Decompression Of Bile Duct Research Articles

Radiofrequency ablation via catheter and transpapillary access in patients with cholangiocarcinoma (ACTICCA-2 trial) – a multicenter, randomized, controlled, open-label investigator-initiated trial

BackgroundDespite the recent advances in cancer treatment, the therapeutic options for patients with biliary tract cancer are still very limited and the prognosis very poor. More than 50% of newly diagnosed patients with biliary tract cancer are not amenable to curative surgical treatment and thus treated with palliative systemic treatment. Malignant bile duct obstructions in patients with perihilar and/or ductal cholangiocarcinoma (CCA) represents one of the most important challenges in the management of these patients, owning to the risk represented by developing life-threatening cholangitis which, in turn, limits the use of systemic treatment. For this reason, endoscopic stenting and/or bile duct decompression is the mainstay of treatment of these patients. Data on efficacy and safety of adding radiofrequency ablation (RFA) to biliary stenting is not conclusive. The aim of this multicenter, randomized trial is to evaluate the effect of intraductal RFA prior to bile duct stenting in patients with unresectable perihilar or ductal CCA undergoing palliative systemic therapy.Methods/DesignACTICCA-2 is a multicenter, randomized, controlled, open-label, investigator-initiated trial. 120 patients with perihilar or ductal CCA with indication for biliary stenting and systemic therapy will be randomized 1:1 to receive either RFA plus bile duct stenting (interventional arm) or bile duct stenting alone (control arm). Patients will be stratified by trial site and tumor location (perihilar vs. ductal). Both arms receive palliative systemic treatment according to the local standard of care determined by a multidisciplinary tumorboard. The primary endpoint is time to first biliary event, which is determined by an increase of bilirubin to > 5 mg/dl and/or the occurrence of cholangitis leading to premature stent replacement and/or disruption of chemotherapy. Secondary endpoints include overall survival, safety according to NCI CTCAE v5, quality of life assessed by questionnaires (EORTC QLQ-C30 and QLQ-BIL21), clinical event rate at 6 months after RFA and total days of over-night stays in hospital. Follow-up for the primary endpoint will be 6 months, while survival assessment will be continued until end of study (maximum follow-up 30 month). All patients who are randomized and who underwent endoscopic stenting will be used for the primary endpoint analysis which will be conducted using a cause-specific Cox proportional hazards model with a frailty for trial site and fixed effects for the treatment group, tumor location, and stent material.DiscussionACTICCA-2 is a multicenter, randomized, controlled trial to assess efficacy and safety of adding biliary RFA to bile duct stenting in patients with CCA receiving palliative systemic treatment.Trial registrationThe study is registered with ClinicalTrials.gov (NCT06175845) and approved by the local ethics committee in Hamburg, Germany (2024-101232-BO-ff). This manuscript reflects protocol version 1 as of January 9th, 2024.Graphical

Minimally invasive and open methods of bile ducts decompression for the treatment of obstructive jaundice

Annotation. Obstructive jaundice (OJ) patients account for one of the most challenging categories of patients with abdominal pathologies. Today, both open and minimally invasive bile duct decompression techniques are used in biliary surgery. However, the criteria for the selection of minimally invasive and open surgeries in patients with OJ remain undefined. The aim – assessment of the effectiveness of using minimally invasive and open methods of bile duct decompression for the treatment of OJ with due account to OJ duration, bilirubin count, the age of patients, associated complications and comorbidities. We analyzed the results of the surgical treatment of 250 patients with OJ. Statistical processing of the obtained data was carried out using the Student’s t-test. The average age was 52±6.0 years. The average duration of OJ was 19±3.5 days. Benign OJ was observed in 210 (84.0%) patients, and malignant OJ in 40 (16.0%) patients. 136 (54.4%) patients were submitted to minimally invasive surgical interventions. One-stage minimally invasive interventions were used in 38 (15.2%) cases and two-stage minimally invasive interventions in 98 (39.2%) cases. 114 (45.6%) patients underwent open surgeries. Post-operative сomplications after minimally invasive interventions were observed in 7 (5.2%) cases and 13 (11.4%) cases after open surgeries. 2 (1.7%) patients died. So, the use of minimally invasive surgical interventions for the treatment of OJ patients makes it possible to reduce the frequency of complications by 2.2 times, which is statistically significant (p<0.05). Two-stage surgical approach to the treatment of OJ patients of senior age groups is a priority. Single-stage correction is reasonable to use for young and middle-aged patients with bilirubin count under 200 μmol/l, OJ duration less than 14 days, compensated (sub-compensated) comorbidities, and not burdened by complications.

