Minimally invasive endoscopic transpapillary interventions in patients with choledocholithiasis

Objective. To study the results of endoscopic transpapillary interventions in the treatment of choledocholithiasis. Subjects and methods. In 2016-2020, the Endoscopy Unit, V.D. Seredavin Samara Regional Clinical Hospital, performed interventions into the major duodenal papilla in 354 patients (249 women and 105 men; the patients’ mean age, 65 years; and patients aged over 60 years (78%)) with obstructive jaundice caused by choledocholithiasis. Results. After various endoscopic interventions, it could be possible to extract concretions into the intestinal lumen and to restore choledocheal patency in 306 (86.3%) patients with single and multiple common bile duct stones of relatively small diameter (0.8-1.4 cm). Nasal biliary drainage was installed in 69 patients, which made it possible to reduce the manifestations of obstructive jaundice and to stop cholangitis. Large concretions measuring >1.5 cm were detected in 32 patients. The sizes of common bile duct concretions were <1.0 cm in 4 patients. To prepare patients for more radical endoscopic intervention, mechanical lithotripsy was attempted to extract bile duct concretions in 36 patients having the latter; nasal biliary drainage was installed in 11 patients of this group after papillotomy, and duodenal biliary endoprosthesis was performed in 10 patients. Before endoscopic lithotripsy, 16 patients underwent balloon dilation to facilitate subsequent extraction of concretion fragments. Conclusion. Endoscopic transpapillary interventions are a highly effective and less traumatic treatment for patients with choledocholithiasis. Papillotomy greatly facilitates the subsequent extraction of common bile duct concretions. Nasal biliary drainage and choledochal endoprosthesis can improve the health of patients and prepare them for more radical endoscopic and surgical treatments.

gastroenterology, choledocholithiasis, endoscopic papillary sphincterotomy, minimally invasive interventions