Abstract:

Aim: was to determine indications for transpapillary external-internal drainage of the biliary tree in benign diseases of the peripapillary region.

Material and methods: results of the use of externally-internally transpapillary drainage of the biliary tree from 256 patients with distal obstruction of the biliary tract were analyzed. In 154 (60,2%) cases the peripapillary obstruction was caused by tumor pathology, in 102(39,8%) cases (39.8 %) - by peripapillary benign stenotic diseases (stenosis of Vater papilla, choledocholithiasis, chronic pancreatitis, parapapillary diverticula) that have not managed to eliminate with the help of endoscopy or endoscopic benefit was initially ineffective.

Results: endoscopic papillosphincterotomy after the external-internal drainage due to syndrome of Vater papilla «acute blockage» required in 7(4,5%) patients of 154 patients with peripapillary tumor obstruction. Endoscopic papillotomy was performed in 80(78,4%) patients among 102 patients with benign distal block of common biliary duct after the external-internal drainage for same indications. In 7 cases of «acute blockage» of papilla we were forced to return to the outside cholangiostomy due to endoscopic unattainable of papilla. In summary, the syndrome of papilla «acute blockage» occurred in 87(85,3%) patients with transpapillary external- internal drainage of the biliary tree on the background of the peripapillary benign obstruction. There were no complications of papillotomy

Conclusion: the external-internal drainage of the biliary tree with the syndrome of obstructive jaundice remains an effective and pragmatic method of return of bile into the lumen of the duodenum. The most common complication of the external-internal drainage with transpapillary drainage placement is a syndrome of «acute blockage» of Vater papilla which requires endoscopic papillotomy With high frequency this syndrome occurs when forced transpapillary the external-internal drainage of the distal benign disorders of patency of the biliary tree. Minimal risk of this syndrome developing has been reported during transpapillary drainage in patients with obstructive jaundice due to peripapillary cancer.

References

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Abstract:

Hemobilia is known as one of the most severe complications of percutaneous transhepatic biliary drainage. In the present case, the severe bleeding developed as a result of balloon dilatation and stenting of malignant stricture. Emergency transhepatic arterial embolization was performed with good results. We also discuss 7 cases of hemobilia in our hospital, 3 of which were successfully treated with transcatheter embolotherapy. We conclude that transhepatic arterial embolization appears to be effective and safe treatment for massive hemobilia.

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Abstract:

Aim: was to estimate possibilities of optical coherence tomography (OCT) in diagnostics of pathology of bile ducts in combination with percutaneous transhepatic biliary drainage (PTBD).

Materials and methods: examined 5 patients with obstructive jaundice, suspected cancerous etiology OCT was performed during or 5-14 days after PTBD. For morphological confirmation of results we performed forceps intraductal biopsies.

Results: tomographic evidences of the malignant stricture were revealed in 4 (80%) patients anc in 1 patient benign stricture was determined. Diagnoses were confirmed histologically (80%) and clinically (20%). Sensitivity of the OCT was 100%.

Conclusion: percutaneous transhepatic OCT appeared to be a perspective method for differential diagnostics of biliary strictures. 

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