Antioxidant effect of negative air ions in correction of hepatic dysfunction in mechanical jaundice

Aim. To evaluate the effectiveness of negative air ions in eliminating hepatic dysfunction in mechanical jaundice. Materials and methods. Experiments on 30 rats were carried out in two series. In the first experiment series, the mechanical jaundice was simulated with subsequent decompression of common bile duct and injection of 0.9% sodium chloride solution in the volume of 40 ml/kg. In the second experimental series, negative air ions (3 mln particles per 1 cm3 ) were exposed for 60 min once a day over the course of 12 days. The levels of bilirubin, malondialdehyde, ALT and AST, alkaline phosphatase and catalase were studied. Results. The use of negative air ions in mechanical jaundice contributed to significant correction of the liver functional activity. Concentration of total and direct bilirubin decreased to 84.4 ± 7.6 and 42.1 ± 5.4 μmol/l, which is 25% and 56% lower than in the control series. The activity of AST, ALT, and alkaline phosphatase, as well as the concentration of malondialdehyde were reported to be lower in than control series (by 17%, 22%, 18%, 47%, correspondingly), while the catalase activity was 3.6 times higher. Conclusion. Application of negative air ions in treatment of mechanical jaundice stimulates production of own antioxidative enzymes which protect hepatocytes from free radical damage.

SURGICAL APPROACH FOR TREATMENT OF OBSTRUCTIVE JAUNDICE IN PATIENTS OF DIFFERENT AGE GROUPS

The aim: Assessment of the effectiveness of using minimally invasive and open methods of bile duct decompression for treatment of obstructive jaundice (OJ) by comparing complications in patients of di!erent age groups. Materials and methods: We analyzed the results of surgical treatment of 250 patients with OJ. The patients were assigned to two groups: Group I (n = 100) consisting of young and middle-age patients, and Group II (n = 150) consisting of elderly, senile and long-living patients. The average age was 52 ± 6.0 years. Results: 62 (24.8%) Group I patients and 74 (29.6%) Group II patients were submitted to minimally invasive surgical interventions. 38 (15.2%) Group I patients and 76 (30.4%) Group II patients were submitted to open surgical interventions. Complications after minimally invasive surgery (n = 62) in Group I patients were observed in 2 (3.2%) cases, and in 4 (10.5%) cases after open surgeries (n = 38). Complications following minimally invasive interventions (n = 74) in Group II patients were registered in 5 (6.8%) cases, and in 9 (11.8%) cases following open operations (n = 76). 2 (2.6%) Group II patients died for transmural myocardial infarction. Conclusions: The use of minimally invasive surgical interventions for treatment of young and middle-aged OJ patients compared to patients of older age groups makes it possible to reduce the frequency of complications by 2.1 times, which is a statistically signi"cant (p <0.05). The frequency of complications after open surgical interventions of bile ducts in patients of di!erent age groups is not statistically signi"cant (p >0.05).

