Slobodyanyk V. Optimization of treatment of patients with choledocholithiasis by use of distance and contact lithothrypsy with endiscopic papillosphyncterotomy.

The results of examination and treatment of 1420 patients with choledocholithiasis (CL), divided into 2 groups: first - 708 patients (2002-2004) and second - 712 patients (2005-2007). On the basis of stone diameter (SD) and diameter of intrapancreatic part (DIP) of common bile duct (CBD) ratio were proposed 3 degrees of endoscopic bile ducts sanation difficulty in CL: first degree (61.9% patients) - SD less than DIP of CBD; second (19.8%) - SD equal (±1 mm) to DIP of CBD; third (18.3%) - SD larger than DIP of CBD or stone located proximal to CBD stricture. Staged diagnostic algorithm to determine the degree of endoscopic bile ducts sanation difficulty was proposed and differential treatment tactic with priority of endoscopic transpapillary operations and different lithotripsy techniques was used. Use of proposed treatment tactic with differential choice of biliary ducts sanation in dependence from determined sanation difficulty degree leads to decrease of endoscopic treatment failures rate from 7.91 inthe first group to 4.92% in the second group (in 1.6 times) (P < 0.05), complications rate from 7.63 to 3.51% (in 2.2 times) (P < 0.05) and mortality from 0.85 to 0.56% (in 1.5 times) (P > 0.05).