hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2017336-44hepato-39Research ArticleСОВРЕМЕННЫЕ ТЕХНОЛОГИИ ЛЕЧЕНИЯ РУБЦОВЫХ СТРИКТУР ЖЕЛЧНЫХ ПРОТОКОВMODERN TECHNOLOGIES OF TREATMENT OF BENIGN BILE DICT STRICTURESЭНДОСКОПИЧЕСКОЕ ЛЕЧЕНИЕ ПОСТТРАВМАТИЧЕСКИХ СТРИКТУР ЖЕЛЧНЫХ ПРОТОКОВENDOSCOPIC TREATMENT OF POSTTRAUMATIC BILIARY STRICTURESСтарковЮ. Г.StarkovYu. G.СолодининаЕ. Н.SolodininaE. N.ЗамолодчиковР. Д.ZamolodchikovR. D.

Замолодчиков Родион Дмитриевич – младший научный сотрудник хирургического эндоскопического отделения ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ. 

Для корреспонденции: 117997, Москва, ул. Большая Серпуховская, д. 27, ФГБУ “Институт хирургии им. А.В. Вишневского” Минздрава России. Тел.: +7-926-133-94-90. E-mail: rzamolod@yandex.ru

Zamolodchikov Rodion Dmitrievich – Junior Researcher of the Endoscopic Surgical Department, A.V. Vishnevsky Institute of Surgery. 

For correspondence: 27, Bol'shaya Serpukhovskaya,  A.V. Vishnevsky Institute of Surgery, Moscow, 115093, Russian Federation. Phone: +7-926-133-94-90. E-mail: rzamolod@yandex.ru

rzamolod@yandex.ruДжантухановаС. В.DzhantukhanovaS. D.ВыборныйМ. И.VyborniyM. I.ЛукичК. В.LukichK. V.ФГБУ “Институт хирургии им. А.В. Вишневского” Минздрава России.РоссияA.V. Vishnevsky Institute of Surgery, Ministry of Healthcare of Russia.Russian Federation2017301020172233644Copyright © Старков Ю.Г., Солодинина Е.Н., Замолодчиков Р.Д., Джантуханова С.В., Выборный М.И., Лукич К.В., 20172017Старков Ю.Г., Солодинина Е.Н., Замолодчиков Р.Д., Джантуханова С.В., Выборный М.И., Лукич К.В.Starkov Y.G., Solodinina E.N., Zamolodchikov R.D., Dzhantukhanova S.D., Vyborniy M.I., Lukich K.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/39Цель

Цель. Оценить возможности эндоскопического лечения ятрогенных стриктур желчных протоков.

Материал и методы

Материал и методы. 14 пациентам в период с 2014 по 2016 г. проведено эндоскопическое лечение ятрогенных стриктур желчных протоков. Протокол лечения включал выполнение ЭРХПГ, баллонную дилатацию или бужирование зоны стриктуры с последующим стентированием несколькими пластиковыми стентами. После первичной манипуляции через каждые 3–4 мес проводили этапное рестентирование с минимальным сроком лечения 12 мес.

Результаты

Результаты. Уровень технического успеха составил 100%. Этапное стентирование завершено у 7 из 10 находящихся под наблюдением пациентов. Клинический успех, определенный как разрешение стриктуры, отмечен у 6 из 7 больных с завершенным стентированием. Интраоперационное осложнение в виде кровотечения отмечено в 1 наблюдении, с гемостатической целью было выполнено успешное стентирование общего желчного протока покрытым металлическим стентом. Рецидив стриктуры отмечен в 1 наблюдении через 5 мес после окончания лечения, что потребовало повторного эндоскопического вмешательства.

Заключение

Заключение. Эндоскопическое лечение может рассматриваться в качестве  эффективного и безопасного метода устранения ятрогенных стриктур желчных протоков. Оценка уровня эффективности и безопасности требует дальнейшего накопления опыта и проведения  крупных исследований. 

Aim

Aim. To demonstrate the feasibilities of endoscopic treatment of iatrogenic biliary strictures.

