Evaluation of the effectiveness, causes of failures and complications of complex minimally invasive treatment of «complex» choledocholithiasis

Zakharova Ja.S.; Budzinskiy S.A.; Tashkinov N.V.; Shapovaliants S.G.; Kosenko P.M.; Murashkina M.V.; Fedorov E.D.

doi:https://doi.org/10.17116/endoskop20263201135

Zakharova Ja.S.

Professor Voino-Yasenetsky Municipal Clinical Hospital;
Far Eastern State Medical University

ORCID: 0000-0003-0571-2501

Budzinskiy S.A.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-4255-0783

Tashkinov N.V.

Far Eastern State Medical University

ORCID: 0000-0001-7473-1250

Shapovaliants S.G.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-0629-3871

Kosenko P.M.

Far Eastern State Medical University

ORCID: 0000-0002-6014-7149

Murashkina M.V.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-1327-8912

Fedorov E.D.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

Evaluation of the effectiveness, causes of failures and complications of complex minimally invasive treatment of «complex» choledocholithiasis

Authors:

Zakharova Ja.S., Budzinskiy S.A., Tashkinov N.V., Shapovaliants S.G., Kosenko P.M., Murashkina M.V., Fedorov E.D.

More about the authors

Journal: Endoscopic Surgery. 2026;32(1): 35‑44

DOI: 10.17116/endoskop20263201135

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To cite this article:

Zakharova JaS, Budzinskiy SA, Tashkinov NV, Shapovaliants SG, Kosenko PM, Murashkina MV, Fedorov ED. Evaluation of the effectiveness, causes of failures and complications of complex minimally invasive treatment of «complex» choledocholithiasis. Endoscopic Surgery. 2026;32(1):35‑44. (In Russ.)
https://doi.org/10.17116/endoskop20263201135

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

Использование инфографики авторами научных работ

OBJECTIVE

The aim of the study was to improve treatment outcomes for patients with “complex” choledocholithiasis through the combined use of modern minimally invasive methods and to develop an algorithm for their clinical application.

MATERIAL AND METHODS

A retrospective analysis of minimally invasive treatment in 245 patients with “complex” choledocholithiasis was performed.

The study group consisted of 187 patients: 150 underwent endoscopic papillary large balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) with subsequent stone extraction; 20 underwent intraductal lithotripsy; 17 underwent extracorporeal shock wave lithotripsy (ESWL). The control group consisted of 58 patients treated solely with standard endoscopic mechanical lithotripsy (ML).

RESULTS

The success rate of the combined approach in the study group was 91.5%. The use of new technical approaches significantly reduced postoperative complications to 3.2%. The rate of surgical interventions required due to the failure of minimally invasive methods was 8.0%, which was statistically significantly (p<0.05) lower than in the control group treated with mechanical lithotripsy alone (8.6% and 13.8%, respectively). Based on these results, a modern algorithm for the combined use of minimally invasive approaches in treating “complex” choledocholithiasis was developed.

CONCLUSION

The proposed integrated approach, based on a sequence of EPLBD with limited EST, intraductal lithotripsy, ESWL, and ML, improves the efficacy of minimally invasive interventions, decreases postoperative complications, and reduces the need for open surgery in patients with “complex” choledocholithiasis.

Keywords:

“complex” choledocholithiasis

stone extraction

endoscopic papillary large balloon dilation (EPLBD)

cholangioscopy

intraductal lithotripsy

extracorporeal shock wave lithotripsy

Authors:

Zakharova Ja.S.

Professor Voino-Yasenetsky Municipal Clinical Hospital;
Far Eastern State Medical University

ORCID: 0000-0003-0571-2501

Budzinskiy S.A.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-4255-0783

Tashkinov N.V.

Far Eastern State Medical University

ORCID: 0000-0001-7473-1250

Shapovaliants S.G.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

ORCID: 0000-0003-0629-3871

Kosenko P.M.

Far Eastern State Medical University

ORCID: 0000-0002-6014-7149

Murashkina M.V.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-1327-8912

Fedorov E.D.

Akademic Savelyeva City Clinical Hospital No.31;
Pirogov Russian National Research Medical University

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

Received:

29.01.2025

Accepted:

24.03.2025

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