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PubMed1989

[Endoscopic papillosphincterotomy in the treatment of stenosing papillitis and choledocholithiasis].

During the period 1982-1988 the author has performed 532 endoscopic papillosphincterotomies. In 288 patients (53.13%) the gall bladder had been previously surgically removed and they suffered from a well-expressed postcholecystectomy syndrome. In 73.6% of the 532 patients there were one or more stones in the main bile duct. In 76 patients a stenosing papillitis was found. The endoscopic papillosphincterotomy was performed mainly in patients over 65 years of age--244 patients (45.86%) suffering from various cardiovascular and other accompanying diseases which increase the risk of operation. The following complications following the endoscopic papillosphincterotomy occurred: bleedings--0.50, acute pancreatitis--3%, lethality--4 patients (0.75%), three patients died following perforation of the duodenal wall (in spite of the immediate surgical treatment) and one patient died from acute destructive hemorrhagic pancreatitis.

Ampulla of Vater↗
PubMed1989

Choledocholithiasis: a comparison between the clinical presentations of multiple and solitary stones in the common bile duct.

The clinical presentations of 20 patients with four or more choledochal stones were compared with those of 68 patients who had one to three choledochal stones, investigated during the same time period. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy. Patients with multiple choledochal stones usually presented with insidious onset of painless jaundice, simulating malignant bile duct obstruction, in contrast to the abrupt onset of cholangitis or pain experienced by patients with one to three stones. The latter patients had an increased number of duodenal diverticula, higher bilirubins, smaller stones, and fewer positive stones as detected by ultrasound of the bile ducts. Cholesterol crystals were more numerous in duodenal aspirates of patients with multiple choledochal stones. We conclude that multiple choledochal stones have a unique, more smoldering clinical presentation, and that ERCP is the diagnostic procedure of choice. Endoscopic sphincterotomy is an efficient, simple, and safe alternative to surgery when there is no cholecystitis.

Adult↗
PubMedDate not supplied

[Difficulties in the differential x-ray diagnosis of choledocholithiasis].

The authors consider some difficulties in the roentgenological interpretation of the filling defect in the biliary tracts revealed by a direct contrast study using the TTC or ERCG methods. The greatest difficulties are observed in the presence of the parietal defect that can be determined by an undisplaceable concrement, a small polypoid cancer of the duct and metastases to the lymph nodes, the lesser omentum along the common bile and hepatic ducts. To differentiate between these diseases one should bear in mind a degree of outlining the filling defect with a contrast medium, the presence of a constricted area below the defect, local tenderness, and bile infectiousness. The authors also consider a problem of how to interpret the symptom of a "snake mouth" or a "concave lens" which (depending on its cause) can be either transient (in a large concrement) or stable (in an exophytic tumor, completely occluding the duct).

Aged↗
PubMed1989

[Transendoscopic mechanical lithotripsy in choledocholithiasis].

When there are large stones in the common bile duct or constrictions of the bile ducts the stones very often cannot pas spontaneously or after an endoscopically performed sphincterotomy. In 54 patients after an unsuccessful attempt to extract the stone with the Dormia-basket endoscopic mechanical lithotripsy was performed followed by balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and securing a bilionasal drainage for prophylaxis of cholangitis. The mechanical lithotripsy was successful in 50 of the patients (92.4%). The jaundice and the cholestasis decreased up to the 10-th day and the cytolytic enzymes became normal. Complications occurred in 2 patients (4%)--hemorrhage up to the 12-th hour after the manipulation. The author recommends, in cases of unsuccessful stone extraction by endoscopic sphincterotomy, the mechanical lithotripsy in combination with balloon extraction of the fragments, balloon dilatation of the constricted sectors of the bile duct and nasobiliary drainage for washing the bile ducts, prevention of bile duct occlusion and treatment of cholangitis in cases of unsuccessful extraction by endoscopic sphincterotomy.

Adult↗
PubMed1989

[Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

Aged↗