THE ANALYSIS OF REASONS OF FAILURES TRANSPAPILLARY METHODS OF TREATMENT OF OBSTRUCTIVE JAUNDICE OF CANCEROUS GENESIS
Aim of the study. To analyze the reasons of failed transpapillary interventions in malignant obstructive jaundice. Material and methods. Single-center retrospective study of results of treatment of patients with malignant obstructive jaundice, in which an attempt of transpapillary endoscopic decompression (n=433) was done. We analyzed cases of clinical and technical failure (n=89) of endoscopic retrograde cholangiopancreatography (ERCP), demanded antegrade biliary drainage. Results. Analysis of cases of technical failure of endoscopic transpapillary decompression revealed following causes: inability to reach major duodenal papilla (MDP) due to stenosis of the gastric outlet - 10 (11.2%); inability to visualize MDP - 3 (3.4%); unsuccessful cannulation of the common bile duct - 26 (29.2%); high biliary stricture - 20 (22.5%); tumor proliferation in the area of MDP - 10 (11.2%); previously performed Billroth-2 gastrectomy - 5 (5.6%). Clinical failure of transpapillary stenting was detected in 15 (16.9%) patients. Conclusion. Transpapillary intervention in malignant obstructive jaundice had technical success rate 82.9%, with clinical failure in 20.6% of patients. High biliary stricture was significantly more frequent in group of failed ERCP (χ²=47.448, p<0.001) in comparison to the group of successful transpapillary decompression (n=8; 5.2%). Frequency of failed endoscopic biliary decompression in patients with previous Billroth-2 gastrectomy was significantly greater than in successful ERCP group (n=1; 0.29%, p=0.002). Despite this, impaired gastroduodenal anatomy and high biliary strictures are not a contraindication for endoscopic transpapillary decompression. Failed ERCP was associated with higher mortality (χ²=4.574; p=0.032). Unit providing treatment of patients with malignant obstructive jaundice should have alternative methods of biliary drainage.