Impact of Early Versus Late Approach on the Management of Acute Cholangitis in an Ecuadorian Level-4 Health Center

Introduction: Acute cholangitis is a bile duct inflammation and infection resulting from complete or partial obstruction due to different etiologies, including gallstones, malignant occlusion, etc. Clinical presentation includes intermittent fever with chills, right upper quadrant pain, and jaundice. With advances in minimally invasive techniques such as endoscopic techniques, the prognosis has improved in the last 30 years with a current mortality of 2.7 to 10%. Objective: compare the impact of the early versus late approach in the management of acute cholangitis according to the TG in patients admitted to the General Surgery Department of Luis Vernaza Hospital during 2018 to 2020. Methodology: Observational, retrospective, comparative and analytical study. Data was obtained from electronic medical records, organized using Microsoft Excel ®, and analyzed using SPSS 25.0 ®. Chi-square or Fisher's test were applied to compare the clinical characteristics by type of approach or severity scale. Statistical significance was established for p- value &lt;0.05. Results: Ninety-eight patients were included, female: 54.08%. Grade II (moderate) cholangitis was the most frequent (64.29%). The main approach for biliary drainage was endoscopic (ERCP) (57.14%). A late approach (&gt; 48 hours since hospital admission) was seen in 69.4%. Mortality by type of approach presented significant differences (p = 0.029): 0% with early approach vs. 14.71% with the late approach. Discussion: Patients with acute cholangitis were mainly approached late for biliary decompression; a worrying fact since it demonstrates non- compliance of fundamental TG recommendations were early or urgent bile duct decompression is described as a mainstay in acute cholangitis. Conclusions: Hospital stay was directly proportional to the type of approach (early or late). Mortality was higher in patients who underwent a late approach, and directly proportional to the severity. An early approach should always be preferred.

MANAGEMENT OF TUMOUR OBSTRUCTIONS OF DISTAL PART OF COMMON BILE DUCT USING RETROGRADE BILIARY STENTING

The aim of this study is to improve endobiliary stenting in patients with tumour obstruction of the distal part of common bile duct, as well as to promote the prevention of complications, and improve immediate results of treatment and quality of life of patients.&#x0D; The study included 68 patients who took the course of treatment at surgical hospitals from 2018 to 2022 and underwent endoscopic transpapillary stenting of the common bile duct for mechanical jaundice. In 37 patients, stenting was performed using a plastic stent, in 31 patients stenting was performed using a nitinol stent. Results of endobiliary stenting, complications, effectiveness and safety of stenting were evaluated.&#x0D; All patients underwent stening of the common bile duct. During endoscopic retrograde biliary stenting, only 5 patients had complications in the form of bleeding from the area of large duodenal papilla that was stopped endoscopically. In early postoperative period, 12 patients had following complications: migration of plastic stent into duodenum (3 cases), obturation of plastic stent (1 case), acute secondary pancreatitis (6 cases), and cholangitis (2 cases). In 64 out of 68 patients, endobiliary stenting provided satisfactory outcomes resulting in the decompression of external bile ducts.&#x0D; Endoscopic transpapillary stenting of common bile duct is a low-traumatic, safe and effective method of the decompression of biliary tract when it is obstructed by a tumour. Depending on the expected life expectancy we should use nitinol stents (≥ 6 months) or plastic one (of ≤ 6 months).

Intrahepatic and Extrahepatic Cholestatic Jaundice Caused by Adenocarcinoma Pancreas with Hepatitis B Infection: A Case Report

Background: Cholestasis is defined as the stagnation of biliary duct secretion. Intrahepatic jaundice cholestasis is caused by inflammation that happens intrahepatic from an infection such as hepatitis. Meanwhile, extrahepatic cholestasis is caused by obstruction of the biliary duct outside the liver. Stagnation of the bile flow due to these couple of conditions occurring concurrently has been rarely reported. Biliary duct stagnation that occurs with an infection of hepatocytes will cause more serious and progressive effects.&#x0D; Case presentation: A 73 years old woman with extrahepatic and intrahepatic cholestasis caused by pancreatic adenocarcinoma along with chronic hepatitis B. The diagnosis is made based on clinical findings, lab findings, and radiology findings. Quick action is mandatory to prevent complications caused by hyperbilirubinemia and slows the progression of hepatitis B-induced liver fibrosis. A Whipple procedure was performed on this patient to treat the biliary duct obstruction. The patient's condition improved after surgery. The patient is then planned to be given adjuvant chemotherapy, preceded by the administration of antivirals for hepatitis.&#x0D; Conclusion: Cholestasis jaundice causes hyperbilirubinemia that presents with clinical complaints such as jaundice, itchy and could cause several complications due to damage to the liver tissue whose clinical manifestations are related to impaired liver function caused by hyperbilirubinemia in the form of hypoalbumin, hypercoagulation, and in advanced stages can end up with liver cirrhosis. The principle management for cholestatic jaundice is bile duct decompression which is expected to rule out the etiology of the blockage. Tenofovir was given before chemotherapy in these patients to prevent hepatitis flare due to hepatitis B.