Material and Methods

Material and Methods. The series of 14 patients underwent endoscopic treatment of biliary strictures for the period 2014–2016. Treatment protocol included ERCP, balloon or bougie dilation of strictures followed by stenting with several plastic stents. After primary endoscopic procedure all patients underwent step-wise re-stenting procedures with minimal duration of treatment of 12 months.

Results

Results. Technical success rate of endoscopic procedures is 100%. Step-wise endoscopic stenting was completed in 7 out of 10 followed-up patients. Clinical success determined by release of stricture was achieved in 6 out of 7 patients with complete endoscopic treatment. Intraoperative bleeding occurred in one patient that required stenting with SEMS for hemostasis. Recurrent stricture was observed in one patient and required repeated endoscopic procedure.

Conclusion

Conclusion. Endoscopic procedures are effective and safe treatment option for iatrogenic biliary strictures, but more wide studies are needed for appropriate assessment of the results.

лапароскопическая холецистэктомияжелчные протокиятрогенное повреждениестриктураэндоскопическое лечениеlaparoscopic cholecystectomybile ductsiatrogenic injurystrictureendoscopic treatmentReferencesMisra M., Schiff J., Rendon G., Rothschild J., Schwaitzberg S. Laparoscopic cholecystectomy after the learning curve: what should we expect? Surg. Endosc. 2005; 19 (9): 1266–1271. DOI: 10.1007/s00464-004-8919-5.Misra M., Schiff J., Rendon G., Rothschild J., Schwaitzberg S. Laparoscopic cholecystectomy after the learning curve: what should we expect? Surg. Endosc. 2005; 19 (9): 1266–1271. DOI: 10.1007/s00464-004-8919-5.Tantia O., Jain M., Khanna S., Sen B. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg. Endosc. 2008; 22 (4): 1077–1086. DOI: 10.1007/s00464-007-9740-8.Tantia O., Jain M., Khanna S., Sen B. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg. Endosc. 2008; 22 (4): 1077–1086. DOI: 10.1007/s00464-007-9740-8.Harboe K.M., Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg. Endosc. 2011; 25 (5): 1630–1641. DOI: 10.1007/s00464-010-1453-8.Harboe K.M., Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg. Endosc. 2011; 25 (5): 1630–1641. DOI: 10.1007/s00464-010-1453-8.Perera M.T., Monaco A., Silva M.A., Bramhall S.R., Mayer A.D., Buckels J.A. Laparoscopic posterior sectoral bile duct injury: the emerging role of nonoperative management with improved long-term results after delayed diagnosis. Surg. Endosc. 2011; 25 (8): 2684–2691. DOI: 10.1007/s00464-011-1630-4.Perera M.T., Monaco A., Silva M.A., Bramhall S.R., Mayer A.D., Buckels J.A. Laparoscopic posterior sectoral bile duct injury: the emerging role of nonoperative management with improved long-term results after delayed diagnosis. Surg. Endosc. 2011; 25 (8): 2684–2691. DOI: 10.1007/s00464-011-1630-4.Bismuth H., Majno P.E. Biliary strictures: classification based on the principles of surgical treatment. World J. Surg. 2001; 25 (10): 1241–1244.Bismuth H., Majno P.E. Biliary strictures: classification based on the principles of surgical treatment. World J. Surg. 2001; 25 (10): 1241–1244.Strasberg S.M., Hertl M., Soper N.J. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J. Am. Coll. Surg. 1995; 180 (1): 101–125.Strasberg S.M., Hertl M., Soper N.J. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J. Am. Coll. Surg. 1995; 180 (1): 101–125.Stewart L. Iatrogenic biliary injuries: identification, classification, and management. Surg. Clin. N. Am. 2014; 94 (2): 297–310. DOI: 10.1016/j.suc.2014.01.008.Stewart L. Iatrogenic biliary injuries: identification, classification, and management. Surg. Clin. N. Am. 2014; 94 (2): 297–310. DOI: 10.1016/j.suc.2014.01.008.Lau W.Y., Lai E.C., Lau S.H. