Endoscopic Transpapillary Interventions Research Articles

Endoscopic transpapillary interventions for cholelithiasis complications

The article provides a review of modern literature on the problem of treatment of cholelithiasis complications and endoscopic transpapillary interventions. The pathogenetic mechanisms of these complications were analyzed. Studies on the impact of the timing of laparoscopic cholecystectomy after endoscopic transpapillary interventions show that the risk of recurrent biliary complications increases significantly in patients when cholecystectomy was delayed, while early performance of this operation after endoscopic transpapillary interventions reduces the risk of developing these complications

The influence of early endoscopic transpapillary interventions on the risk of infection of pancreatic necrosis

The influence of early endoscopic transpapillary interventions on the risk of infection of pancreatic necrosis

The Use of L-Menthol in Endoscopic Transpapillary Interventions. Prospective Randomized Dual-Center Study

Aim: to study the effect of L-menthol on duodenal peristalsis, the results of cannulation of the papilla, the effectiveness and safety of endoscopic retrograde transpapillary interventions (ERTI).Materials and methods. A prospective two-center randomized placebo-controlled trial was carried out from January to November 2022 in two centers. The study included 126 patients, 69 (54.8 %) men and 57 (45.2 %) women, mean age — 62.1 ± 1.8 years. The inclusion criteria were age 18–75 years, indications for ERTI, absence of previous endoscopic papillotomy, absence of allergy to menthol, consent to participate in the study. After randomization, the main group (“L”) included 70 patients, the control group — 56. Patients in group “L” were irrigated with 25 mL (160 mg) of L-menthol (Spectavium), patients in the control group — with 25 mL of saline solution. Peristaltic activity was studied before and three minutes after administration of the drug. The intensity of peristalsis was assessed according to a modified Hiki scale: 0 points — complete absence of peristalsis; 1 point — single peristaltic waves; 2 points — intense peristalsis, little amenable to straightening at maximum insufflation; 3 points — pronounced peristalsis.Results. Three minutes post-irrigation, the suppression of peristaltic waves was noted in the experimental group “L”: 0 points — 63 (90 %) patients, 1 point — 6 (8.6 %) patients, compared to the control, with no change in peristalsis (p < 0.05). Successful selective cannulation was achieved in 64 (91.4 %) patients of group “L” and in 41 (73.2 %) — of the control group (p < 0.05). Non-cannulation endoscopic papillotomy had to be used in 6 (8.5 %) cases in group “L” and in 14 (25 %) cases in the control group. In general, successful cannulation was achieved in 100 % of patients in group “L”, and in 94.5 % — in the control group (p < 0.05). The duration of the intervention was significantly reduced in group “L” — 40 ± 2.5 vs. 50.3 ± 3.6 min. Among the complications, only intraoperative bleeding was registered (2 (2.9 %) — group “L”, 5 (8.9 %) — the control group), which was eliminated endoscopically in all cases.Conclusion. The use of L-menthol during ERTI helps to achieve noticeable inhibition of peristalsis, promotes successful cannulation, reduces the intervention time, minimizes the risk of intraoperative complications. Thus, L-menthol has demonstrated its effectiveness and safety, which makes it possible to use it in the arsenal of combating enhanced peristalsis during ERTI.

Ways to prevent acute postmanipulatory pancreatitis in endoscopic transpapillary interventions in patients with mechanical jaundice

To evaluate the effectiveness of preventive measures in relation to the development of acute postmanipulatory pancreatitis in patients after endoscopic transpapillary interventions. Materials and methods: In the period from September 2021 to June 2022, 73 endoscopic transpapillary interventions for benign pathology and malignant pathology were performed in patients. The analysis of the frequency of the development of acute postmanipulatory pancreatitis in different time intervals in patients who underwent prophylaxis in various ways, depending on the combination of risk factors. Results and discussion: Acute postmanipulatory pancreatitis developed in 2 (3.7 %) patients who underwent transpapillary interventions in various volumes for complicated cholelithiasis. Drug prophylaxis of acute postmanipulatory pancreatitis was carried out in the preoperative period for all patients. Preventive stenting of the main pancreatic duct was performed in the presence of a combination of risk factors. Conclusion: The analysis of the results of endoscopic transpapillary interventions made it possible to identify the most significant measures that allowed to reduce the number of developed to 3 acute postmanipulatory pancreatitis to 3.7 % and thereby increase the safety of transpapillary interventions.

