THERAPEUTIC AND DIAGNOSTIC POSSIBILITIES OF ENDOSCOPIC ENDOBILIARY INTERVENTIONS IN MECHANICAL JAUNDICE OF TUMOR GENESIS

F.A. KHADJIBAEV, K.S. RIZAEV, M.A. KHASHIMOV, B.I. SHUKUROV, S.O. TILEMISOV, A.T. KHAKIMOV, R.I. RAKHIMOV

Abstract

Patients. Evaluation of the therapeutic and diagnostic capabilities of endoscopic retrograde endobiliary interventions for obstructive jaundice of tumor genesis (OJTG) was carried out in 562 patients, who underwent a total of 708 ERCP procedures. The patients were between 18 and 92 years old (mean age 58.1 ± 15.7 years). Endoscopic retrograde endobiliary interventions were limited to explorative endoscopic retrograde cholangiopancreatography (ERCP) only in 22 (3.1%) cases. In all other cases (686 (96.9%) procedures) ERCP was supplemented with various endoscopic     35Shoshilinch tibbiyot axborotnomasi, 2020, 13-tom, 6-sontherapeutic manipulations: revision and flushing of the previously installed stent (38), lithotripsy and lithoextraction with concomitant choledocholithiasis (13), stenting and biliary duct (BD) restentation (336). Results. In the etiological structure of OJTG, the distal lesion of the biliary tract at the level of the major duodenal papilla (MDP) (124; 22.1%), the head of the pancreas (HP) and the terminal section of the common bile duct (TSCBD) (319; 56.8%) significantly predominates. Significantly less frequently, retrograde interventions were performed with a block at the level of the gallbladder and an average 1/3 of the common bile duct (56; 10.0%), as well as with tumors of the hepatic hilum (63; 11.2%). The rate of successful retrograde bile duct decompression was 75.4% with a range from 27.0% for lesions of the hepatic hilum to 99.2% for MDP tumors. After ERCP, the development of purulent cholangitis was observed in 13.7% of patients, acute pancreatitis - in 3.0%, bleeding from a papillatoma wound - in 2.7%, progression of hepatic failure after decompression of the BD - in 2.1% and iatrogenic perforation of the duodenum posterior wall - in 0.4%. The overall mortality rate was 9.2%.Conclusion. Considering the rather limited possibilities of endoscopic retrograde endobiliary technologies in OJTG. At the present time, when choosing a method for BD decompression in this category of patients, it is necessary to attach decisive importance to MRI cholangiography - the presence of MRI signs of a high block of bile ducts is the main indication for performing primary PCTCG when detecting block shows endoscopic transpapillary interventions.