ENDOSCOPIC STENTING OF BILE DUCTS IN THE TREATMENT OF MECHANICAL JAUNDICE AND EXTERNAL BILIOPANCREATIC FISTULAS

Objective. To evaluate the effectiveness of endoscopic retrograde stenting of the extrahepatic bile ducts and the main pancreatic duct in malignant diseases and benign lesions of the pancreatobiliary zone. Materials and methods. Over the past six years, endoscopic retrograde stenting of extrahepatic bile ducts has been performed in 509 patients at the Perm Regional Clinical Hospital: 450 with malignant diseases, 59 with benign lesions. Plastic and partially covered self-expandable metal stents were used for primary stenting. After the intervention, the patients were observed for 1-3 years. According to the indications, repeated endoscopic interventions were performed. Results. Out of 450 patients with malignant diseases, the stent was able to be installed in 421 cases (93.55%): in 356 cases - plastic, in 65 - self-expandable. In six cases (1.42%) there was post- sphincterotomy bleeding. The plastic stent was replaced from two to seven times after 2-5 months (median 4), 37 patients were replaced with a self-expandable one. In 29 cases, a second stent was performed, and 13 more patients managed to install a "stent in a stent" during occlution of a self- expandable stent. The median life expectancy ranged from 4.5 to 11 months. Stenting with external biliary and pancreatic fistulas in 31 patients led to their closure. In benign strictures of bile ducts, plastic stent replacement was performed in 3-4 months in 28 patients at least three times. Conclusion. Endoscopic retrograde stenting of the bile ducts allowed in 93.25% of cases to eliminate mechanical jaundice in malignant neoplasms of the pancreatobiliary zone. In case of obstruction of plastic and self-expandable stents, it is possible to carry out a second stent or use the "stent to stent" technique. Endoscopic installation of stents in the bile and main pancreatic ducts above their defect in the presence of external bile or pancreatic fistulas leads to their rapid closure.