ANALYSIS OF COMPLICATIONS FOLLOWING INTRALUMINAL ENDOSCOPIC INTERVENTIONS ON MAJOR DUODENAL PAPILLA
Objective. To define the ways of complications prevention and improvement of endoscopic papillosphincterotomy outcomes. Methods. Outcomes of endoscopic interventions in 2150 patients with the pathology of hepatopancreatoduodenal zone were analyzed. The performed interventions were the following: endoscopic papillosphincterotomy (EPST) - 1485, endoscopic retrograde cholangiopancreatography (ERCPG) - 457, EPST combined with the common bile duct stone extraction - 148, EPST combined with ERCPG - 130, nasobiliary drainage - 18, biliary ducts stenting - 16, intraoperative EPST - 13, sanitation of the stents - 3, cutting the choledochoduodenal anastomosis - 1. Two- and three-staged interventions were performed in 118 patients. The criteria for the evaluation of the endoscopic interventions results were: incidence and outcomes of complications in the period from 1 to 30 days after manipulations. Results. Complications following interventions were observed in 60 (2.8%) patients. The most frequent complications were: acute pancreatitis - 26 cases (1.2%), bleeding - 20 cases (0.9%), retroperitoneal perforation of the duodenum - 4 cases (0.2%). Lethal outcomes - in 21 cases (1.0%). The risk of acute pancreatitis increased almost by 2 times in young and middle-aged patients, in patients with postcholecystectomy syndrome. In case of absolute indications absence for endoscopic interventions mortality rate increased by 30 times (27.3%). Bleeding occurred 2 times more often in patients with obstructive jaundice (1.8%). In case when two- and three-staged endoscopic interventions were carried out no complications were observed. Conclusions. Prevention of complications should be aimed at diagnosis and treatment of choledocholithiasis in patients with chronic calculous cholecystitis in the preoperative period. Care should be taken in young and middle-aged patients. In cases of obstructive jaundice sparing papillosphincterotomy should be carried out. Endoscopic interventions on the major duodenal papilla should be performed according to strong indications.