Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT).
Material and methodA total of 352 patients with primary hyperparathyroidism were operated on over the last 7 years. A preoperative parathyroid 99Tc-sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: 3 with persistent HPT after parathyroid extirpation, 1 recurrent HPT and 1 HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location.
ResultsThe endoscopic ultrasound showed a clear image of adenoma with an accurate location in 4 patients. No tumour was present in 1 patient. All 5 patients were operated on. The exact location was confirmed in the 4 patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All 5 patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound.
ConclusionsOesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands.
Considerar la utilidad de la ecoendoscopia trasesofágica en la localización del hiperparatiroidismo primario recidivado o persistente.
Material y métodoDurante 7 años consecutivos, hemos intervenido a 352 pacientes con hiperparatiroidismo primario (HPP). Sistemáticamente se realiza gammagrafía paratiroidea con 99Tc-sestamibi preoperatorio y determinación intraoperatoria de paratirina. Sólo 5 (1,4%) pacientes han presentado problemas de localización: 3 por persistencia tras cirugía paratiroidea, 1 por recidiva y 1 por HPP con antecedente de hemitiroidectomía derecha. Antes de indicar una cervicotomía exploradora, se decide la realización de una ecoendoscopia trasesofágica para intentar una localización definitiva.
ResultadosLa ecoendoscopia detecta una imagen clara de adenoma con localización precisa en 4 pacientes. Sólo en 1 paciente no se visualiza tumoración. Los 5 pacientes fueron intervenidos. Se confirmó la exactitud del diagnóstico en los 4 pacientes con visualización positiva. La exploración quirúrgica del quinto paciente resultó ser una paratireosis. Los 5 pacientes tuvieron un postoperatorio favorable, sin lesiones recurrenciales ni morbilidad asociada a la ecoendoscopia.
ConclusionesLa ecoendoscopia trasesofágica resulta muy útil en los hiperparatiroidismo que presenta dificultades para localizar la glándula patológica, especialmente en casos con alteración anatómica por cirugía previa. Así, ayuda a que el cirujano pueda explorar la zona sospechosa de forma más selectiva y más eficiente.
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