Endoscopic bile duct sanation technique under difficult cannulation in ERCP
Currently, the technical capabilities and effectiveness of transpapillary interventions in the diagnosis and treatment of biliary obstruction have significantly increased. In this regard, they are widely used as preliminary or final methods of treatment of patients with choledocholithiasis and its complications, as well as benign and malignant obstruction of the biliary tract. At the same time, it is not uncommon for these methods to be accompanied by severe complications and deaths. The aim of this work is to identify the causes of difficulties and ways to overcome them with endoscopic debridement of the biliary tract in patients with obstructive jaundice. Material and methods: the article is based on the analysis of the work of the endoscopic department of the Research Institute of the Joint Venture named after I. I. Dzhanelidze in the period 2012-2018 During this period, transpapillary interventions for complicated fonns of cholelithiasis and oncological diseases of the biliary tract were performed in 830 patients. Atypical EPST was performed in 234 (28.2%) patients, whose age ranged from 21 years to 95 years, the average age was 64 years. There were 78 men (33.3%), twice as many women - 156 (66.6%). Results and discussion: for 7 years at the Research Institute of the Joint Venture named after I. I. Dzhanelidze endoscopic correction of bile outflow in complicated forms of cholelithiasis and oncological diseases of the biliary tract was perfonned in 830 patients. For every fourth of them (234 - 28.2%), it is regarded as atypical. Conclusion: the developed algorithm for performing EPST is a universal method of biliary tract rehabilitation and can reduce the number of intra- and post-manipulation complications (3.4%) and mortality (0.8%). The technology of “two or more instruments in one channel” is the method of choice for “difficult” cannulations.