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J. Surg. 2010; 80 (1–2): 75–81. DOI: 10.1111/j.1445-2197.2009.05205.x.Lau W.Y., Lai E.C., Lau S.H. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J. Surg. 2010; 80 (1–2): 75–81. DOI: 10.1111/j.1445-2197.2009.05205.x.Гальперин Э.И., Чевокин А.Ю. Факторы, определяющие выбор операции при “свежих” повреждениях магистральных желчных протоков. Анналы хирургической гепатологии. 2009; 14 (1): 49–56.Galperin E.I., Chevokin A.Yu. Master factors of choice in surgery of main bile duct “fresh” injuries. Annaly khirurgicheskoy gepatologii. 2009; 14 (1): 49–56. (In Russian)Thompson C.M., Saad N.E., Quazi R.R., Darcy M.D., Picus D.D., Menias C.O. Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics. 2013; 33 (1): 117–134. DOI: 10.1148/rg.331125044.Thompson C.M., Saad N.E., Quazi R.R., Darcy M.D., Picus D.D., Menias C.O. Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics. 2013; 33 (1): 117–134. DOI: 10.1148/rg.331125044.Zepeda-Gomez S., Baron T.H. Benign biliary strictures: current endoscopic management. Nat. Rev. Gastroenterol. Hepatol. 2011; 8 (10): 573–581. DOI: 10.1038/nrgastro.2011.154.Zepeda-Gomez S., Baron T.H. Benign biliary strictures: current endoscopic management. Nat. Rev. Gastroenterol. Hepatol. 2011; 8 (10): 573–581. DOI: 10.1038/nrgastro.2011.154.Costamagna G., Familiari P., Tringali A., Mutignani M. Multidisciplinary approach to benign biliary strictures. Curr. Treatm. Opt. Gastroenterol. 2007; 10 (2): 90–101.Costamagna G., Familiari P., Tringali A., Mutignani M. Multidisciplinary approach to benign biliary strictures. Curr. Treatm. Opt. Gastroenterol. 2007; 10 (2): 90–101.Fazel A., Draganov P., Moezardalan K. Navigating the hilum: utility of a steerable catheter for selective cannulation of the intrahepatic bile ducts. Gastrointest. Endosc. 2005; 61: AB204.Fazel A., Draganov P., Moezardalan K. Navigating the hilum: utility of a steerable catheter for selective cannulation of the intrahepatic bile ducts. Gastrointest. Endosc. 2005; 61: AB204.Baron D.E. Dilation of a difficult benign pancreatic duct stricture using the Soehendra stent extractor. Gastrointest. Endosc. 1997; 46 (2): 178–180.Baron D.E. Dilation of a difficult benign pancreatic duct stricture using the Soehendra stent extractor. Gastrointest. Endosc. 1997; 46 (2): 178–180.Ziebert J.J., DiSario J.A. Dilation of refractory pancreatic duct strictures: the turn of the screw. Gastrointest. Endosc. 1999; 49 (5): 632–635.Ziebert J.J., DiSario J.A. Dilation of refractory pancreatic duct strictures: the turn of the screw. Gastrointest. Endosc. 1999; 49 (5): 632–635.Pozsar J., Sahin P., Laszlo F., Topa L. Endoscopic treatment of sphincterotomy-associated distal common bile duct strictures by using sequential insertion of multiple plastic stents. Gastrointest. Endosc. 2005; 62 (1): 85–91.Pozsar J., Sahin P., Laszlo F., Topa L. Endoscopic treatment of sphincterotomy-associated distal common bile duct strictures by using sequential insertion of multiple plastic stents. Gastrointest. Endosc. 2005; 62 (1): 85–91.Kassab C., Prat F., Liguory C., Meduri B., Ducot B., Fritsch J. Endoscopic management of post-laparoscopic cholecystectomy biliary strictures. Long-term outcome in a multicenter study. Gastroenterol. Clin. Biol. 2006; 30 (1): 124–129.Kassab C., Prat F., Liguory C., Meduri B., Ducot B., Fritsch J. Endoscopic management of post-laparoscopic cholecystectomy biliary strictures. Long-term outcome in a multicenter study. Gastroenterol. Clin. Biol. 2006; 30 (1): 124–129.Draganov P., Hoffman B., Marsh W., Cotton P., Cunningham J. