[Complications after endoscopic interventions on the major duodenal papilla]. / Oslozhneniia posle éndoskopicheskikh vmeshatel'stv na bol'shom duodenal'nom sosochke.

An analysis of 83 cases of complications following endoscopic procedures on the major duodenal papilla was made: 62 cases after 2110 retrograde cholangiopancreatographies (RChPG) and 21 after 620 endoscopic papillosphincterotomies (EPST). Among most frequent complications there were acute pancreatitis (49 cases), purulent cholangitis (11 cases), suppurations of the pancreatic cysts and purulent pancreatitis (8 cases). Bleedings took place after EPST in 11 patients. Risk factors of the development of acute pancreatitis were established: the presence of scarry stenosis of the papilla, chronic pancreatitis with the last exacerbation less than 1 month before the examination, more than 3 cannulations and contrasts of the pancreatic duct of the 2nd order or its acini, little (less than 10 mm) cuts of the papilla in EPST. Acute obturative pancreatitis is not a contraindication for EPST. On the opposite, after the procedure a rapid regression of the disease takes place. Asymptomatic hyperamylasuria observed in 329 patients (238 patients after RChPG and 91 after EPST) is considered to be a manifestation of flaccid pancreatitis, suggests a complication of the endoscopic procedure and is considered to be an indication for the corresponding treatment. Operations for the complications were performed on 21 patients. Four patients died because of complications of RChPG (0.2%) and two from complications of EPST (0.5%). Pancreonecrosis and purulent pancreatitis were causes of the deaths.

[The importance of endoscopic papillosphincterotomy in biliary tract surgery]. / Znachenie éndoskopicheskoi papillosfinkterotomii v khirurgii zhelchnykh putei.

Based upon 129 endoscopic operations in 98 patients with choledocholithiasis and stenosis of the major duodenal papilla the authors came to a conclusion on an increasing significance of endoscopic papillosphincterotomy (EPST) in the surgery of bile ducts. EPST was shown to be followed by less amount of complications and less lethality as compared with surgical papillosphincterotomy. The intrahospital lethality after EPST was 1%. EPST allowed to elevate efficiency of the treatment in elderly and senile patients. It may be considered as an alternative surgical intervention after preceding cholecystectomy and can be used as an emergency procedure for acute obstructive purulent cholangitis and pancreatitis. In patients with little operative risk and preserved bile duct the indications for EPST must be restricted.