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RELEVANCE AND PROSPECTS OF ENDOSCOPIC METHODS (ERCP AND
EPST) IN OBSTRUCTIVE JAUNDICE
Kholmukhamedov Zh. R.
Fergana Medical Institute of Public Health, Uzbekistan Scientific supervisor: G. N. Raimov
Fergana Medical Institute of Public Health, Uzbekistan
Relevance.
Jaundice is one of the main symptoms of various diseases of the liver and
bile ducts. Timely determination of the genesis of jaundice contributes to the correct solution
of a number of issues related primarily to treatment tactics, the choice of the method of surgical
intervention. Improving the results of surgical treatment is possible with timely diagnosis and
selection of the optimal method of surgical intervention in each specific situation.
Purpose of the study.
Retrospective analysis of the use of minimally invasive methods
in patients with mechanical jaundice of various origins.
Materials and methods of the study.
The results of using combined endoscopy with
X-ray contrast examination of the biliary tract in 197 patients were studied in the period from
2017 to 2020 in order to establish the genesis of jaundice. The age of the patients ranged from
21 to 70 years. Of these, 61 (31%) were men and 136 (69%) were women. As a result of ERCP,
the following causes of mechanical jaundice were revealed in patients: common bile duct
stones in 87 (44.2%) patients, stricture of the terminal section of the common bile duct in 4
(2%) patients, liver hilum cancer in 9 (4.6%), gallbladder cancer in 3 (1.52%), ampulla cancer
in 4 (4.6%), post-cholecystectomy condition, choledocholithiasis in 19 (9.6%), Mirrizi
syndrome in 2 (1.1%), papillitis in 8 (4.06%), obliterating cholangitis in 1 (0.5%) patient.
Results of the study. A total of 164 patients underwent EPST (endoscopic papillospintrotomy).
Our limited experience shows that EPST is a highly effective method for treating
choledocholithiasis. We did not set any absolute contraindications to EPST, except for rare
cases when the stricture of the terminal part of the common bile duct extends more than 3 cm
and above the intermual part of the common bile duct.
Good results were obtained in 154 patients and were determined mainly by adequate
dissection of the BDS to create conditions for the passage of all stones. However, one of the
disadvantages of EPST is the reflux of duodenal contents into the bile and pancreatic ducts
with the subsequent development of cholangitis and pancreatitis. Acute destructive pancreatitis
in our case developed in 3 (1.8%) patients after EPST and ended with laparotomy, sanitation,
drainage of the omental bursa and abdominal cavity with cholecystostomy. The outcome is
recovery. In 11 (6.7%) patients, cholangitis and acute pancreatic edema were observed, which
were relieved by conservative measures: prosthetic inhibitors, antispasmodics, antibiotics and
detoxification therapy. Conclusions. ERCP is a highly informative method for differential
diagnostics of jaundice. The undoubted advantages of EPST, allowing its use in the most
severe patients, especially the elderly, and good immediate results, indicate the advisability of
using this operation in each patient with choledocholithiasis, stricture of the major duct,
complicated by mechanical jaundice.
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