The role of endoscopic draining in the treatment of mechanical jaundice of different etiology on the background of chronic opistorchiasis

Purpose of the study: to conduct a comparative analysis of endoscopic retrograde transpapillary interventions in patients with chronic opisthorchiasis and obstructive jaundice of various etiologies.Material and Methods. The results of treatment of 129 patients with chronic opisthorchiasis and obstructive jaundice of various etiologies who underwent transpapillary interventions to correct bile duct, were analyzed. In order to assess the condition of patients, general clinical methods and a set of laboratory and instrumental methods were used. The study was carried out in two groups, in the first endoscopic drainage of the bile ducts was carried out, in the second – either endoscopic papillosphincterotomy with choledocholitholite extraction, or endoscopic papillosphincterotomy with bougienage of the ducts. Each group of patients was divided into subgroups according to nosology: 1 – diseases of the biliary tract; 2 – oncological diseases of the hepatopancreatic zone; 3 – pancreatitis. Laboratory indicators before and after the application of minimally invasive interventions were compared.Results. The use of various methods of transpapillary interventions normalizes indicators of bilirubin, and aminotransferases in patients by 5–10 days. Endoscopic stenting of the ducts was the method of choice with cancers of the parasitic organs. With concomitant choledocholithiasis, the endoscopic papillosphincterotomy technique with subsequent lithotripsy and lithoextraction were used. Draining operations showed a good efficacy in the treatment of jaundice in the case of impossibility of removing the calculus. Endoscopic papillosphincterotomy with ductal bougienage was the operation of choice for streak tours of the common bile duct. With purulent cholangitis, endoscopic papillotomy with the installation of nasobiliary drainage and subsequent sanitation of the bile ducts was used.Conclusion. The use of endoscopic drainage has proven itself well in patients with obstructive jaundice of tumor etiology, as well as in patients with choledocholithiasis when it is impossible to remove the calculus. This surgery allows for quick normalization of the bilirubin level.

Эндоскопическая ультрасонография и транспапиллярные вмешательства у пациентов с парапапиллярными дивертикулами

Aim: to evaluate the possibilities of diagnosed during endoscopic ultrasound (EUS) in clarifying diagnosis of peripapillary diverticula (PD) and optimization of treatment tactics depending on the type of mutual location of the diverticulum and the major duodenal papilla (MDP). Patients and Methods: the study included 304 patients (186 (61.2%) female patients) with peripapillary duodenal diverticulum (PDD). By the criterion of the diverticulum and MDP mutual location, patients were divided into three groups: 195 (64.1%) patients with suprapapillary diverticulum, 59 (19.4%) — with diverticulum of the "butterfly" type, 50 (16.5%) — with intradiverticular MDP. Anatomical features of various diverticula types and associated pathology of periampullary region were studied on the basis of endosonography data, as well as the treatment results of biliary diseases, technical success and complications of transpapillary interventions in various types of diverticula were analyzed. Results and Discussion: patients with intradiverticular MDP were significantly older (69.8±4.4 years). In this group, the size of diverticula (21 mm) and dilatation of choledochus (18 mm) were larger. Patients in this group were significantly more commonly diagnosed with stenosis of the MDP and secondary choledocholithiasis. Indications for endoscopic papillosphincterotomy in patients with PDD were choledocholithiasis — 124 (57.1%), stenosis of the MDP — 44 (20.3%), diverticular compression in terminal choledochus — 49 (22.6%), EUS. The complication rate of transpapillary interventions did not significantly differ and amounted to 2.8%. However, the share of failures during MDP standard biliary cannulation and lithoextraction was higher in the intradiverticular MDP and amounted to 34.5% and 8.8%, respectively, which forced the use of rendezvous procedures that were used in 10 (34.5%) patients of this group. Conclusion: EUS is a highly informative method of diagnostic clarification in PD, providing direct visual inspection of the papillary zone and its echocardiogram. The use of EUS at the initial stage of diagnostics allows to significantly optimize the treatment tactics, determining the indications for transpapillary interventions and ensuring their rational choice. The greatest technical difficulties and failures are expected to occur during manipulations on the intradiverticular MDP, which forces the use of rendezvous procedures, antegrade common bile duct access and laparotomic interventions. KEYWORDS: peripapillary diverticulum, endoscopic ultrasound, transpapillary interventions endoscopic papillosphincterotomy, biliary hypertension. FOR CITATION: Belozerov V.A., Grigoriev N.N., Prokopov V.A., Belozerova D.E. Endoscopic ultrasound and transpapillary interventions in patients with peripapillary diverticula. Russian Medical Inquiry. 2023;7(5):258–263 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-3.

