The importance of the degrees of complexity of retrograde interventions in the treatment of obstructive

Abstract

Aim. To improve the results of treatment of patients with obstructive jaundice caused by choledocholithiasis
by optimizing and improving the diagnostic and treatment stages of endoscopic retrograde interventions.
Materials and methods. The results of treatment of 115 patients with clinical symptoms of obstructive
jaundice, the cause of which were stones of the extrahepatic bile ducts, are presented. The patients were divided
into 2 groups: control and main. In the main group, unlike the control group, we applied the classification we
developed, which included determining the degree of the angle of confluence of the common bile duct into
the major duodenal papilla (MDP), the location and visualization of the MDP and its mouth, the presence of
parafateral diverticula, as well as the presence of previous operations on the gastrointestinal tract, according
to which 4 degrees were distinguished difficulties of ERCP.
Results. The use of MDP cannulation techniques based on the classification of the degree of difficulty of ERCP
made it possible to reduce the number of unsuccessful MDP cannulations from 20% to 3,3%, reduce the
incidence of complications from 12,7% to 6,6% and mortality – from 3,6% to 0%.
Conclusion. The use of new technical approaches and techniques during retrograde manipulations in
patients with benign obstructive jaundice made it possible to improve treatment results, reduce the number
of unsuccessful cannulations, and reduce the incidence of post-manipulation complications and mortality by
2–2,5 times