Analysis of morphological changes in gallbladder walls after endoscopic bile duct decompression

BACKGROUND: In patients who have undergone retrograde endoscopic choledocholithoextraction, technical difficulties are frequently encountered when performing laparoscopic cholecystectomy, which is associated with the development of destructive changes in the gallbladder wall. However, no studies on the assessment of morphological changes occurring in the gallbladder wall at different terms after endoscopic retrograde bile duct interventions are currently available in the literature. The relevance and insufficient knowledge of the research area prompted this study.&#x0D; AIM: This study aimed to determine the optimal terms of laparoscopic cholecystectomy after endoscopic bile duct decompression performed for cholelithiasis complicated by choledocholithiasis based on morphological changes in the gallbladder wall.&#x0D; MATERIALS AND METHODS: A comparative analysis of the pathological examination of 198 gallbladders removed surgically on different days after endoscopic bile duct decompression performed for cholelithiasis complicated by choledocholithiasis is presented.&#x0D; RESULTS: In group 1, cholecystectomy after endoscopic bile duct decompression was performed on days 13. Gallbladder wall changes were observed in 10 (12.8%) patients. In group 2, cholecystectomy was performed on days 47. Inflammatory changes were revealed in 13 (37.1%) preparations. Pathological examination of the surgical specimens of the patients in group 3 who underwent cholecystectomy on days 1430 revealed changes in the gallbladder wall in 48 (56.4%) cases.&#x0D; CONCLUSIONS: Laparoscopic cholecystectomy after endoscopic bile duct decompression within the first 72 h is the most optimal.

The impact of minimally invasive palliative decompression of bile ducts on quality of life in patients with distal malignant mechanical jaundice

Palliative treatment for mechanical jaundice is aimed at improving patient quality of life (QoL) and prolonging life. The current QoL studies indicate that there is limited evidence on various techniques for decompression of bile ducts (BD) in terms of their impact on quality of life in patients with distal malignant mechanical jaundice, and their data are contradictory.&#x0D; The aim of the study is to evaluate the effect of minimally invasive palliative techniques on QoL in patients with distal mechanical jaundice (MJ) after palliative decompression of bile ducts.&#x0D; Materials and methods. From 2017 to 2021, 98 patients who underwent palliative decompression of bile ducts for distal MJ of malignant origin were examined. A validated MOS SF‑36 questionnaire was used to assess patient QoL. The survey was conducted before the minimally invasive intervention and 2 months after it. Depending on the technique used for decompression of BD, patients were divided into the following groups: percutaneous transhepatic biliary drainage (PTBD) — 25, internal‑external transpapillary biliary drainage (IETBD) — 19, internal‑external biliary‑jejunal drainage (IEBJD) — 29, and endoscopic retrograde biliary stenting (ERBS) — 25.&#x0D; Results. Before treatment, a low level of patient QoL was detected in all groups on all scales of physical and psychological components of health (all p &gt; 0.05). After 2 months, in the PTBD group, the indicator of the Mental Component Summary (MCS) decreased by an average of 6.9 ± 1.2 points (due to the deterioration of the indicator of social functioning scales by 12.5 ± 5.0 points and mental health by 11.1 ± 1.8 points), while the indicator of the Physical Component Summary (PCS) improved by 11.3 ± 1.1 points. In the IETBD and IEBJD groups, there was an improvement in MCS (by 11.7 ± 1.3 points and 13.0 ± 1.1 points, respectively) and PCS (by 5.2 ± 1.2 and 8.6 ± 1.1 points). With regard to MCS and PCS, slight improvement (by 4.7 ± 2.2 and 2.0 ± 1.9 points) was observed in the ERBS group.&#x0D; Conclusions. The IEBJD technique provided important advantages in comparison with other minimally invasive palliative techniques for decompression of BD in terms of its impact on patient QoL. Patients in the IEBJD group had better PCS scores (on average, 47.3 ± 1.3 points) compared to the IETBD (42.1 ± 1.5 points) and ERBS (39.1 ± 1.3 points, p &lt; 0.05) groups, and those in the PTBD group (46.2 ± 1.4 points) had better scores than patients in the IETBD group (p &lt; 0.05). In the IETBD and IEBJD groups, MCS scores were better 41.9 ± 1.1 and 40.3 ± 1.1 points, respectively) compared to the PTBD (22.6 ± 0.9 points) and ERBS (34.0 ± 1.1 points, p &lt; 0.05) groups, and in the ERBS group, they were better than in the PTBD group.&#x0D;

Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis.

ObjectivesConsidering that pathogens resistant to initial antibiotic therapies for cholangitis can affect mortality rates, appropriate initial empiric antibiotic therapy is important. However, evidence regarding the influence of pathogens resistant to initial antibiotics in patients with cholangitis who have undergone early endoscopic retrograde cholangiopancreatography (ERCP) is limited, and the conditions in several cases can improve with early ERCP even when pathogens resistant to initial antibiotics are detected on time. Therefore, this study aimed to assess the influence of pathogens resistant to initial antibiotics on the course of cholangitis in patients undergoing early ERCP.Materials and methodsPatients (n=266) with positive blood or bile culture results treated with early ERCP were divided into those with cultures that were resistant to the initial antibiotics (antibiotic-resistant group; n=66; 24.8%) and those with cultures that were sensitive to the initial antibiotics (antibiotic-sensitive group; n=200; 75.2%). The duration of hospitalization, in-hospital mortality rates due to cholangitis, rates of increased disease severity, and complications during hospitalization were studied.ResultsEnterococcus, Enterobacter, Citrobacter, and Pseudomonas species showed high resistance to several antibiotics. No significant between-group differences were found in the duration of hospitalization, in-hospital mortality rates due to cholangitis, and rates of increased disease severity. However, the rate of post-ERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245).ConclusionsEven if the initial antibiotics were ineffective, the rate of fatal outcomes did not increase among patients with cholangitis who had undergone early ERCP. However, when initial antibiotics were ineffective, the frequency of post-ERCP cholecystitis increased even after early bile duct decompression.

Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm.

Choledocholithiasis in post-surgical bariatric Roux-en-Y gastric bypass patients presents a significant challenge secondary to altered anatomy. We aim to review the existing management options including either endoscopic, surgical, percutaneous or hybrid means. Current literature suggests reasonably successful cannulation rates for single- or double-balloon ERCPranging from 50 to 70% and 63-83%, respectively. The hybrid technique of laparoscopic transgastric ERCP has gained popularity with successrates ranging from 90 to 100%. Conventional laparoscopic techniques like transcystic duct and transcholedochalbile duct exploration are still useful options (i.e. high success rates of 81-100% and 83-96%, respectively). The role of percutaneous transhepatic choledochography remains limited although it can help with rapid bile duct decompression. If feasible, treatment pathways should progress from least to more invasive options as required.

