SELECTION OF THE OPTIMAL ENDOSCOPIC TREATMENT OPTION FOR PATIENTS WITH CHOLEDOCHOLITHIASIS

Abstract

Introduction. When using traditional endoscopic methods of choledocholithiasis treatment, the issues related to the remaining high risk of post manipulative complications remain unsolved. The priority task is the development of new methods of endoscopic treatment, which will prevent the development of postoperative complications. Aim. The aim of the study was to determine the optimal treatment option based on the comparative analysis of different ways of endoscopic interventions in patients with choledocholithiasis. Material and methods. The paper presents the outcomes of endoscopic interventions in 127 patients with choledocholithiasis. Of them 84 patients composed the main group in which choledocholithiasis treatment was performed according to the original method including two operative stages. On the first one we performed partial papillotomy, temporary stenting of common bile duct (in 100%) and main pancreatic duct (in 45%), and papillotomy over the stent to the muscular layer of Oddi sphincter. On the second one after 2–4 days the biliary stent was removed, lithoextraction was performed along with bile duct restenting. Pancreatic and biliary stents were removed after 24 hours and 3–8 weeks respectively. A comparison group was composed of 43 patients who underwent endoscopic surgeries by the classical well-known methods. Results and discussion. The analysis showed that the differences in the groups with classical method of choledocholithiasis endoscopic treatment (CMCLET) and original method of choledocholithiasis endoscopic treatment (OMCLET) between the levels of «Average number of surgeries per patient» (2,05 surgeries ranging from 1 to 4 for CMCLET versus 2,41 surgeries ranging from 2 to 5 for OMCLET; p=0,0176) and «Duration of hospitalization» (10,4 days to 8,95 days; p=0,0377), there was an inverse relationship between the number of surgeries and duration of hospitalization, which was largely due to different levels of the rate of early postoperative complications (p=0,0005). Twenty times higher blood amylase levels in the main group compared to the reference values did not lead to the development of acute pancreatitis, the incidence of which was 7 times lower in the comparison group (p=0,001). Conclusion. Comprehensive study of the outcomes of endoscopic treatment in patients with choledocholithiasis using different variants of interventions has shown convincing superiority of the original method of surgical aid.