Comparative assessment of endoscopic treatment methods for patients with «complex» choledocholithiasis

Introduction. Despite the active development of minimally invasive methods for treating «complex» choledocholithiasis, this disease is characterized by a high frequency of complications. The issue of developing treatment tactics for patients with «complex» bile duct stones remains relevant today. The purpose of the study. To evaluate the results of treating patients with «complex» choledocholithiasis using endoscopic interventions on the bile ducts, major duodenal papilla and biliodigestive anastomoses. Materials and methods. From 2017 to 2023. The methods of statistical processing were based on determining the causes, circumstances, and frequency of complications in the treatment of patients with «complex» choledocholithiasis during retrograde endoscopic inter ventions. Treatment results. Before using the algorithm for treating patients with «complex» choledocholithiasis, we achieved the success of full-fledged one-stage sanitation in 80 % of the total number of cases of «complex» choledocholithiasis. In the group of patients treated with «complex» choledocholithiasis, guided by the algorithm, the success of full-fledged one-stage sanitation was achieved in 92 % of cases. Stenting of patients with concomitant hypocoagulation, as the first stage of treatment before correction of coagulogram parameters, allowed to reduce the frequency of postoperative bleeding by 5 times. Discussion. The use of balloon technologies in endoscopic biliary retrograde surgery is a therapeutic procedure that can be performed in various clinical and anatomical «scenarios» and sometimes in technically complex situations. Prevention and prophylaxis of complications, and leveling of failures that can occur at any stage of retrograde intervention is the most important task of the entire endoscopic team performing the operation. Analyzing the literature data and my own experience, we can conclude that with a correct assessment of the possibility of using large balloon catheters in specific clinical and anatomical situations, taking into account all the technical and methodological features of their use, these endoscopic retrograde manipulations are highly ef fective and safe. Conclusion. The use of the method of large-balloon dilation in combination with dosed papillosphincterotomy increased the effectiveness of the treatment of «complex» choledocholithiasis to 98.3 %, which proves the more effective use of this method in comparison with mechanical lithotripsy.