<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1130-0108</journal-id>
<journal-title><![CDATA[Revista Española de Enfermedades Digestivas]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. esp. enferm. dig.]]></abbrev-journal-title>
<issn>1130-0108</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Patología Digestiva]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1130-01082018000800008</article-id>
<article-id pub-id-type="doi">10.17235/reed.2018.5255/2017</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Revisión de las perforaciones duodenales tras colangiopancreatografía retrógrada endoscópica en el Hospital Puerta de Hierro de 1999 a 2014]]></article-title>
<article-title xml:lang="en"><![CDATA[Review of duodenal perforations after endoscopic retrograde cholangiopancreatography in Hospital Puerta de Hierro from 1999 to 2014]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jiménez-Cubedo]]></surname>
<given-names><![CDATA[Elena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López-Monclús]]></surname>
<given-names><![CDATA[Javier]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lucena-de-la-Poza]]></surname>
<given-names><![CDATA[José-Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Alcolea]]></surname>
<given-names><![CDATA[Natalia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Calvo-Espino]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Pavía]]></surname>
<given-names><![CDATA[Arturo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez-Turrión]]></surname>
<given-names><![CDATA[Víctor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitario Puerta de Hierro Servicio de Cirugía General y Aparato Digestivo ]]></institution>
<addr-line><![CDATA[Majadahonda, Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<volume>110</volume>
<numero>8</numero>
<fpage>515</fpage>
<lpage>519</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1130-01082018000800008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1130-01082018000800008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1130-01082018000800008&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  la colangiopancreatografía retrógrada endoscópica (CPRE) sigue siendo la prueba de elección para el diagnóstico y el tratamiento de la patología biliar y pancreática, pero cuenta con una tasa de morbimortalidad no desdeñable, por lo que se proponen algoritmos para el manejo y tratamiento de sus complicaciones.  Objetivo:  revisar las perforaciones post-CPRE tratadas en el Servicio de Cirugía General del Hospital Puerta de Hierro de 1999 a 2014, evaluando los resultados en función del tipo de perforación y el tratamiento.  Métodos y resultados:  se ha realizado un estudio descriptivo y observacional de todas las perforaciones post-CPRE comunicadas y tratadas por el Servicio de Cirugía General del Hospital Puerta de Hierro de 1999 a 2014, en relación a la indicación de la prueba y hallazgos, el tipo de perforación (clasificación de Stapfer), el tiempo hasta el diagnóstico y el método de diagnóstico, el tiempo hasta la intervención y la técnica empleada, las complicaciones posteriores, así como la evolución y el tiempo de ingreso. Los resultados se han evaluado en función del tipo de perforación (Stapfer) y del tipo de tratamiento realizado. Se comunicaron 36 perforaciones (21 de tipo I, ocho de tipo II, dos de tipo III y cinco de tipo IV), lo que supone una incidencia menor del 1%. El diagnóstico fue inmediato (en las primeras 24 horas) en el 67% de los casos, siendo las de tipo I las más frecuentes. Se intervino a 28 de los 36 pacientes (77,7%), realizándose en la mayoría una colecistectomía seguida, siempre que fue posible, de sutura, colangiografía intraoperatoria y exploración de la vía biliar y drenaje. Fallecieron cuatro pacientes (dos intervenidos y dos manejados de manera conservadora), todos con perforaciones de tipo I. La complicación más frecuente fue la colección/fístula, que apareció en el 21,42% de los pacientes intervenidos.  Conclusiones:  el tratamiento de las perforaciones periduodenales secundarias a CPRE debe orientarse en función de los hallazgos clínicos y radiológicos. Según nuestra experiencia, las perforaciones de tipo I requieren una intervención quirúrgica inmediata, mientras que las perforaciones tipo II y III permiten, en algunos casos, un manejo conservador, siempre ante la ausencia de complicaciones como colecciones abdominales asociadas y/o signos de sepsis o de irritación peritoneal. Las perforaciones tipo IV responden bien al manejo conservador]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Introduction: endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard in biliary and pancreatic pathology. Although the procedure has a significant morbidity and mortality rate. Algorithms are needed for the management and treatment of the associated complications.  Objective:  to review the post-ERCP perforations treated in the Department of General Surgery of the Hospital Puerta de Hierro from 1999 to 2014. The results were evaluated according to the types of perforation and treatment.  Methods and results:  this is a descriptive and observational study of all post-ERCP perforations reported and treated by the Department of General Surgery of the Hospital Puerta de Hierro from 1999 to 2014. The following data were collected: indication for the test and findings, type of perforation, time and method of diagnosis, time to surgery and the technique used; the subsequent complications as well as the evolution and time of admission were registered. Results were evaluated according to the type of perforation (Stapfer classification) and the treatment performed. Thirty-six perforations were reported (21 type I, eight type II, two type III and five type IV), with an associated incidence of less than 1%. The diagnosis was immediate (in the first 24 hours) in 67% of cases; type I was the most frequent: 28 of 36 patients (77.7%) required surgery. The majority underwent a cholecystectomy followed by suture, intraoperative cholangiography, bile duct exploration and drainage whenever possible. Four patients died with type I perforations; two were intervened and two were managed conservatively. The most frequent complication was a collection/fistula which occurred in 21.42% of patients who underwent surgery.  Conclusions:  periduodenal perforations secondary to ERCP treatment should be oriented according to the clinical and radiological findings. In our experience, type I perforations require immediate surgical intervention, whereas type II and III perforations can be managed conservatively in some cases when there are no complications such as associated abdominal collections, peritoneal irritation and/or sepsis. Type IV perforations respond to conservative management.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Colangiografía]]></kwd>
<kwd lng="es"><![CDATA[Colelitiasis]]></kwd>
<kwd lng="es"><![CDATA[Perforación intestinal]]></kwd>
<kwd lng="en"><![CDATA[Cholangiography]]></kwd>
<kwd lng="en"><![CDATA[Cholelithiasis]]></kwd>
<kwd lng="en"><![CDATA[Intestinal perforation]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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