CHOICE OF THE OPTIMAL METHOD AND DIAGNOSTICS OF BILIARY DECOMPRESSION IN OBSTRUCTIVE JAUNDICE

Purpose. Optimization of the treatment and diagnostic complex in patients with obstructive jaundice syndrome. Materials and methods. A prospective and retrospective study of the experience of treating 285 patients with obstructive jaundice was conducted. For the diagnosis of obstructive jaundice, the following were used: ultrasound, CT, MRI, MRCP, endo-ultrasound, cholangioscopy. Among the admitted patients, there were 135 men (47.4%) and 150 women (52.6%). The main causes of admission with mechanical jaundice syndrome were as follows: choledocholithiasis in 226 (79.3%), cholangitis in 21 (7.4%), extrahepatic bile duct strictures in 30 (10.5%), and BDS stricture in 8 (2.8%). The main methods of decompression were trans-papillary interventions. Such symptoms of mechanical jaundice as yellowness of the sclera and skin, acholic stool were detected in all patients. Skin itching with characteristic scratches on the body was observed among 98.2% of patients, and epigastric pain was observed only in 12 (4.2%) patients. Blood biochemistry parameters showed significant changes indicative of liver failure. Bilirubin levels ranged from 81 to 752 mmol/L. Results. The effectiveness of trans-papillary endoscopic retrograde interventions in mechanical jaundice was 94%. Post-ERCP pancreatitis was the most common complication in 12 (4.2%) and 93% of cases among men and women, respectively, and resolved spontaneously, requiring only conservative treatment. Bleeding occurred in 5 (1.75%) patients, and in all cases it was associated with trans-papillary endoscopic intervention. Cholangitis developed in 12 (7.4%) patients, in most cases due to incomplete drainage. One case of perforation was also detected (0.35%). Other complications accounted for 1.4% of cases. Patient characteristics associated with an increased risk of pancreatitis included sphincter of Oddi dysfunction (21.7%) confirmed by manometry; ERCP-induced pancreatitis (19%); and recurrent pancreatitis (16.2%). Pain during the procedure was a significant predictor of increased risk of post-ERCP pancreatitis (27%). Independent risk factors for post-ERCP pancreatitis were a history of recurrent pancreatitis; pancreatitis associated with previous ERCP; multiple cannulation attempts, pancreatic cytology, and pain during the procedure. In-hospital mortality was 0.8%. Conclusion. The main methods of biliary decompression are retrograde and antegrade minimally invasive procedures performed for specific indications. Today, the development of new methods of X-ray imaging, interventional endoscopy and laparoscopy allows for more intensive and accurate diagnosis.