Enfermedad litiásica biliar

  1. Fernández, R. Mejuto
  2. Senra, N. Vallejo
  3. Ríos, E. Flores
  4. Mauriz Barreiro, V.
  5. Domínguez-Muñoz, J.E.
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Ano de publicación: 2020

Serie: 13

Número: 9

Páxinas: 488-496

Tipo: Artigo

DOI: HTTPS://DOI.ORG/10.1016/J.MED.2020.05.027 DIALNET GOOGLE SCHOLAR

Outras publicacións en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumo

Resumen Entre un 5 y un 15% de la población occidental presenta litiasis biliar. La mayoría de los cálculos están formados por colesterol y se crean en el interior de la vesícula, desde donde pueden migrar a la vía biliar, causando eventualmente cuadros obstructivos y otras complicaciones. El diagnóstico de la enfermedad litiásica biliar se basa en datos clínicos, analíticos y de imagen. La primera prueba diagnóstica es la ecografía abdominal, muy sensible para el diagnóstico de colelitiasis. En la mayoría de las ocasiones, la colelitiasis es asintomática y no requiere ningún tratamiento específico. Cuando da lugar a síntomas o complicaciones, está indicada la realización de una colecistectomía. Se recomienda la extracción de cualquier coledocolitiasis diagnosticada, aunque sea asintomática, dada la gravedad de sus potenciales complicaciones (colangitis y pancreatitis aguda), siendo el método de elección la colangiopancreatografía retrógrada endoscópica (CPRE). Five to 15% of the western population presents cholelithiasis. Most calculi are formed from cholesterol and are created inside the gallbladder, where they can migrate to the bile duct, eventually causing obstructive conditions and other complications. The diagnosis of biliary stone disease is based on clinical, laboratory and imaging data. The first diagnostic test is abdominal ultrasonography, which is highly sensitive for diagnosing cholelithiasis. In most cases, the cholelithiasis is asymptomatic and requires no specific treatment. When the disease causes symptoms or complications, cholecystectomy is indicated. The recommendation is to extract any diagnosed choledocholithiasis, even if it is asymptomatic, given the severity of its potential complications (cholangitis and acute pancreatitis). The method of choice is endoscopic retrograde cholangiopancreatography.

Referencias bibliográficas

  • Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part III: liver, biliary tract, and pancreas. Gastroenterology. 2009;136:1134-44.
  • Zhao J, Kim H, Han Y, Choi YJ, Byun Y, Kwon W, et al. Chronological changes in epidemiologic features of patients with gallstones over the last 20 years in a single large-volume Korean center. Ann Surg Treat Res. 2019;97(3):136-41.
  • Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: a Mende-lian randomization study. Hepatology. 2013;58:2133.
  • Carulli L, Del Puppo M, Anzivino C, Zambianchi L, Gabbi C, Baldelli E, et al. In vivo degradation of cholesterol to bile acids is reduced in patients receiving parenteral nutrition. JPEN J Parenter Enteral Nutr. 2014;38(2): 220-6.
  • Rodríguez Rangel DA, Pinilla Orejarena AP, Bustacara Diaz M, Henao García L, López Cadena A, Montoya Camargo R, et al. Gallstones in association with the use of ceftriaxone in children. An Pediatr (Barc). 2014;80(2):77-80.
  • Buch S, Schafmayer C, Völzke H, Becker C, Franke A, von Eller-Ebers-tein H, et al. A genome-wide association scan identifies the hepatic cho-lesterol transporter ABCG8 as a susceptibility factor for human gallstone disease. Nat Genet. 2007;39:995.
  • Lammert F, Wang DQ, Wittenburg H, Bouchard G, Hillebrandt S, Taen-zler B, et al. Lith genes control mucin accumulation, cholesterol crystalli-zation, and gallstone formation in A/J and AKR/J inbred mice. Hepatolo-gy. 2002;36(5):1145-54.
  • Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet 2006;368:230-9.
  • Lacarta García G. Práctica clínica en gastroenterología y hepato-logía. En: Montero Huguet MA, García Pagán JC, editores. Práctica clínica en gastroenterología y hepatología. Capítulo 53. Vol. II. 1ª ed. Madrid: Grupo CTO; 2016; 889-909.
  • European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-81.
  • Lammert F, Gutt C. Prophylaxis, diagnosis and treatment of gallstones – the most important facts of the Updated S3-Guideline of the DGVS and DGAV. Dtsch Med Wochenschr. 2019;144(3):194-200.
  • Colli A, Conte D, Valle SD, Sciola V, Fraquelli M. Meta-analysis: nonste-roidal antiinflammatory drugs in biliary colic. Aliment Pharmacol Ther. 2012;35:1370-8.
  • Venneman NG, Besselink MG, Keulemans YC, Vanberge-Hene-gouwen GP, Boermeester MA, Broeders IA, et al. Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallsto-nes awaiting cholecystectomy. Hepatology. 2006;43(6):1276-83.
  • Kedia P, Tarnasky PR. Endoscopic management of complex biliary stone disease. Gastrointest Endosc Clin N Am. 2019;29(2):257-75.
  • Okoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity gra-ding of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54.
  • Buckman SA, Mazuski JE. Review of the Tokyo Guidelines 2018: Antimicrobial therapy for acute cholangitis and cholecystitis. JAMA Surg. 2019;159(9):873-4.
  • Ahmed O, Rogers AC, Bolger JC, Mastrosimone A, Lee MJ, Keeling AN, et al. Meta-analysis of outcomes of endoscopic ultrasound-guided gall-bladder drainage versus percutaneous cholecystostomy for the manage-ment of acute cholecystitis. Surg Endosc. 2018;32(4):1627-35.
  • Luk SW, Irani S, Krishnamoorthi R, Wong Lau JY, Wai Ng EK, Teoh AY. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy. 2019;51(8):722-32.
  • Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gaba-ta T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):17-30.
  • Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):96-100.
  • Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, et al. Gallstone ileus: An overview of the literature. Rev Gastroenterol Mex. 2017;82(3):248-54.
  • Kulkarni SS, Hotta M, Sher L, Selby RR, Parekh D, Buxbaum J, et al Complicated gallstone disease: diagnosis and management of Mirizzi syn-drome. Surg Endosc. 2017;31(5):2215-22.
Fonte de datos: Dialnet