Prevention of complications of transpapillary endoscopic interventions

Abstract

This study analyzed the treatment results of 345 patients who underwent planned and emergency transpapillary surgical interventions for various diseases of the biliopancreatoduodenal region. Among these patients, 68.9% were women and 31.1% were men aged 18–92 (mean age, 63.7 ± 4.5) years. The study included patients who used various types of transpapillary endoscopic interventions as a treatment method, such as endoscopic papillo-sphincterotomy (71.9%, including choledocholite extraction in 68.7% of the patients), endoprosthetics of the common bile duct and main pancreatic duct (17.8%), balloon dilatation and bougienage of bile duct strictures (6.2%), mechanical lithotripsy (2%), nasobiliary drainage (1%), endoscopic wirsungotomy (0.8%), and endoscopic papillectomy (0.3%). Variants of the inflow of hepaticoholedochus and Wirsung duct were assessed using magnetic resonance cholangiopancreatography. The active implementation of preventive measures regulated by the global community made it possible to reduce the overall incidence of complications of transpapillary interventions to 13.1% and the rates of postoperative mortality to 1.3% (p < 0.05). The use of these measures led to a significant decrease in the incidence of acute post-manipulation pancreatitis from 10.3% to 4.8%, postoperative bleeding from 8.9% to 5.5%, cholangitis from 2.8% to 0.7%, and a low incidence of retroduodenal perforation in 1.1%. Personalized consideration of the modern recommendations of the global endoscopic communities (Europeans, Americans, and Japanese) when performing endoscopic retrograde cholangiopancreatography, as well as original approaches associated with the determination of the anatomical features of the structure of the Vater papilla with variants of fusion of hepaticocholedochus and Wirsung duct, helped to significantly reduce the overall incidence of complications following transpapillary endoscopic procedures from 22.2% to 13.1%.

Keywords

transpapillary endoscopic interventions / complications of endoscopic papillosphincterotomy / postoperative pancreatitis / bleeding after papillotomy / duodenum perforation / cholangitis / prevention of complications

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Feklyunin A.A., Romashchenko P.N., Maistrenko N.A., Omran V.S.