Endoscopic Transpapillary Interventions Research Articles

Retrograde minimally invasive technologies in the treatment of obstructive jaundice syndrome

Approaches and results of endoscopic transpapillary procedures in the treatment of patients with obstructive jaundice of various origins are analyzed. Modern trends in the development of endobiliary surgery and recommendations devoted to various endoscopic techniques and methods of biliary decompression depending on etiology and severity of obstructive jaundice, management of patients and dates of interventions are described. Leading specialized centers are characterized by quite high effectiveness of endoscopic transpapillary interventions in patients with cholelithiasis complicated by obstructive jaundice (95.2–97.5%), benign biliary strictures (63.7–92.8%) and biliopancreatoduodenal malignancies (70–96.8%). Analysis of modern tactical and technical approaches and international guidelines for transpapillary interventions allowed us to determine the current capabilities of retrograde minimally invasive curative technologies, systematize and optimize the basic algorithms for endoscopic care in patients with obstructive jaundice, and outline the prospects for the introduction and improvement of the effectiveness of new techniques.

Surgical Treatment for Septic Complications in Patients with Duodenal Perforation Following Endoscopic Retrograde Transpapillary Interventions

Background The most severe clinical cases following transpapillary endoscopic interventions are duodenal perforation with damage to the common bile duct and pancreatic duct, entrance into the abdominal cavity and retroperitoneum the aggressive contents of intestine and the infections. They usually lead to higher mortality. Aim Evaluation of the optimal management for duodenal perforation in patients who have undergone transpapillary endoscopic interventions. Material and Methods A retrospective analysis of surgical treatment in thirty-two patients with duodenal perforation after transpapillary endoscopic interventions from the year 2007 to 2018 in one center was carried out. Nineteen cases (59.4%) were diagnosed less than 24 hours, 13 (40.6%) – more than 24 hours after injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of injury area. In 19 cases there were a two-stage surgical procedure according the original method: 12 had a primary surgery, 7 were reoperated. Results After primary reconstruction of duodenum 11 patients (55.0%) had complications, seven (63.6%) – were re-operated, in four we have applied efferent treatments and symptomatic therapy. Three patients (15.8%) died. After two-stage surgery procedure 7 patients (36.8%) had surgical complications, five (26.3%) – were re-operated. Three patients (15.8%) – were died. Conclusion Primary duodenum reconstruction can be performed if the injury occurred less than 24 hours before surgery. Two-staged surgery is justified in cases with purulent inflammation in abdominum and reproperitoneal cavity because procedure allows reducing mortality from abdominal sepsis

The Comparative Analysis of the Effectiveness of Endoscopic Transpapillary Interventions (Literature Review)

This article presents a comparative analysis of the effectiveness of endoscopic transpapillary management in patients with choledocholithiasis. The minimal complications are achieved using classical endoscopic papillosphincterotomy. However, in some cases, cannulation can be extremely difficult (stenosis, tumor of the major duodenal papilla, the anatomical features of the major duodenal papilla) or even impossible (wedged stone), and the introduction of a guidewire into the pancreatic duct significantly increases the risk of developing postoperative pancreatitis. The desire to increase the success when performing endoscopic papillosphincterotomy with diagnostic purpose (to perform endoscopic retrograde cholangiopancreatography after failure of traditional cannulation) and for the purpose of performing transpapillary operations has naturally led to the development of new non-standard methods of endoscopic papillotomy, the introduction of new instruments – wire guides and guided cannulas. Further increase in the frequency of successful endoscopic papillotomy can be facilitated by using atypical methods of surgery. Some authors show that classical papillosphincterotomy is comparable to the method of endoscopic papillosphincterotomy with balloon dilatation in effectiveness of extracting stones from the common bile duct. However, balloon dilatation in the extraction of choledocholithiasis is preferable due to fewer postoperative complications.The authors of this article note that endoscopic management do not always solve the problem of choledocholithiasis, but still have undeniable advantages compared with the laparotomy, in which choledocholithotomy sometimes has to be expanded, and duodenotomy with transduodenal papillosphincterotomy is conducted. Literature shows that main mortality causes after endoscopic interventions in patients with choledocholithiasis were progression of purulent cholangitis, biliary sepsis, acute postoperative pancreatitis, “discharge” syndrome.

Safety and Efficacy of a Small J-Tipped Guidewire for Pancreatic Duct Endoscopic Intervention.

Background and Aims The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention. Methods This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW. Results The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22–0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30–0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61–8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09–0.85, P = 0.02). Conclusions Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.