Stage interventions in the treatment of patients with malignant diseases of the common bile duct terminal segment complicated by acute mechanical jaundice

Obstructive mechanical jaundice is a well-researched complication of various diseases and causes, yet considering patients` condition with malignant diseases according to the stage of the malignant process, severity of complications and etc. Selection of the most appropriate method of surgical treatment is always an option where it is essential to consider finding a way between efficiency and surgical trauma.&#x0D; The aim of the research is to optimize the results of surgical treatment of patients with malignant tumours of the common bile duct terminal segment complicated by acute mechanical jaundice.&#x0D; Materials and methods: patients over 18 y.o. with duodenal obstruction; the presence of other active cancer pathology or blood diseases.&#x0D; The research was performed on 2 different groups divided according to the use of biliary passability restoring method concluding the preferability of minimally invasive methods of bile duct decompression.&#x0D; Results: minimally invasive methods are not inferior to the effectiveness of biliary decompression comparing to open methods, have a number of advantages, such as minimal invasiveness, relative safety, low incidence of complications and mortality&#x0D; Conclusions: the introduction of the developed algorithm for surgical treatment of blastomatous mechanical jaundice with the consistent use of antegrade and open methods, as well as antegrade, retrograde and “rendezvous” techniques in surgically incurable patients allowed to reduce the number of early postoperative complications from 32.7 % to 13.3 %, the number of complications requiring surgery – from 5.8 % to 1.3 % and the level of postoperative mortality – from 11.5 % to 2.7 %.

Trends in performance of ERCP among patients with surgically unresectable pancreatic cancer: a Survival, Epidemiology and End Results–Medicare database study

Patients with biliary obstruction caused by adenocarcinoma of the pancreas head may require bile duct decompression to treat symptomatic cholestasis and/or permit systemic chemotherapy. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement is the preferred intervention in such cases. The primary aim of this study was to determine what proportion of patients with surgically unresectable pancreatic adenocarcinoma undergo ERCP and whether this proportion has changed over time. We used SEER-Medicare linked data to identify a cohort of individuals diagnosed with adenocarcinoma of the pancreas head between December 31, 2000 and December 31, 2015 and who did not receive pancreas surgery. ERCP use was measured in the 30 days before and after cancer diagnosis. Additional covariates of interest were extracted for multiple variable analysis. A total of 14,810 patients met study inclusion and exclusion criteria. 53% (7,034/14,810) underwent ERCP within 30 days of cancer diagnosis. The proportion of patients who underwent ERCP declined from 57% in 2001 to 46% in 2015 (P for trend < 0.001). Among those who underwent ERCP, the mean number of ERCP performed per patient over the year after diagnosis declined from 2.3 (SD:1.6) in 2001 to 1.8 (SD:1.1) in 2015 (P=<0.001). Despite decline in ERCP use, adjusted 1-year survival increased over time. In a SEER-Medicare population between the years 2001 and 2015, both the proportion of patients with unresectable pancreas cancer who underwent ERCP, and the mean number of ERCP per patient decreased over time. Survival improved over time despite decreased use of ERCP.

Современные подходы к лечению механической желтухи на фоне злокачественного поражения панкреатобилиарной зоны

Aim. To study the role of tumors of the pancreatobiliary zone in the development of obstructive jaundice. To evaluate the effectiveness of endoscopic methods of diagnosis and treatment of this pathology. Materials and methods. The study is based on the results of the activities of JSC “MSU Neftyanik” in Tyumen for 2011-2020. During this period, 1284 patients with obstructive jaundice were admitted for emergency indications. Of this number, 181 patients had signs of cancerous lesions of the organs of the pancreatobiliary zone. The results obtained were used to evaluate effective endoscopic methods of diagnosis and treatment of patients in this group. Results. Malignant lesion of the pancreatobiliary zone is 14.3% of all cases of emergency treatment of patients with obstructive jaundice. The main cause is cancer of the pancreas, cancer of the bile ducts, as well as cancer of the large duodenal papilla and compression of the bile ducts “from the outside”. Performing emergency duodenoscopy on the first day after admission of patients made it possible to accurately verify the cancerous nature of the disease in the vast majority of patients. The most effective method for the relief of biliary hypertension syndrome in this group is bile duct stenting. Despite the varied nature of the cancer lesion, effective stenting was achieved in 71.3% of patients. If it is technically impossible to carry out stenting, minimally invasive puncture catheterization of the intrahepatic bile ducts is performed. Conclusion. Currently, cancer of the pancreatobiliary zone was established in every 5-7 patients with obstructive jaundice. Emergency duodenoscopy and ERCH is an effective diagnostic method that allows you to verify the “cancerous” nature of jaundice with a probability close to 100%. The most effective method of bile duct decompression in this group of patients is endoscopic transpapillary stenting.