Endoscopic ultrasonography and transpapillary interventions in the therapeutic and diagnostic algorithm in patients with parapapillary duodenal diverticulum

Endoscopic ultrasonography and transpapillary interventions in the therapeutic and diagnostic algorithm in patients with parapapillary duodenal diverticulum

Steerable catheter based on wire-driven seamless artificial blood vessel tube for endoscopic retrograde transpapillary interventions.

Current steerable catheters (SCs) for endoscopic retrograde cholangiopancreatography (ERCP) have performance limitations caused by an asymmetric multiple-slit tube design with a small maximum bend angle, lesser curvatures, and insufficient durability. We propose a wire-driven SC for balanced bidirectional bending using artificial blood vessel material to overcome these limitations. We assess the SC prototype's steerability using phantom and animal models. The SC prototype employed a slit-less and multiple-lumen seamless tube with a polytetrafluoroethylene (PTFE) body with stretch-retractable porous expanded PTFE at the distal end, and loop-formed control wires. We evaluated the wire routing design using a static model. The bending performance was compared with conventional SCs. Feasibility studies were performed, including major duodenal papilla insertions and ductal branch selections in desktop phantoms and a mini-pig model. The proposed design reduced the wire contact force by 48% compared to the single wire configuration. The maximum bend angle was 162°, almost twofold larger than that for conventional SCs. The lateral tip position in the bent shape was maximally 56% smaller. The tip flexibility was comparable to conventional SCs, and the insertion resistance was similar to the passive catheters. Phantom studies showed that the SC prototype could perform the large and protuberant papilla insertions and fine ductal branch selections without breaking; the animal study was completed successfully. We propose a wire-driven SC design for ERCP using a multi-lumen seamless tube and two loop-formed control wires, different from the conventional SC design with a multiple-slit tube and single control wire. The SC prototype records balanced bidirectional bending with a maximum bending angle of ± 162° without breakage risk. The phantom and animal studies show that the prototype performance potentially facilitates papilla cannulations and intrahepatic ductal branch seeking.

A critical analysis of the ten-year experience of using endoscopic transpapillary interventions in an urgent surgical hospital

The aim of this work was to provide a critical analysis of the ten-year experience of using transpapillary interventions in an urgent surgical hospital with a detailed study of all groups of registered complications.Material and methods. In the period from 2008 to 2018, 1188 retrograde endoscopic transpapillary grafts were performed on the bile ducts with dissection of the major duodenal papilla in a typical and atypical way on the basis of our clinic. The group of observed patients included 1188 patients with endoscopic papillosphincterotomy, including 839 women (70.6%) and 349 men (29.4%). The average age was 63.2 ± 1.25.Results. During the period, 25 complications (2.1%) were revealed when performing transpapillary interventions with dissection of the major duodenal papilla: acute pancreatitis — 10 patients (0.8%); bleeding from the opening of the major duodenal papilla — 4 (0.33%), perforation 12p. intestines — 4 (0.33%), breakage of the basket cable with wedging — 1 (0.08%), cholangitis — 1 (0.08%), overlapping with a stent of the lobar duct — 1 (0.08%). The overall mortality associated with complications is 0.25%. Based on the analyzed material, the iatrogenic index was calculated. It was 0.044. After the analysis of complications, on the basis of the data obtained, we proposed an algorithm of actions when performing transpapillary interventions.Conclusion. Based on the study, we come to the conclusion that it will not be possible to completely level the risk and avoid possible papillotomic-induced complications. In this regard, the early, preferably intraoperative diagnosis of the latter and the prompt implementation of correlating therapeutic measures are of great importance, which will undoubtedly improve the treatment results and have a positive eff ect on the outcome of the disease.

