Avanços e desafios nos métodos diagnósticos da coledocolitíase aguda: uma investigação aprofundada

Abstract

The paper addresses choledocholithiasis, a hepatobiliary condition resulting from the migration of gallstones from the gallbladder to the common bile duct, with a focus on Western nations. The incidence of cholelithiasis ranges from 6 to 10%, progressing to choledocholithiasis in 10% of cases. Half of the patients with choledocholithiasis remain asymptomatic, emphasizing the need for comprehensive evaluation in cases of cholelithiasis. Predictive factors have been established to prevent inappropriate approaches, including clinical, laboratory, and imaging criteria. The combination of these criteria demonstrates a sensitivity of 96-98%, playing a crucial role in managing the condition. Clinical signs such as jaundice and cholestasis, along with laboratory markers, indicate biliary tract obstruction. Abdominal ultrasound is essential in the diagnosis. Risk determination guides diagnostic options, with videolaparoscopic cholecystectomy recommended for low-risk cases. Intermediate-risk patients require pre or intraoperative examinations, such as MRCP and EUS. High-risk patients should undergo preoperative ERCP. MRCP stands out as an advanced and non-invasive technique for identifying stones with high precision. In the intraoperative scenario, cholangitis is effectively managed with advanced imaging techniques, enhancing stone removal and minimizing complications. In summary, the diagnostic and therapeutic approach to choledocholithiasis is optimized through the combination of predictive factors, advanced imaging diagnosis (MRCP), and personalized surgical strategies, providing efficacy and safety in treating this complex hepatobiliary condition.