ENDOSCOPIC TRANSPAPILLARY TREATMENT OF CHOLEDOCHOLITHIASIS

Aim. To evaluate the results of endoscopic treatment of choledocholithiasis in clinically difficult cases. Material and Methods. We have analyzed treatment of 322 patients with choledocholithiasis. EPT, mechanical lithotripsy, nasobiliary drainage and transpapillary stenting were applied to restore biliary flow-out and sanitation of bile duct. Effectiveness of endoscopic stone removal was compared in 2 groups of patients: group 1 – patients with large stones and normal anatomy of periampullary zone and group 2 – patients with choledocholithiasis and periampullary diverticula, strictures and stenoses of bile ducts. Results. Endoscopic sphincterotomy was performed in 301 (97.4%) patients. In 88 (29.2%) patients with periampullary diverticula stones were removed using standard extractors, in other 213 (70.8%) cases attempts of mechanical lithotripsy were made. The stones were successfully destroyed in 196 (92%) patients. Lithotripsy was not successful in 14 patients of group 1 and 3 patients of group 2. Herewith lithotripsy efficiency was not significantly different in both groups. Complications of endoscopic interventions were observed in 30 (9.9%) patients including 8 cases of bleeding after endoscopic sphincterotomy, 8 – acute pancreatitis, 12 – adverse course of cholangitis and in 2 cases – impaction of lithotripter basket with a captured stone. Incidence of complications in group 1 was 13.5%, in group 2 – 6.1%. There is no mortality in our study. Conclusion. Bile ducts sanitation was successful in 88% of patients. Endoscopic treatment was equally effective in both groups of patients.