Stenting of the main pancreatic duct in the prevention of acute post-manipulation pancreatitis during endoscopic transpapillary interventions

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценка результатов превентивного стентирования главного протока поджелудочной железы (ГППЖ) у пациентов после эндоскопических транспапиллярных вмешательств в профилактике острого постманипуляционного панкреатита (ОПМП). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В период с 2015 по 2021 г. выполнили 1135 эндоскопических транспапиллярных вмешательств. По поводу доброкачественной патологии (папиллостеноз, холедохолитиаз, аденомы большого сосочка двенадцатиперстной кишки (БС ДПК), стриктуры общего желчного протока) выполнено 879 (77,4%) вмешательств и 256 (22,6%) манипуляций по поводу злокачественных заболеваний панкреатодуоденальной зоны (рак головки поджелудочной железы, БС ДПК, желчного пузыря, метастазов в лимфатические узлы ворот печени). <h3>РЕЗУЛЬТАТЫ</h3> Факторами риска развития ОПМП являются женский пол, молодой возраст, трудности при канюляции БС ДПК, атипичная папиллосфинктеротомия. Доказано, что у пациентов, которым выполнялось превентивное стентирование ГППЖ, риск развития ОПМП уменьшается с 15,9 до 4,3%. <h3>ЗАКЛЮЧЕНИЕ</h3> Превентивное стентирование ГППД как завершающий этап транспапиллярного эндоскопического вмешательства, позволяет достигнуть высокого профилактического эффекта в отношении острого постманипуляционного панкреатита.

Endoscopically non-removable stones of the common bile duct

To evaluate the effectiveness of long-term biliary stenting in the treatment of endoscopically intractable common bile duct stones. The study enrolled 247 patients with endoscopically non-removable bile duct calculi («difficult» choledocholithiasis) divided into two comparable groups. The main group included 129 patients who underwent biliary stenting with original stents with a nanocarbon inert coating (RF patent No. 84226), including those with inclusion of silver nanoclusters (RF patent No. 129397). The control group included 118 patients who underwent all methods of surgical treatment of choledocholithiasis, while biliary stents with original nanocarbon silver-containing inert coating were excluded. The vast majority of patients were women of advanced age (mean 66.8±4.7 and 66.3±5.6, max 89 and 90, min 32 and 37 years, respectively). In the control group, all patients underwent endoscopic transpapillary interventions as soon as possible. We could not extract common bile duct stones via endoscopic approach in 56.8% of cases. These patients underwent open or laparoscopic choledocholithotomy with lithoextraction. Complications occurred in 28.5% of cases. Mortality rate was 4.2%. Standard stenting of common bile duct was performed in 28.8% of cases. At the same time, stent dysfunction followed by relapse of obstructive jaundice occurred in 27.1% of patients within 3-3.5 months. Of these, 16 patients (13.5%) underwent stent removal and lithoextraction. Re-stenting was performed in 18 patients (15.3%). Moreover, shock wave lithotripsy with subsequent removal of common bile duct calculi was performed in 8 (6.8%) of these patients the next day. In the main group, original biliary plastic stents with nanocarbon silver-containing inert coating were implanted in all patients. Under permanent therapy with ursodeoxycholic acid drugs, we observed significant shrinkage of calculi to 11.8±1.8 mm and decrease in their density. This made it possible to carry out successful extraction of calculi in 81 patients (62.8%) after 6±0.3 months. Shock wave lithotripsy was performed in 36 (27.9%) cases. This procedure was successful and allowed final lithoextraction in 28 patients (21.7%). Re-stenting was performed in 15 (11.6%) cases, laparotomy - in 5 (3.9%) patients. Mortality rate was 0.78%. Our data allow us to discuss high efficiency of long-term bile duct stenting with plastic stents with nanocarbon silver-containing inert coating in complex treatment of choledocholithiasis. This approach ensures acceptable incidence of undesirable complications and mortality. This situation undoubtedly dictates the need for further larger prospective studies.

