, bilirrubina y fosfatasa alcalina.
12. Endoscopic papillary balloon dilation (EPBD) is an alternative method of endoscopic sphincterotomy (EST). Although concerns regarding post-procedure pancreatitis have been expressed, EPBD has come to be recognized as an effective and safe method for stone removal in specific cases. To analyze the proper indications, ideal methods, complications, and long-term follow-up results for EPBD, we reviewed articles about EPBD located through a search of the PubMed data base. We analyzed the ballooning methods, indications, results and complications of EPBD among the articles found and compared the results with those of EST.
13. We considered the authors’ own clinical experience and knowledge in developing recommendations for EPBD. EPBD showed similar efficacy and safety for the removal of choledocholithiasisto that of EST. Although large or multiple stones were difficult to remove by EPBD, it was safer and easier to apply in patients with coagulopathy or abnormal anatomy. To prevent severe pancreatitis, excessive ballooning and impractical cannulation should be avoided, and precut sphincterotomyor adjuvant prophylaxis should be considered. Due to its preservation of the sphincter of Oddi, EPBD is expected to have fewer long-term complications, such as stone recurrence, cholangitisand cholecystitis. In conclusion, EPBD appears to be safe and effective for the treatment of choledocholithiasis with proper selection of ballooning methods and patients.