Dynamics of the serum bilirubin level during bile ducts drainage in patients with hilar tumor stenosis and jaundice

Palliative bile duct decompression with various modifications are currently performed in 75-80% of patients with hilar stenosis caused by the tumor. The main goal of palliative care is to reduce the manifestations of jaundice, intoxication, pain syndrome, prolong life period and improve patient’s conditions for chemotherapy.Objective: to evaluate the effectiveness of bile ducts antegrade drainage methods by bilirubin reducing in the palliative treatment of patients with jaundice due to hilar stenosis caused by the tumor.Materials and methods. In a prospective study included 78 patients with hilar obstructive jaundice, who were underwent of palliative antegrade draining of bile ducts: percutaneous transhepatic cholangiostomy (group PTC) - n = 24, externally-internal suprapapillary cholangiostomy (group EISC) - n = 26, percutaneous transhepatic antegrade endobiliary stenting (group PTAES) - n = 28. Endpoints of the study: total serum bilirubin before the procedure, after 3, 7 days and every 10 days for two months. The mean values of bilirubin and the average percentage of decrease in its value at each of the control periods were evaluated in relation to the initial level. Also, at the same time, the cumulative percentage of patients in which bilirubin had a value of ≤34.2 μmol / L (2 mg / dL) or ≤ 85.5 μmol / L (5 mg / dL) was assessed - the threshold values at which a certain type of chemotherapy is possible.Results. In all groups, there was a decrease in the average values of bilirubin levels with an increase in the time passed after the procedure. At all control periods, the mean bilirubin values and the percentage of decrease in the mean bilirubin values did not differ statistically between groups (all p &lt; 0.05). The highest rates of decrease in the level of bilirubin were observed during the first 10 days (about 60.0%). From the 10th to the 60th day, the decrease in the level of bilirubin was approximately 20% from the initial one. The cumulative percentage of patients with the bilirubin level on the 60th day ≤ 34.1 μmol / l (2 mg / dl) was 45.8% in the EISC group, 64.5% in the PTC group, and 63.9% in the PTAES group (p = 0.257) in a month these indicators were 11.7%, respectively; 12.5% and 17.9% (all p &lt;0.05). The decrease in the level of bilirubin ≤ 85.5 μmol / L (5 mg / dL) was more rapid. So, already after 10 days, the cumulative percentage of such patients in the groups exceeded 50.0%: 58.3% in the EISC group, 63.6% in the PTC group, 57.7 % in the PTAES group (p = 0.26) in a month these indicators were respectively 83.3%; 77.3% and 80.8%, after two months, respectively 91.7%, 86.4 and 100% (p = 0.80).Conclusions. The methods of transcutaneous bile ducts drainage/stenting effectively reduce the level of total bilirubin in patients with obstructive jaundice due to hilar stenosis caused by tumor and have no statistically significant differences in the dynamics of bilirubin level within two months of observation.

EFFECTIVENESS OF ENDOSCOPIC TREATMENT OF BILIARY FISTULAS

Abstract. Despite the great experience in biliary surgery, the total frequency of iatrogenic bile duct lesions, accompanied by the formation of biliary fistulas, reaches 2%. The aim of the study is to analyze the results of endoscopic treatment of patients with biliary fistulas after cholecystectomy. Materials and methods of research. The results of endoscopic treatment of 19 patients with biliary fistulas that occurred after cholecystectomy were studied. Women were 11 (57.9%), men – 8 (42.1%). Research results. The reason of the formation of bile fistula was biliary hypertension in case of choledocholithiasis in 14 (73.6%) patients. Endoscopic papillosphincterectomy was performed to restore the free passage of bile into the duodenum. Lithoextraction with balloon was carried out in 11 (57.9%) patients, and in 3 (15.8%) patients was used litoextraction with basket. Endobiliary drainage was performed in 5 (26.3%) patients. Conducting decompression of bile ducts in all cases of type A fistulas resulted in the cessation of bile fistula the day after surgery. Conclusions. ERCP is a highly effective method for treating biliary fistulas, which identifies the location of leakage of bile, and restoring of bile flowing to the duodenum helps to heal the fistula.

