Endoscopy 2018; 50(04): S193
DOI: 10.1055/s-0038-1637632
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

COMPLICATED CHOLEDOCHOLITHIASIS – DIAGNOSTIC AND TREATMENT

M Korolev
1   State Pediatric Medical University of the Ministry of Healthcare of Russia, Saint-Petersburg, Russian Federation
,
L Fedotov
1   State Pediatric Medical University of the Ministry of Healthcare of Russia, Saint-Petersburg, Russian Federation
,
R Avanesyan
1   State Pediatric Medical University of the Ministry of Healthcare of Russia, Saint-Petersburg, Russian Federation
,
A Ogloblin
1   State Pediatric Medical University of the Ministry of Healthcare of Russia, Saint-Petersburg, Russian Federation
,
B Fedotov
1   State Pediatric Medical University of the Ministry of Healthcare of Russia, Saint-Petersburg, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

To show effectiveness of combined transcutaneous and endoscopic manipulations in complicated choledocholithiasis

Methods:

Department of common surgery with the course of endoscopy treating mentioned patients in last 25 years. Methods of combined interventions under ultrasonic, x-ray and endoscopic control were used for treatment patients with complicated choledocholithiasis since 2006. Now we have an experience of 156 treated patients with choledocholithiasis, wich we evaluate as “complicated”. Patients in this group are:

  1. very high level of bilirubin in blood (500 mmol/l and more) – 16 patients

  2. patients with choledocholithiasis in which you can't remove stones because of the severe comorbidities – 23 patients

  3. unremovable stones with Dormia basket or lithotripter – 39 patients

  4. technical difficulties during cannulation of papilla Vateri (diverticula, malformations) – 73 patients

  5. altered anatomy of upper GI-tract (surgical interventions), when you can't get the scope to the papilla

All patients of these groups were treated using combined miniinvasive interventions, which included antegrade and retrograde methods, made under ultrasonic, x-ray and endoscopic control in several stages or in the same time.

Results:

Percutaneous biliary drainage before removing stones – 78 patients. Percutaneous guidewire into the duodenum in cases with diverticula and malformations – for safe sphincterotomy – 73 patients. Method of antegrade placed manipulation catheter in gastric stump or diverting intestinal loop – 5 patients with altered anatomy, to get scope to papilla.

After performing these manipulations we had complications in 11 patients (7,4%), mortality was 1,28% (2 patients), all other patients were treated successfully

Conclusions:

  1. combined miniinvasive interventions in almost all cases of choledocholithiasis (also complicated) allow to remove stones from bile ducts

  2. percutaneous biliary drainage is necessary after combined stone removing