Minimally Invasive Interventions in Patients with Pyogenic Cholangitis

In patients with acute cholangitis, any intervention that provides sufficient drainage of the bile tree is considered adequate, because it eliminates one of the principal links (biliary hypertension) in the pathogenesis of cholangitis. Traditional surgical interventions for bile drainage, percutaneous drainage and endoscopic transduodenal decompression are used to drain the bile ducts. The endoscopic approach is considered more effective, and if it is not feasible, percutaneous transhepatic biliary decompression is performed, which has a greater percentage of complications, technical characteristics, and the probability of sepsis development. Endoscopic papillosphincterotomy and lithoextraction, according to various data, are successful in approximately 90% of cases with lethality less than 1%. In case of unsuccessful lithoextraction attempts, biliary decompression should consist of stent or nasobiliary drainage, especially in severe forms of cholangitis, in order to minimize the risk of sepsis manifestations and decrease the time of the procedure, sedation and anesthesia. After resolving the critical situation, complete removal of the stones from the bile ducts through cholangioscopy with intraductal lithotripsy is performed. This allows removing even "difficult" extrahepatic stones in 83-100% of patients. Endobiliary interventions play a decisive role in diagnosing and preparing patients for subsequent radical surgical methods of treatment. The purpose of the study was to analyze the results of using miniinvasive transduodenal endoscopic and percutaneous transhepatic interventions to improve their use in pyogenic cholangitis. Material and methods. In frames of presented study, 136 patients with pyogenic cholangitis underwent a total of 260 mini-invasive procedures. 119 of these underwent eidoscopic transduodenal interventions and 17 patients had percutaneous transhepatic drainage of the bile ducts. In carrying out endoscopic transduodenal surgical procedures on the large papilla of the duodenum and the general bile duct, all of the 119 patients underwent endoscopic papillosphinkterotomy. The latter served as a prologue to further manipulation on choledochus in most cases. 39 patients had endoscopic mechanical lithotripsy with extraction of stones residues, 56 patients underwent endoscopic lithoextraction, 20 patients had endoscopic stenting of choledochus, and 9 patients underwent nasobiliary drainage. Conclusions. Complications of endoscopic and percutaneous surgical interventions were acute pancreatitis, hemobilia, subdiaphragmatic hematoma and bleeding from the papillotomic wound.