O uso da pinça de biópsia como técnica auxiliar na visualização da papila duodenal maior utilizando-se o esofagogastroduodenoscópio de visão frontal

Abstract

Introduction: Conventional esophagogastroduodenoscopy (EGD) is the best method for evaluation of the upper gastrointestinal tract (UGT), but it has limitations for the identification of the major duodenal papilla (MDP), even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examination of MDP in patients at high risk for lesions in this region. Objective: to evaluate the use of the biopsy forceps during conventional EGD as an additional tool to the straightening maneuver, in the evaluation of the MDP. Methods: A total of 671 patients were studied between 2013 and 2015, with active MDP search in three endoscope steps: not straightened, straightened and use of the biopsy forceps after straightening. In all of them it was recorded whether: MDP was fully visualized (Position A), partially visualized (Position B) or not visualized (Position C). If MDP was not fully visualized, patients continued to the next step. Results: 341 were female (50.8%) with mean age of 49 years. Of the 671 patients, 324 (48.3%) MDP was identified in position A, 112 (16.7%) in position B and 235 (35%) in position C. In the 347 patients who underwent the straightening maneuver, position A was found in 186 (53.6%), position B in 51 (14.7%) and position C in 110 (31.7%). Of the 161 remaining patients and after biopsy forceps use, position A was seen in 94 (58.4%), position B in 14 (8.7%) and position C in 53 (32.9%). The overall rate of complete visualization of MDP was 90%. Conclusion: the use of the biopsy forceps significantly increased the total MDP visualization rate by 14%, reaching 604/671 (90%) of the patients (P<0.01) and it can be easily incorporated into the routine endoscopic examination of the UGT.