Treatment of acute cholangitis caused by benign processes in the major duodenal papilla

Objective: to improve the surgical treatment of acute cholangitis caused by benign tumors in the area of the major duodenal papilla.Material and methods. Analysis of the surgical treatment of 83 patients with acute cholangitis arising from benign diseases in the area of the major duodenal papilla was made. Among them, there were 49 men and 34 women. The average age of patients was 49.7 ± 6.9 years. According to the nosological forms, it looked as follows: papillary stenosis — 51, adenomas of the major duodenal papilla — 13, parapapillary duodenal polyps — 12, diverticulum of the duodenum in the area of the major duodenal papilla — 5, peptic duodenal ulcer — 2.Results. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla, parapapillary polyps was eliminated using endoscopic transduodenal techniques with the removal of the immediate cause of acute cholangitis. For this used endoscopic papillo-sphincterotomy, endoscopic mechanical lithotripsy, lithoextraction, electroexcision of polyps and adenomas. Among 83 patients, 19 (22,9%) patients had to perform 2 or more endoscopic transpapillary interventions. The greatest difficulties were in the cannulation of the major duodenal papilla in patients with parapapillary ulcers and duodenal diverticulum. Two patients underwent laparoscopic and two patients underwent open surgical interventions. Among 83 patients treated with acute cholangitis on the background of benign pathology of the major duodenal papilla, 11 (13,3%) had different complications. Conclusions. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla and parapapillary polyps with concomitant choledocholithiasis can be completely treated exclusively with endoscopic interventions (if necessary — multiple) with a small number of complications (13,3%). Treatment of acute cholangitis on the background of parapapillary ulcers and duodenal diverticulum in most cases requires the use not only endoscopic transduodenal techniques, but also the use of laparoscopic biliary and open resection surgical interventions.

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.

Various endoscopic transpapilary interventions for choledocholithiasis

To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial. There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy. The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2. Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.

METHODS OF MINIMALLY INVASIVE DECOMPRESSION OF THE BILIARY TRACT WITH MECHANICAL JAUNDICE

OBJECTIVE. The aim of the study is to improve the results of treatment of patients with mechanical jaundice. MATERIAL AND METHODS. The results of treatment of 350 patients with mechanical jaundice of benign genesis were analyzed. The causes of this disease in 230 (68.6 %) cases were choledocholithiasis, in 75 (21.4 %) cases were cicatrical narrowing of the large papilla of the duodenum (n = 50), in 45 cases were the formed biliodigestive anastomoses (n=25) and chronic pancreatitis (12.8 %). RESULTS. To eliminate mechanical jaundice, 154 (44 %) patients underwent various percutaneous decompressive echo-controlled interventions under the ultrasound control in terms of their nature and volume. In addition, endoscopic transpapillary interventions were performed in 196 (56 %) observations. various postoperative complications were noted after performing percutaneous decompressive echo-control interventions under ultrasound in 14 (4 %) observations, and after endoscopic transpapillary interventions in 21 (6 %) cases. CONCLUSION. Minimally invasive endoscopic and echo-controlled interventions as the first stage of surgical treatment are effective methods of treatment of patients with mechanical jaundice.

RETROGRADE ENDOSCOPIC INTERVENTIONS IN OBSTRUCTIVE JAUNDICE MANAGEMENT

Aim. To determine the effectiveness of endoscopic transpapillary techniques in diagnosis and treatment of patients with obstructive jaundice of various origin. Materials and Methods. We analyzed the effectiveness of endoscopic diagnosis and treatment of patients with obstructive jaundice for the period 2008–2012. The total number of patients was 900. Patients with mechanical obstacle for bile outflow and bilirubin level over 20 mmol/l were included. We used retrograde cholangiopancreatography (ERCP), endoscopic papillotomy (EPT), endoscopic mechanical lithotripsy and lithoextraction (EMLE, EMLT), nasobiliary drainage (NBD), probing and stenting of bile ducts, endoscopic contact electrohydraulic lithotripsy, balloon dilatation of the common bile duct. Results. Interventions were effective in 874 patients (97.11%). Complications occurred in 31 patients (3.44%). Mortality was absent. Conclusion. Endoscopic transpapillary interventions are highly effective in patients with obstructive jaundice. Instrumental hardware equipment and complex application have a great importance in this case.