COMPARATIVE ASSESSMENT OF BILE DUCT DECOMPRESSION METHODS IN PATIENTS WITH OBSTRUCTIVE JAUNDICE OF NON-TUMOR GENESIS

Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world's population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis. Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days. Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier. Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.

Clinical Outcomes of Bilateral Stent-in-Stent Placement Using Self-Expandable Metallic Stent for High-Grade Malignant Hilar Biliary Obstruction.

PurposeEndoscopic bile duct decompression using bilateral self-expandable metallic stents (SEMSs) deployed via a stent-in-stent (SIS) method is considered a preferred procedure for malignant hilar biliary obstruction (MHBO). However, occlusion thereof occurs frequently. Here, we investigated stent patency duration and risk factors related to stent obstruction with bilateral SIS placement for MHBO at two large centers.Materials and MethodsThe present study reviewed data on patients with MHBO who underwent endoscopic biliary drainage using the SIS method. Clinical outcomes, including stent patency duration and patient overall survival, were analyzed. Factors associated with stent patency were evaluated using Cox proportional hazards models.ResultsSeventy patients with MHBO underwent endoscopic biliary drainage using the SIS method. Median age was 68 years old, and median follow-up duration was 140 days (interquartile range, 57–329). The proportion of high-grade MHBOs (Bismuth type IV) was 57.1%. Median stent patency duration with the SIS method was 108 days according to Kaplan-Meier curves. Median patient survival analyzed by the Kaplan-Meier method was 181 days. Multivariate analysis indicated that higher baseline bilirubin (> 6.1 mg/dL) as an independent risk factor related to stent patency (p<0.05).ConclusionIn endoscopic biliary decompression using SEMS placed with the SIS method, obstructive jaundice was a risk factor for stent patency. The SIS method for high-grade MHBO showed short stent patency.

Safety and Complications of Interventional Endoscopic Ultrasound.

Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.

ВПЛИВ ДЕКОМПРЕСІЇ ЖОВЧОВИВІДНИХ ШЛЯХІВ НА ДИНАМІКУ ПРОЦЕСІВ ЛІПОПЕРОКСИДАЦІЇ, АНТИОКСИДАНТНОГО ЗАХИСТУ І ЦИТОЛІЗУ ПІСЛЯ ЕКСПЕРИМЕНТАЛЬНОГО ТРИДОБОВОГО ХОЛЕСТАЗУ

Позапечінковий холестаз належить до актуальних проблем сучасної абдомінальної хірургії. Найменш дослідженими продовжують залишатися особливості відновлення морфофункціонального стану печінки після декомпресії загальної жовчної протоки. В експериментах на нелінійних білих щурах моделювали обтураційний холестаз шляхом перев’язки загальної жовчної протоки. Через 3 доби пасаж жовчі відновлювали й оцінювали інтенсивність процесів ліпідної пероксидації, антиоксидантного захисту та цитолізу через 1, 3, 5 і 7 діб. Встановлено, що через добу після реканалізації загальної жовчної протоки відмічається погіршення метаболічних процесів у печінці, яке завдяки стимуляції механізмів саногенезу через 7 діб призводить до їх відновлення, зокрема нормалізації інтенсивності процесів ліпідної пероксидації, зниження явищ цитолізу. Провідним компенсаторним механізмом є збільшення активності антиоксидантних ферментів супероксиддисмутази і каталази та основного антиоксиданта крові – церулоплазміну, які продовжують бути підвищеними через 7 діб експерименту.