Проблемные вопросы эндоскопического билиарного стентирования

Abstract

Objective. To study the results of endoscopic biliary stenting (EBS) for biliary obstruction of various genesis to determine the problematic issues of the procedure and possibility of its efficacy raising.

Маterials and methods. Experience of conduction of 5748 endoscopic transpapillary interventions in 2010 – 2017 yrs was analyzed: endoscopic papillosphincterotomy was performed in 2919 (50.8%) observations, stenting of biliary ducts – in 379 (6.6%). In 296 (78.1%) observations plastic stents (PS) were introduced, while in 83 (21.9%) – the self–expanding metallic stents. Results. Of 208 patients, in whom primary temporary EBS was performed for tumoral biliary obstruction, using PS, in 153 (73.6%) the next stage of treatment have constituted elective operation in 10 – 14 days after elimination of hyperbilirubinemia, signs of cholangitis, additional examination and determination of the intervention volume. Among these patients in 56 (36.6%) radical operations were performed, and in 97 (63.4%) – palliative operations. In 47 patients PS for closure of external biliary fistula (EBS) PS was introduced: in 13 (27.7%) – for tubular stenosis of distal part of common biliary duct, in 7 (14.9%) – for insufficiency of sutures of common biliary duct (after choledocholithotomy), in 14 (29.8%) – for intraoperative damages of extrahepatic biliary ducts, in 5 (10.6%) – for presence of Luschka channels, in 8 (17.0%) – for a state after hepatic resection, echinococectomy. Presence of concrements, which due to some reasons were not removed endocopically, in environment of purulent cholangitis have constituted the indication for performance of EBS in 24 (8.1%) observations, chronic pancreatitis, complicated by obturation jaundice – in 9 (3.0%). Correction of iatrogenic damages of biliary ducts with development of their partial strictures, EBF, using EBS with introduction of PS, were performed in 8 (2.7%) patients.

Conclusion. The necessity exists to study the treatment results in patients, suffering biliary obstruction of various genesis, to determine problematic issues of the main procedures and possibilities of their efficacy raising.