15-YEAR EXPERIENCE WITH ENDOSCOPIC RETROGRADE OPERATION (ERO) ON THE BILIARY TRACT P. 50-53

T.I. TAMM, B.M. DATSENKO, K.O. KRAMARENKO, O.J. BARDIUK, O.P. ZAHARCHUK, V.V. NEPOMNIASHCHY, I.M. MAMONTOV, ABUD HAMAM

Анотація


Long-term outcomes of endoscopic retrograde operation
(ERO) were analysed in 1109 patients (368 men, 741 women;
age range, 18 to 92 years). The most frequent indications
for ERO were choledocholithiasis (725 patients; 65.4%) and
stenosis of the papilla (218 patients; 19.6%). In the remaining
15% of cases, indications included other forms of tumor
pathology in the biliary tract and pancreatic head cancer,
Mirizzi syndrome, deformed papilla in diverticula, chronic
and acute pancreatitis, biliary tract dyskinesia, postoperative
biliary leakage in the abdominal cavity, and others for which
endoscopic papillotomy (EPT) was performed. The main
indications to perform ERO were: 1. clinical obstructive
jaundice and cholangitis with hyperbilirubinemia and
hyperphosphatemia; 2. bile ducts dilatation to more than 8
mm on ultrasound; 3. a history of previous attacks of
cholangitis and obstructive jaundice. Based on our
experience, we have developed an algorithm for ERO that
shows the sequence of actions depending on the
endoscopically visualized changes of the papilla, and biliary
tract and ERCP-obtained X-ray data. In the algorithm given,
ERO is a complex diagnostic and therapeutic intervention
in the papilla, and the sequence may differ. Among the
therapeutic manipulations, we used EPST, extraction of bile
duct stones, nasobiliary drainage (NBD), and replacement
bile ducts in various combinations. Note that NBD was used
in almost half of the patients (49%). This is due to the frequent
presence of cholangitis in patients with biliary tract
obstruction, and therapeutic manipulation in 30 - 35% of
patients was performed in 2 - 3 stages, with a break between
stages of 2 days. Each of these stages included installing an
NBD for biliary tract decompression and treatment of
cholangitis. Biliary stenting was also performed with
repeated ERO after preliminary NBD. The therapeutic
effectiveness of ERO was assessed as complete, partial, or
ineffective. Full restoration of biliary permeability and
resolution of cholangitis and obstructive jaundice were
achieved in 876 patients (79%), and temporary restoration
of bile passage and elimination of cholangitis and obstructive
jaundice with endoscopic drainage were achieved in 166
patients (15%). ERO was ineffective or unsuccessful in 67
patients (6%). All patients in the second group with temporary
recovery of biliary function underwent surgery in a planned
manner. Thus, in 94% of cases, ERO had a significant
therapeutic effect. Complications after ERO occurred in 48
(4.3%) patients, of whom 12 (1.1%) had serious
complications requiring surgery. Two patients (0.18%) died.
Key words: endoscopic retrograde operation (ERO), bile
duct, endoscopic papillotomy (EPT), ERCP


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