The first assessment of the impact of possible methods for the prevention of pancreatitis in endoscopic transpapillary interventions on the level of amylasemia

The paper is devoted to the assessment of prevention methods of post-ERCP pancreatitis on the analysis of hyperamilasemia in patients with pathology of the pancreatobiliary system, who underwent endoscopic transpapillary interventions.The aim of the study: initial assessment of the impact of possible methods for the prevention of pancreatitis in endoscopic transpapillary interventions on the level of amylasemia.The study is based on a continuous retrospective analysis of 73 case histories of patients undergoing EPST. For analysis, patients were divided into three groups: in the 1st, stenting of the pancreatic duct was performed by plastic stents, in the 2nd group, parapapillary blockade of 0.5% novocaine solution in a volume of 10ml was performed, in the 3rd group the described methods were not used. In the study, in patients with stenting, the development of hyperamilasemia was detected in 22% of cases, with only parapapillary blockade with novocaine solution - in 38% of cases, without the use of the described methods of prevention - in 15%. Amylasemia relief periods were significantly longer with stenting. The study demonstrated the equally low effectiveness of the methods used and the need to continue data analysis of described methods for the prevention of post-ERCP pancreatitis.

Tactics and techniques of choledochal sanation after papillotomy

Сholelithiasis ranks third in terms of the prevalence of diseases among the adult population. A complication such as choledocholithiasis occurs in up to 33% of patients with gallstone disease. Despite the improvement in treatment methods and the use of “gold” standards, the number of complicated forms of cholelithiasis has no tendency to decrease. Timely resolution of choledocholithiasis by a correctly chosen technique helps to reduce complications and increases the frequency of favorable outcomes of the disease, returning patients to social activity.That is why it is important to know and, if possible, to use various methods of rehabilitation of the common bile duct when performing modern endoscopic transpapillary interventions.

PREVENTION OF POST-ERCP PANCREATITIS IN HIGH-RISK PATIENTS

Aim. To study the efficacy of thoracic epidural analgesia (TEA) for the prevention of post-ERCP pancreatitis in high-risk patients. Materials and methods. A parallel, blinded, randomized study. The first (TEA group) group included patients (n = 98) in whom thoracic epidural analgesia was used during endoscopic transpapillary interventions (ETI), the second (OAI group) group included patients (n = 97) in whom opioid analgesics and indomethacin (per rectum). Results. The study showed that acute pancreatitis was diagnosed significantly less frequently in patients with the TEA group than in patients with the OAI group (p = 0.0135). If in the TEA group post-ERCP pancreatitis (PEP) was verified in 3.1% (3/98) patients, in the OAI group — in 12.4% (12/97) patients. When TEA was used in high risk patients of developing post-ERCP pancreatitis, its incidence decreased from 23.3% (10/43) to 4.4% (2/46) observations (p = 0.0095). Conclusion. The use of TEA is an effective and justified method of prevention in patients at high risk of developing post-ERCP pancreatitis. In patients with a low risk of developing this complication, the use of TEA is inappropriate due to the invasiveness of the method.

Minimally invasive endoscopic transpapillary interventions in patients with choledocholithiasis

Minimally invasive endoscopic transpapillary interventions in patients with choledocholithiasis

The place of transpapillary endoscopic interventions in complicated acute cholecystitis