Endoscopic transpapillary interventions in treatment of patients with biliary hypertension of various genesis

OBJECTIVE. The study determined the efficacy of endoscopic transpapillary methods in diagnostics and treatment of patients with obstructive jaundice of different etiology. MATERIAL AND METHODS. The efficacy of endoscopic methods of diagnostics and treatment was analyzed in 1508 patients with obstructive jaundice (obstruction of bile outflow and increased bilirubin level more than 20 mkmol/l) at the period from 2008 to 2015. There was applied all possible methods of diagnostic and treatment endoscopic transpapillar interventions. RESULTS. The surgeries were efficient in 1463 (97,02 %) patients and they were ineffective in 45 (2,98 %) patients. There weren’t any lethal outcomes. CONCLUSIONS. The application of endoscopic interventions is a compulsory condition of the work of gastroenterological center.

PREVENTION OF ACUTE PANCREATITIS DURING ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

Aim. To identify the major risk factors of acute postoperative pancreatitis, to determine optimal volume of drug prevention, to study the possibility of intravenous administration of octreotide 600 mcg/ml in transpapillary endoscopic interventions. Material and Methods. In group I (72 patients) prevention of acute post-manipulation pancreatitis prior to endoscopic transpapillary interventions included intravenous administration of octreotide 600 mcg diluted in 60 ml 0.9% sodium chloride solution (NaCl). On the day of endoscopic intervention octreotide was administered fractionally 200 mcg 3 times per day. In group II (78 patients) acute pancreatitis was prevented by subcutaneous injection of octreotide 100 mcg before endoscopic intervention and subsequent 3-fold subcutaneous injection of 100 mcg on the day of surgery. Results. Risk factors of acute pancreatitis are young age, difficult cannulation of major duodenal papilla, atypical papillosphincterotomy, contrast injection into pancreatic duct. It is proved that intravenous administration of octreotide 600 mcg/ml reduces the risk of acute pancreatitis and transient hyperamylasemia from 16.7% and 19.2% to 11.1% and 16.7% respectively compared with conventional subcutaneous injection (100 mcg). Thus, it reduces the duration ( p &lt; 0.016) and severity of hyperamylasemia (p &lt; 0.005). Conclusion. Intravenous administration of octreotide 600 mcg/day is more effective and convenient compared with conventional scheme to prevent acute postmanipulation pancreatitis.

Темп декомпресії жовчних шляхів після ендоскопічного транспапілярного втручання у хворих з обтураційною жовтяницею на ґрунті холедохолітіазу (повідомлення 1)

У роботі представлено динаміку біохімічних показників цитолізу та холестазу у 59 хворих на обтураційну жовтяницю, зумовлену холедохолітіазом із різним рівнем білірубіну, на 1–3 та 4–6 добу після транспапілярної ендоскопічної біліарної декомпресії. Темп відповіді жовтяниці на декомпресію визначали за формулою T. Shmizu і K. Yoshida в модифікації Э. И. Гальперина. Встановлено, що у пацієнтів з обтураційною жовтяницею і рівнем гіпербілірубінемії до 100 мкмоль/л і від 100 до 200 мкмоль/л транспапілярна ендоскопічна біліарна декомпресія супроводжується затяжним і помірним темпом відповіді жовтяниці на декомпресію. У хворих із рівнем гіпербілірубінемії &gt;200 мкмоль/л встановлено трансформацію затяжного темпу декомпресії в швидкий темп на 4–6 добу після декомпресії, що може призвести до розвитку синдрому “швидкої декомпресії”.

LONG-TERM RESULTS OF ENDOSCOPIC TRANSPAPILLARY TREATMENT OF POSTOPERATIVE BILIARY STRICTURES

Aim. To evaluate treatment options and long-term results of endoscopic transpapillary interventions for postoperative biliary strictures. Material and Methods. 83 patients with postoperative biliary strictures underwent endoscopic transpapillary interventions. In all cases strictures were caused by iatrogenic injury of the bile ducts. Strictures type «0» were in 18 (21.7%) cases, «+1» in 37 (44.6%) cases, «+2» in 25 patients (30.1%), «–1» in 3 cases. Results. Endoscopic repair of strictures was performed in 64 cases (77.1%) and became final treatment in all of them. Endoscopic management lasted from 8 to 46 months. Time between repeat stenting was 3–4 months. Deployment of two stents was performed in 29 (45.3%) patients, 3 stents – in 9 (14.1%) patients, 4 and 5 stents in 2 and 1 patients, respectively. In 19 (22.9%) out of 83 patients retrograde stenting was failed: in 13 (62%) of 21 patients with strictures type «−1» and «0» and in 6 (9.7%) of 62 patients with strictures type «+1» and «+2», p < 0.01. 16 of 19 patients were further operated. Long-term results were followed-up in 49 (76.5%) patients for the period from 1 to 20 years including 3 patients with strictures «−1» and «0» and 46 patients with strictures type «+1» and «+2». Good, satisfactory and unsatisfactory long-term results were obtained in 42 (85.7%), 4 (8.2%) and 3 (6.1%) patients, respectively. Conclusion. Endoscopic transpapillary repair of postoperative biliary strictures is technically feasible and provides stable positive result in more than 90% of patients with strictures type «+1» and «+2». Technical possibility and positive results of stenting were achieved in 33% of stricture type «−1» and in 39% of type «0». Unsatisfactory long-term results were observed in 6% of patients and were associated with high extent type of stricture.

