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Year 2013 Vol. 21 No 2
THE METHOD OF POSTPAPILLOTOMY BLEEDINGS PREVENTION
FSEI HPE "Khakassia State University named by NF Katanov", Abakan
The Russian Federation
Objectives. To decrease the incidence of postpapillotomy bleedings in patients with hemostasis system disturbances occurring in the mechanical jaundice.
Methods. The aim was achieved by the two-staged endoscopic papillosphincterotomy (EPST) with the inter-staged biliary ducts stenting. The first stage included slight dissection (up to the separation of the orifices of the common bile and main pancreatic ducts) of the major duodenal papilla and endobiliary stenting. At normalization of biochemical and coagulation parameters, the removal of the endoprosthesis and maximal EPST by cannulation method were performed. Efficacy of the method was assessed by comparing the results in two groups of patients with the mechanical jaundice. In the research group (93 patients) EPST was carried out in two stages. In the group of comparison (91 patients) generally accepted single-staged EPST was applied.
Results. Endoprosthesis displacement in the group of comparison during the first 24 hours was revealed in 5 cases (5,4%), in 3 cases (3,2%) the bile entered the duodenum freely. In these three patients the stent replacement wasn’t carried out as they were functioning. In two cases the endoprosthesis replacement was performed. In the research group the bleeding after EPST developed in 5 (5,3%) patients; in the group of comparison – in 16 (17,6%) cases. Hemostasis resistant forms of postpapillotomy bleedings in the research group were revealed in 1 (1,1%) case; in the group of comparison – in 10 (10,9%).
Conclusions. Two-staged endoscopic papillosphincterotomy with the inter-staged biliary ducts stenting in patients with the planned extensive dissection of the major duodenal papilla on the background of its marked benign stenosis or large concretions of the main bile ducts is considered to be an effective way to decrease incidence of the postpapillotomy bleedings mainly severe and resistant forms to hemostasis.
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655017, Rossiiskaia Federatsiia, Respublika Khakasiia, g. Abakan, ul. Lenina, d. 92, FGBOU VPO «Khakasskii gosudarstvennyi universitet im. N. F. Katanova», kafedra khirurgii,
Iurchenko Vladimir Vladimirovich
Yurchenko V.V. MD, professor of the chair of surgery FSBEI HPE "Khakassia State University named by NF Katanov".