Objective . To determine the need and role of transpapillary endoscopic interventions in acute cholecystitis complicated by the main bile ducts pathology based on refined diagnostics using modern radiology examination methods. Materials and methods . The experience of treatment of 1137 patients operated on for acute cholecystitis during the last three years was analyzed. A differentiated approach for the use of highly informative methods of radiology diagnostics was based on clinical, anamnestic, laboratory and ultrasound data. In the selected groups of increased risk of bile duct pathology, endoscopic ultrasonography and magnetic resonance cholapgiopancreatography were used to clarify the diagnosis. The need for these studies was substantiated in 23.4% of cases. Based on the data obtained, indications for minimally invasive interventions aimed at decompression and correction of pathological changes in the biliary tract were formulated. They were performed in 182 (16%) patients, mainly by the endoscopic transpapillary route. Results. The need for a detailed assessment of clinical, laboratory, and ultrasound data is shown, indicating a possible biliary tract pathology and justifying the use of high-tech methods of radiology diagnosis. The options of decompression interventions, their rational sequence and combinations in acute cholecystitis complicated by bile ducts pathology are considered. Attention is focused on the need for careful monitoring of the effectiveness of interventions with a view to timely correction. Using the proposed diagnostic and treatment algorithm, the mortality rate was 0.26%. Conclusion . In acute cholecystitis, a detailed assessment of clinical, laboratory, and ultrasound data allows us to identify the “alarming” symptoms of a possible bile ducts pathology. These patients require an in-depth assessment of the state of the biliary tract using high-tech non-invasive diagnostic methods — endoscopic ultrasonography or magnetic resonance cholangiopancreatography. The detected changes (choledocholithiasis, stenosis of large papilla of the duodenum) should be eliminated by endoscopic transpapillary interventions as the first stage of treatment before removal of the gallbladder.

ROLE OF TRANSDERMAL AND ENDOSCOPIC TECHNIQUES IN THE TREATMENT OF PATIENTS WITH GALLSTONE DISEASE AND ITS COMPLICATIONS

Summary. In recent years, along with the steady growth of patients with gall-stone disease (cholelithiasis), the growth of its complicated forms is also noted. Most of these patients are elderly and senile people with various concomitant diseases. They constitute the so-called risk group.&#x0D; Materials and methods. The present work is based on an analysis of the results of surgical treatment of 320 patients with complicated forms of cholelithiasis for the period from 2015 to 2020, who were treated at the surgical department of the Department of Surgery KNP «OOKMT» OOR Department of Surgery No. 2 of ONMedU.&#x0D; Results. LCE was performed in 133 (67.2 %) patients, MLCE was performed in 39 (19.7 %) patients, and TCE was performed in 26 (13.1 %) patients. A phased method of surgical treatment was used in 70 (35.4 %) patients with acute cholecystitis with concomitant cardiopulmonary pathology. In 52 patients with choledocholithiasis and obstructive jaundice, in whom it was not possible to eliminate choledocholithiasis using endoscopic transpapillary interventions after external drainage of the bile ducts and resolution of jaundice, the second stage was performed cholecystectomy with correction of the pathology of extrahepatic bile ducts.&#x0D; Conclusions. Realized tactics of stage treatment in patients with concomitant pathology of cardiovascular pathology, as well as the widespread use of minimally invasive technologies, have reduced mortality and the incidence of postoperative complications in patients with concomitant cardiopulmonary pathology.

GALLBLADDER WALL CONDITION IN THE LONG-TERM AFTER ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

The aim of research. Study changes in the gallbladder wall in the long-term (more than 7days) after endoscopic transpapillary interventions on the common bile duct.Material and methods. Preparations of the 29 gallbladder wall, operatively removedmore than 7 days after endoscopic transpapillary interventions on the common bile ductwere painted with hematoxylin-eosin and pyrofuksin by Van Gison, the thickness ofmechanically strong structures (muscle layers, collagen) and mechanically weakstructures (intermediate edema, areas of necrosis, areas of leukocyte infiltration) of thegallbladder wall.Results. In terms more than 7 days after endoscopic transpapillary surgical interventionthe following types of changes in the gallbladder wall: "infiltrative sclerotic" and"restorative" were revealed. Basically, collagen structures and leukocyte infiltration havebeen detected in the period from 7 to 18 days following endoscopic transpapillaryintervention on the common bile duct in the gallbladder wall and distant surroundingtissues on the serous membrane side, that indicates strong adhesions with surroundingstructures against a background of pronounced inflammatory response in the area of thecystic duct and cystic artery ("infiltrative sclerotic" type). After 18 days followingendoscopic transpapillary interventions on the common bile duct signs of restoration ofthe structure of the gall bladder wall ("restorative" type of changes in the wall of the gallbladder) are observed.Conclusions. Standard therapy in preparation for the second stage of surgical treatmentof acute cholangitis in some cases does not restore the gallbladder wall and its strength,which is associated with varying degrees of inflammation, necrosis, atrophy, sclerosis ofthe gallbladder wall after endoscopic transpapillary intervention, as well as individualboth regenerative and immune capabilities. Changes in the gallbladder wall can bedescribed as changes in the "infiltrative sclerotic" and "restorative" types.