Міні-інвазивні транспапілярні втручання в ургентній аб-домінальній хірургії

Вивчено результати ендоскопічного лікування 2305 хворих з холедохолітіазом та іктерогенними пухлинами періампулярної зони, що перебували на лікуванні у відділі лапароскопічної хірургії та холелітіазу з 2010 до 2016 р. З них малоінвазивні транспапілярні втручання при холедохолітіазі виконано у 1690 хворих, при періампулярних пухлинах – у 615 пацієнтів. Ускладнення після ендоскопічних втручань з приводу холедохолітіазу виникли у 7,5 % хворих, при періампулярних пухлинах – у 11,7 % пацієнтів. Усі транспапілярні втручання виконували в ургентному порядку з метою ліквідації явищ гнійного холангіту та обтураційної жовтяниці.

Endoscopic palliation of unresectable periampullary tumors

Aims: Distal malignant biliary obstruction may be caused by various neoplasms, such as pancreatic cancer, ampullary tumors and cholangio-carcinoma. The endoscopic approach is more cost-effective than the operative approach. The use of plastic stents is nowadays recommended in patients with poor prognosis (less than 5–6 months). Initial endoscopic placement of a metal stent is a cost-saving strategy only in patients expected to survive longer than six months. Methods: Over a 6 - year period, from 2009 to 2014, a total of 458 endoscopic transpapillary interventions were analyzed. Results: 235 patients (51,3%) were treated for pancreatic head tumor, 122 patients (26,6%) - for papilla of Vater tumor, and 101 (22,1%) - due to distal cholangiocarcinoma. 32 patients (7.0%) had endoscopic treatment failure.Plastic prostheses were inserted in 218 (51.2%) patients, self-expanding metal prostheses - in 96 patients (22.5%), suprapapillary choledochoduodenostomy - in 112 (26,3%) cases. 38 (9%) patients had following complications of endoscopic treatment: bleeding into the digestive tract - 15 cases (3,5%), acute pancreatitis -6 cases (1,4%), bile duct perforation - 1 case (0,2%), stent migration - 7 (1.6%), early stent obstruction - 10 (2.3%) cases. All cases of pancreatitis were treated successfully with conservative therapy. 13 cases of bleeding stopped after endoscopic hemostasis, 2 - after endovascular embolization. In cases of early clogging of the prostheses and stent migration we performed an urgent stent replacement. The 30-day mortality rate was 0.7%, as a result of fatal septic conditions in three patients. Stent occlusion occurred after a mean of 285 days for the metal stent group vs 82 days for the plastic stent group. Conclusions: Endoscopic stent insertion is the modality of choice. It provides effective palliation and may offer lower morbidity and mortality, shorter hospital stay, and diminished overall cost compared with surgical or radiological approaches.

Ways to prevent complications in endoscopic transpapillary interventions

Aim. To assess the effectiveness of preventive measures in endoscopic interventions on the major duodenal papilla.Methods. 1028 transpapillary interventions related to benign and malignant diseases were performed on 575 patients from 2007 to 2015. The analysis of complications rate and structure in different time intervals, taking into account the changing of patients management tactics and the use of different preventive technologies, was performed.Results. During 2007-2015, 30 cases of post-manipulational complications were registered (2.9% of patients) with a mortality rate of 0.09%. In the period from 2007 to 2008 post-manipulational complications rate was 8.5%. The main causes of complications were surgery long duration (up to 2 hours) and the lack of endoscopist experience. During this period, there was only one death, which was caused by acute cardiovascular insufficiency. From 2009 to 2011, the complications number decreased to 3.4% due to the careful patients selection for elective surgery, including the endosonography in diagnostic algorithm, octreotide, and hyoscine butylbromide use, the expansion of indications for the bile ducts stenting, exclusion the main pancreatic duct contrast, nasobiliary drainage in obstructive jaundice and suppurative cholangitis. In the period from 2012 to 2015, in the presence of a high risk of post-manipulational pancreatitis, every fifth intervention was completed by the main pancreatic duct stent placement with reducing of manipulations duration to 25-35 minutes, and increasing the surgery phases number. During this period, post-manipulational complications rate was 1.2%.Conclusion. Analysis of post-manipulational complications allowed to identify the most important measures to enhance the transpapillary interventions safety, thereby reducing the number of complications from 8.5% in the period of 2007-2008, to 1.2% in the period of 2014-2015.

