OBJECTIVE
Improving the results of diagnosis and treatment of patients with benign obstructive pathology of the distal common bile duct in combination with a parapapillary diverticulum, including by identifying criteria for a direct compressive effect from the diverticulum on the wall of the common bile duct, which can be effectively eliminated by transpapillary intervention.
MATERIAL AND METHODS
The study included 285 patients with diverticula of the papillary zone treated at the Kursk State Clinical Hospital from 2015 to 2022. Based on the data of endoscopic ultrasonography using the methodology of synthesis of hybrid fuzzy decision rules based on hybrid artificial intelligence, a set of criteria indicating the compressive effect of the diverticulum on the terminal part of the common bile duct was formed. Based on them, a group of 47 patients was identified who had indications for endoscopic papillosphincterotomy.
RESULTS
In 47 patients of this group and in 142 patients with a combination of parapapillary diverticulum and benign obstruction of the terminal choledochus, transpapillary interventions were performed, which were successful in 174 (92.0%) cases. In 31 patients, due to the ineffectiveness of retrograde interventions, minimally invasive treatment was implemented using rendezvous technologies. In 83.3% of patients with diverticular compression of the terminal choledochus after papillosphincterotomy, regression of clinical, laboratory and instrumental signs of impaired bile flow was noted. The condition for the effectiveness of endoscopic papillosphincterotomy was a clear visualization of the longitudinal fold in the diverticulum and the possibility of performing an incision with a length of at least 2/3 of its length. The proportion of complications of transpapillary interventions in patients with parapapillary diverticula was 3.4%, which is lower than the frequency presented in the literature.
CONCLUSION
The combination of endoscopic ultrasonography with hybrid artificial intelligence technologies made it possible to reliably diagnose diverticulum compression on the terminal choledochus and optimize indications for transpapillary interventions.
