ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 14 of 45
JMBS 2018, 3(3): 73–77
Clinical Medicine

Minimally Invasive Interventions in Patients with Pyogenic Cholangitis

Vovk V. A.

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.

Keywords: cholangitis, minimally invasive interventions

Full text: PDF (Ukr) 194K

  1. Arya N, Nelles SE, Haber GB, Kim YI, Kortan PK. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol. 2004; 99: 2330–4.
  2. ASGE Standards of Practice Committee. Chathadi KV, Chandrasekhara V, Acosta RD, et al. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015; 81: 795–803.
  3. Carr-Locke DL. Therapeutic role of ERCP in the management of suspected common bile duct stones. Gastrointest Endosc. 2002; 56: 170–4.
  4. Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World Journal of Gastroenterology. 2014: 20 (37): 13382–401.
  5. Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, Kelsey PB. Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy. Endoscopy. 2005; 37: 542–7.
  6. Lee DW, Chan AC, Lam YH, Ng EK, Lau JY, Law BK, Lai CW, Sung JJ, Chung SC. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial. Gastrointest Endosc. 2002; 56: 361–5.
  7. Lee SH, Park JK, Yoon WJ, Lee JK, Ryu JK, Yoon YB, Kim YT. Optimal biliary drainage for inoperable Klatskin’s tumor based on Bismuth type. World J Gastroenterol. 2007; 13: 3948–55.
  8. Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009; 20: 1059–65.
  9. Piraka C, Shah RJ, Awadallah NS, Langer DA, Chen YK. Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones. Clin Gastroenterol Hepatol. 2007; 5: 1333–8.
  10. Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 2010; 21: 789–95.