Role of endoscopy in diagnosis and treatment of gallstone disease complicated by the pathology of the extrahepatic bilary tract (literature review)

Abstract

The article presents current literature data of domestic and foreign authors on the main problems of endoscopic diagnostics and complex approach to treatment of gallstone disease complicated by pathology of the extrahepatic biliary tract. Efficiency of one-stage and two-stage methods of surgical treatment of cholelithiasis and the possibility of their practical application are considered. Complex approach for minimally invasive bile duct interventions with cholecystoccholedocholitiase, which can be conditionally divided into laparoscopic, mini-access, endoscopic by duodenoscope, cholangioscopy, ultrasound-controlled biliary intervention, is analyzed. Methods of diagnostic testing that can be divided into preoperative and intraoperative, non-invasive and invasive used in patients with cholecystoccholedocholitiase, namely fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, percutaneous-transhepatic cholangiography, diagnostic laparoscopy, intraoperative cholangiography, intraoperative ultrasound, angiography. New concepts of providing surgical care to patients with this pathology are presented, which include one-stage performance of cholecystectomy with priority use of intraoperative antegrade endoscopic papillosphincterotomy, and retrograde litho-extraction under duodenoscope control, in comparison with the two-stage tactics of correction of cholelithiasis with pathology of extrahepatic biliary tract, when the first stage includes its decompression, rehabilitation, and the second — cholecystectomy. Statistical data of complications arising during diagnostic and therapeutic manipulations in patients with cholelithiasis complicated by pathology of the extrahepatic biliary tract are presented. Number of cases of postoperative mortality depending on the severity of complications of cholelithiasis is also considered.