Endoscopic interventions in diagnosis and treatment of Mirizzi syndrome

To define the role of endoscopic interventions in diagnosis and treatment of Mirizzi syndrome. Results of treatment of 41 patients with Mirizzi syndrome are presented. Endoscopic transpapillary interventions including cholangiography, papillosphincterotomy lithoextraction, nazobiliary drainage were used as a first step in all cases. In 4 cases laparoscopic cholecystectomy was performed after biliary tree sanitation. In 6 advanced age patients with severe comorbidities common bile duct stenting alone was preferred. Open interventions were performed in 15 patients (36.6%) including cholecystectomy, choledocholithotomy with common bile duct drainage. It is shown that endoscopic transpapillary methods of diagnosis and treatment of Mirizzi syndrome provides adequate decompression and sanitation of the bile ducts in most cases and significantly reduces number of open surgical procedures.

On the issue of the «difficult cannulation» of the ampulla of Vater (Evaluation of efficacy of endoscopic transpapillary interventions in patients with difficult cannulation of the ampulla of Vater. Gabriel S.A., Dynko V.Yu., Golfand V.V., Zobenko V.Ya.)

On the issue of the «difficult cannulation» of the ampulla of Vater (Evaluation of efficacy of endoscopic transpapillary interventions in patients with difficult cannulation of the ampulla of Vater. Gabriel S.A., Dynko V.Yu., Golfand V.V., Zobenko V.Ya.)

BIOMECHANICAL MODELING OF CHOLEDOCH BILE FLOW IN CHOLEDOCHOLITHIASIS IN THE PROJECT “VIRTUAL PHYSIOLOGICAL HUMAN”

Aim. To ground the role of biomechanics in development of the model of biliary system within the norm and pathology in the frame of the project “Virtual Physiological Human”. The model will be based on the methods of computational biomechanics using anatomical, experimental, physiological data of hepatopancreatoduodenal (HPD) organs obtained by means of radial diagnostic methods determining the unique anatomy of a patient. Mathematical solution of the task of bile flow in the common bile duct in case of chloledocholithiasis is presented as an initial stage in realization of dynamic modeling of bile flow in the anhepatic bile-excreting tracts. Materials and methods. The problem was posed and the mathematical model of bile flow in the choledoch with concretion in its acute blockade was developed. The model is based on solution of the Navier-Stokes equation recorded for non-newton fluid (Casson fluid) in special conditions. Results. Flow rate profiles, dependence of duct lumen bile flow on time and concretion size as well as dependence of biliary pressure on choledoch and concretion diameter are presented in the paper. Conclusions. The worked out mathematical model permits to estimate dynamics of the postoperative period and to predict the development of specific complications based on changes in the values of choledoch biliary pressure from the side of HPD organs. Moreover, estimation of biliary pressure in the duct is objective for determination of biliary decompression efficiency during endoscopic transpapillary interventions on the large duodenal papilla when the pressure is high and the bile excretion volume is less than 35 % of the proposed standard.

Endoscopic transpapillary interventions in diagnostics and treatment of patients with diseases of the pancreatobiliary area

It was performed analysis of efficiency of endoscopic retrograde transpapillary interventions in diagnostics and treatment of 1513 patients with diseases of the pancreatobiliary area for the period 2008--2012. About half of patients had choledocholithiasis. There were tumors in 9.5% of patients. Associated diseases confirmed or first identified during transpapillary intervention (stricture + choledocholithiasis, cancer + choledocholithiasis, etc.) were revealed in 6.8% of patients. We used almost all types of endoscopic transpapillary techniques which are applies for biliary hypertension including retrograde cholangiopancreatography, endoscopic papillotomy, endoscopic mechanical lithoextraction and lithotripsy, nasobiliary drainage, bougienage, balloon dilatation, stenting and endoscopic contact electrohydraulic lithotripsy of calculus of common bile duct. Efficiency of endoscopic transpapillary interventions was 96.5%. Complications were observed in 4.3% of patients. Mortality rate was 0.06%.