Problematic issues of endoscopic biliary stenting

Objective. To study the results of endoscopic biliary stenting (EBS) for biliary obstruction of various genesis to determine the problematic issues of the procedure and possibility of its efficacy raising.&#x0D; Materials and methods. Experience of conduction of 5748 endoscopic transpapillary interventions in 2010 - 2017 yrs was analyzed: endoscopic papillosphincterotomy was performed in 2919 (50.8%) observations, stenting of biliary ducts - in 379 (6.6%). In 296 (78.1%) observations plastic stents (PS) were introduced, while in 83 (21.9%) – the self-expanding metallic stents.&#x0D; Results. Of 208 patients, in whom primary temporary EBS was performed for tumoral biliary obstruction, using PS, in 153 (73.6%) the next stage of treatment have constituted elective operation in 10 - 14 days after elimination of hyperbilirubinemia, signs of cholangitis, additional examination and determination of the intervention volume. Among these patients in 56 (36.6%) radical operations were performed, and in 97 (63.4%) – palliative operations. In 47 patients PS for closure of external biliary fistula (EBS) PS was introduced: in 13 (27.7%) – for tubular stenosis of distal part of common biliary duct, in 7 (14.9%) – for insufficiency of sutures of common biliary duct (after choledocholithotomy), in 14 (29.8%) – for intraoperative damages of extrahepatic biliary ducts, in 5 (10.6%) – for presence of Luschka channels, in 8 (17.0%) – for a state after hepatic resection, echinococectomy. Presence of concrements, which due to some reasons were not removed endocopically, in environment of purulent cholangitis have constituted the indication for performance of EBS in 24 (8.1%) observations, chronic pancreatitis, complicated by obturation jaundice – in 9 (3.0%). Correction of iatrogenic damages of biliary ducts with development of their partial strictures, EBF, using EBS with introduction of PS, were performed in 8 (2.7%) patients.&#x0D; Conclusion. The necessity exists to study the treatment results in patients, suffering biliary obstruction of various genesis, to determine problematic issues of the main procedures and possibilities of their efficacy raising.

Current approaches to the treatment of complications of endoscopic transpapillary interventions

Objective. Retrospective analysis of the treatment of complications after endoscopic retrograde transpapillary interventions. Material and methods. There were 5701 endoscopic retrograde interventions for the period from 01.01.2008 to 01.01.2019. Overall incidence of complications was 1.5%, mortality rate – 0.24%. Bleeding after endoscopic papillosphincterotomy developed in 13 (0.22%) cases, acute postoperative pancreatitis in 49 (10.85%) cases, ERCPassociated perforation in 24 (0.42%) patients. Results. Endoscopic approach (epinephrine injection into the edges of major duodenal papilla and cautery) was usually effective for bleeding after endoscopic retrograde cholangiopancreatography. Massive intraoperative bleeding required surgical treatment in one case with favorable outcome. There were no cases of recurrent bleeding. One patient died due to severe bleeding in 3 days after surgery. ERСP-associated (“retroduodenal”) perforation occurred in 24 (0.42%) patients. Endoscopic treatment was undertaken in 16 cases and was effective in 15 (93.75%) cases. Overall mortality among patients with ERCP-induced perforation was 20.8%. An attempt of pancreatic duct stenting for postoperative pancreatitis was made in 30 cases; successful procedure was in 28 (93.3%) cases. Surgery resulted recovery in 26 (86.7%) patients. Progression of acute postoperative pancreatitis followed by death occurred in 2 cases despite successful pancreatic duct stenting. Mortality rate was 25%. Conclusion. Treatment of ERCP-associated complication is lengthy, time-consuming and expensive. Timely diagnosis and assessment of severity of complications is essential. It is necessary to determine an adequate surgical approach. Everyone should keep in mind all possible risk factors, clearly define the indications for ERCP and follow the technique of the procedure strictly in order to reduce complication rate. In our opinion, endoscopic approach is advisable for post-ERCP complications, because conventional surgery results higher postoperative mortality, increased duration and cost of treatment.