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Budzinsky S.A.
Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31
Shapovolyants S.G.
Pirogov Russian National Research Medical University
Fedorov E.D.
Pirogov Russian National Research Medical University of the Russian Ministry of Health
Chernyakevich P.L.
City Clinical Hospital No. 31
Platonova E.N.
City Clinical Hospital No. 31
Plakhov R.V.
Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31
Role of balloon dilation of the graduated endocsopic papillosphincterotomy area in the treatment of patients with «complex» choledocholithiasis
Journal: Endoscopic Surgery. 2020;26(4): 12‑21
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To cite this article:
Budzinsky SA, Shapovolyants SG, Fedorov ED, Zakharova MA, Chernyakevich PL, Platonova EN, Plakhov RV. Role of balloon dilation of the graduated endocsopic papillosphincterotomy area in the treatment of patients with «complex» choledocholithiasis. Endoscopic Surgery.
2020;26(4):12‑21. (In Russ.)
https://doi.org/10.17116/endoskop20202604112
Endoscopic papillosphincterotomy (EPST) followed by lithoextraction (LE) is the gold standard in the treatment of patients with choledocholithiasis (CL). In cases of «complex» CL (the diameter of the calculus is more than 15 mm, the number of calculi is more than 2, non-standard features of the anatomy of the peripapillary area), generally accepted tactics may be unsuccessful. One of the most effective and safe options for the sanation of the biliary tract in patients of this group is an additional balloon dilatation (BD) of the area of previously performed dosed EPST, if necessary combined with intraductal mechanical lithotripsy (MLT).
Demonstration of the results of the DB of dosed area EPST, including in combination with intraductal MLT in patients with «complex» CL.
A retrospective analysis of 192 cases of DB of the EPST area was performed in 187 patients with «complex» CL who underwent treatment at City Clinical Hospital No. 31 from 01.01.13 to 01.07.19. There were 125 women and 62 men. The average age was 70.7±14.5 years. In 147 (76.6%) cases, the indication for intervention was the clinical picture of obstructive jaundice, and in 45 (23.4%) — dilatation of extrahepatic bile ducts without clinical signs of impaired bile outflow. Single (1 or 2) concrements of the biliary tract were found in 125 (65.1%) cases, and multiple CL (3 calculi or more) — in 67 (34.9%). The diameter of the detected concrements of the biliary tract varied from 8 to 45 mm. The complete sanation of the biliary tract, as well as the regression of obstructive jaundice according to physical examination, laboratory tests and instrumental diagnostics, were the sign of successful in performing the intervention.
In all the observations, a BD of the EPST area was carried out with a subsequent attempt to LE. In 114 (59.4%) cases, success was achieved after the initial intervention, in 10 (5.2%) patients for complete sanation of the biliary tract, staged treatment was required. In 63 (32.8%) cases, when the BD of the EFST area was not enough for performing LE, additional MLT was required, which was effective in 61 (96.8%) patients. Complete sanation of the bile ducts was achieved in 47 (74.6%) cases after the initial intervention, in 14 (22.2%) cases after the second intervention. In 5 (2.6%) cases no additional lithotripsy was attempted. In total, when combining the two methods, it was possible to achieve of clinical success in 185 (96.5%) of 192 cases. It was noted that the use of balloons with a larger diameter (12-20 mm) makes it possible to achieve complete sanation of the gall tree more often than when using balloons with a diameter of less than 12 mm (98.6% versus 90%) after the initial procedure. Complications were observed in 6 (3.2%) cases; 1 (0.53%) death was registered.
The method of the BD of the dosed papillosphincterotomy area in combination with mechanical intraductal lithotripsy allows achieving complete bile duct sanation in 96.5% of cases in patients with «complex» CL. At the same time, the use of large-diameter balloons makes it possible to increase the effectiveness of the intervention and to perform a complete sanation in one manipulation with a relatively low frequency of complications and deaths.
Authors:
Budzinsky S.A.
Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31
Shapovolyants S.G.
Pirogov Russian National Research Medical University
Fedorov E.D.
Pirogov Russian National Research Medical University of the Russian Ministry of Health
Chernyakevich P.L.
City Clinical Hospital No. 31
Platonova E.N.
City Clinical Hospital No. 31
Plakhov R.V.
Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31
Received:
27.12.2019
Accepted:
08.04.2020
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