Choledocholithiasis is an urgent problem of modern hepatobiliary surgery and accounts for 60% of all obstructive jaundice. Stones of the common bile duct cause cholestasis and mechanical jaundice syndrome and in case of untimely diagnostics lead to the development of such severe complications as acute cholangitis and biliary sepsis. The criteria for determining the sequence, stages and volume of diagnostic measures with choledocholithiasis have not been determined by now. The purpose of the study. Optimization of the instrumental stage of the diagnostics of patients with choledocholithiasis. Materials and methods. 56 patients with choledocholithiasis were studied. The diagnostic program was expanded due to the instrumental stage using ultrasound, duodenopapiloscopy, endoscopic retrograde cholangiopancreatography and magnetic resonance tomography. The criterion for the patients selection was the syndrome of distal choledochal patency violation and the presence of stones in it according to echosonography and endoscopic cholangiopancreatography. Results and discussion. At sonography bilious hypertension was established in all 72 (100%) patients. Mechanical jaundice was present in 54 (96.4%) patients. Hepatic dysfunction with 84±9.6 mmol/l hyperbilirubinemia and an increase in AST and ALT levels to 1.2±0.9 mmol/l and 1.5±1.1 mmol/l, were verified respectively. At endoscopic retrograde cholangiopancreatography choledocholithiasis was found in 54 (96.4%) patients. Single stones were present in 18 (32.1%) and multiple – in 38 (67.9%) patients. In 52 (92.9%) cases, stones up to 1.5 cm in diameter were removed with a Dormia basket at one time or after mechanical lithotripsy. In 4 (7.1%) patients stones from 1.7 to 2.0 cm could not be removed endoscopically. Choledoch stenting was performed in 12 (21.4%) patients. One-stage transpapillary treatment was carried out in 38 (67.9%) patients, two and three stage treatment – in 14 (25%) cases, and «open» choledocholithotomy – in 4 (7.1%) cases. Conclusion. The program of choledocholithiasis diagnostics with the gradual use of clinical, laboratory, radiological and endoscopic data allows carrying out correct detailing of the cause, level, degree of common bile duct obstruction and the complicated course of the disease in 100% of cases

Keywords: gallstone disease, choledocholithiasis, mechanical jaundice, endoscopic retrograde cholangiopancreatography, transpapillary minimally invasive interventions

Full text: PDF (Ukr) 291K

1. Borisenko VB. Ustrojstvo dlya endoskopicheskogo transpapillyarnogo drenirovaniya i sanaczii zhelchnykh protokov [Device for endoscopic transpaapillary drainage and bile duct sanitation]. Kharkviska khirurhichna shkola. 2015; 1: 45- 48. [Russian]
2. Dziubanovskyi OI. Klinichni formy kholedokholitiazu [Clinical forms of choledocholithiasis]. Visnyk naukovykh doslidzhen. 2017; 1: 77–80. [Ukrainian]. https://doi.org/10.11603/2415-8798.2017.4.8275
3. Savoliuk SI. Diahnostychnyi alhorytm u khvorykh z hostrym kalkuloznym kholetsystytom ta pidozroiu na kholedokholitiaz [Diagnostic algorithm in patients with sharp calculous cholecystitis and suspicion of choledocholitical]. Shpytalna khirurhiia. 2016; 4: 33-36. [Ukrainian]
4. Williams E, Beckingham I, Sayed G El, Gurusamy K, Sturgess R, Webster G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut. 2017; 66(5): 765–782. https://doi.org/10.1136/gutjnl-2016-312317
5. Karamanos E, Inaba K, Berg RJ, Resnick S, Okoye O, Alexopoulos S, et al. The relationship between age, common bile duct diameter and diagnostic probability in suspected choledocholithiasis. Dig Surg. 2017; 34(5): 421–428. https://doi.org/10.1159/000455272
6. Saito H, Kakuma T, Kadono Y, Urata A, Kamikawa K, Imamura H, et al. Increased risk and severity of ERCP–related complications associated with asymptomatic common bile duct stones. Endosc Int Open. 2017; 5(9): 809–817. https://doi.org/10.1055/s-0043-107615
7. Cai J S, Qiang S, Bao–Bing Y. Advances of recurrent risk factors and management of choledocholithiasis. Scand J Gastroenterol. 2017; 52(1): 34–43. https://doi.org/10.1080/00365521.2016.1224382
8. Kang SK, Hoffman D, Ferket B, Kim MI, Braithwaite RS. Risk–stratified versus non–risk–stratified diagnostic testing for management of suspected acute biliary obstruction: comparative effectiveness, costs, and the role of MR cholangiopancreatography. Radiology. 2017; 284 (2): 468–461. https://doi.org/10.1148/radiol.2017161714
9. Lan Cheong Wah D, Christophi C, Muralidharan V. Acute cholangitis: current concepts. ANZ. J Surg. 2017; 87(7–8): 554–559. https://doi.org/10.1111/ans.13981
10. Makmun D, Fauzi A, Shatri H. Sensitivity and specificity of magnetic resonance cholangiopancreatography versus endoscopic ultrasonography against endoscopic retrograde cholangiopancreatography in diagnosing choledocholithiasis: the Indonesian experience. Clin еndosc. 2017; 50(5): 486-490. https://doi.org/10.5946/ce.2016.159
11. Molvar C, Glaenzer B. Choledocholithiasis: evaluation, treatment, and outcomes. Semin Intervent Radiol. 2016; 33(4): 268–276. https://doi.org/10.1055/s-0036-1592329
12. Tazuma S, Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M, et al. Evidence–based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017; 52(3): 276–300. https://doi.org/10.1007/s00535-016-1289-7
13. Jeon TJ, Cho JH, Kim YS, Song SY, Park JY. Diagnostic value of endoscopic ultrasonography in symptomatic patients with high and intermediate probabilities of common bile duct stones and a negative computed tomography scan. Gut Liver. 2017; 11(2): 290–297. https://doi.org/10.5009/gnl16052
14. D'Angelo T, Racchiusa S, Mazziotti S, Cicero G. Magnetic resonance (MR) cholangiopancreatography demonstration of the cystic duct entering the right hepatic duct. Am J Case Rep. 2017; 18: 242–245. https://doi.org/10.12659/AJCR.902620
15. Chandra A, Gupta V, Rahul R, Kumar M, Maurya A. Intraoperative ultrasonography of the biliary tract using saline as a contrast agent: a fast and accurate technique to identify complex biliary anatomy. Can J Surg. 2017; 60(5): 316–322. https://doi.org/10.1503/cjs.011116
16. Wallace MB, Wang KK, Adler DG, Rastogi A. Recent Advances in Endoscopy. Gastroenterology. 2017; 153(2): 364–381. https://doi.org/10.1053/j.gastro.2017.06.014
17. Abdelaal A, El–Matbouly M, Sulieman I, Elfaki A, El-Bakary T, Abdelaziem Sh, et al. Role of intraoperative cholangiography for detecting residual stones after biliary pancreatitis: still useful? A retrospective study. World J Emerg Surg. 2017; 12: 18. https://doi.org/10.1186/s13017-017-0130-9