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest. Endosc. 2002; 55 (6): 680–686.Draganov P., Hoffman B., Marsh W., Cotton P., Cunningham J. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest. Endosc. 2002; 55 (6): 680–686.Costamagna G., Tringali A., Mutignani M., Perri V., Spada C., Pandolfi M. Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up. Gastrointest. Endosc. 2010; 72 (3): 551–557. DOI: 10.1016/j.gie.2010.04.052.Costamagna G., Tringali A., Mutignani M., Perri V., Spada C., Pandolfi M. Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up. Gastrointest. Endosc. 2010; 72 (3): 551–557. DOI: 10.1016/j.gie.2010.04.052.Saleem A., Baron T.H., Gostout C.J., Topazian M.D., Levy M.J., Petersen B.T. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy. 2010; 42 (8): 656–660. DOI: 10.1055/s-0030-1255557.Saleem A., Baron T.H., Gostout C.J., Topazian M.D., Levy M.J., Petersen B.T. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy. 2010; 42 (8): 656–660. DOI: 10.1055/s-0030-1255557.Raithel M., Dormann H., Naegel A., Boxberger F., Hahn E.G., Neurath M.F. Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients. World J. Gastroenterol. 2011; 17 (18): 2302–2314. DOI: 10.3748/wjg.v17.i18.2302.Raithel M., Dormann H., Naegel A., Boxberger F., Hahn E.G., Neurath M.F. Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients. World J. Gastroenterol. 2011; 17 (18): 2302–2314. DOI: 10.3748/wjg.v17.i18.2302.Wang A.Y., Sauer B.G., Behm B.W., Ramanath M., Cox D.G., Ellen K.L. Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy. Gastrointest. Endosc. 2010; 71 (3): 641–649. DOI: 10.1016/j.gie.2009.10.051.Wang A.Y., Sauer B.G., Behm B.W., Ramanath M., Cox D.G., Ellen K.L. Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy. Gastrointest. Endosc. 2010; 71 (3): 641–649. DOI: 10.1016/j.gie.2009.10.051.Kahaleh M., Tokar J., Le T., Yeaton P. Removal of selfexpandable metallic Wall stents. Gastrointest. Endosc. 2004; 60 (4): 640–644.Kahaleh M., Tokar J., Le T., Yeaton P. Removal of selfexpandable metallic Wall stents. Gastrointest. Endosc. 2004; 60 (4): 640–644.Yamaguchi T., Ishihara T., Seza K., Nakagawa A., Sudo K., Tawada K. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis. World J. Gastroenterol. 2006; 12 (3): 426–430.Yamaguchi T., Ishihara T., Seza K., Nakagawa A., Sudo K., Tawada K. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis. World J. Gastroenterol. 2006; 12 (3): 426–430.van Boeckel P.G., Vleggaar F.P., Siersema P.D. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol. 2009; 9: 96. DOI: 10.1186/1471-230X-9-96.van Boeckel P.G., Vleggaar F.P., Siersema P.D. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol. 2009; 9: 96. DOI: 10.1186/1471-230X-9-96.Pausawasadi N., Soontornmanokul T., Rerknimitr R. Role of fully covered self-expandable metal stent for treatment of benign biliary strictures and bile leaks. Korean J. Radiol. 2012; 13 Suppl. 1: S67–73. DOI: 10.3348/kjr.2012.13.S1.S67.Pausawasadi N., Soontornmanokul T., Rerknimitr R. Role of fully covered self-expandable metal stent for treatment of benign biliary strictures and bile leaks. Korean J. Radiol. 2012; 13 Suppl. 1: S67–73. DOI: 10.3348/kjr.2012.13.S1.S67.Cote G.A., Slivka A., Tarnasky P., Mullady D.K., Elmunzer B.J., Elta G. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA. 2016; 315 (12): 1250–1257. DOI: 10.1001/jama.2016.2619.Cote G.A., Slivka A., Tarnasky P., Mullady D.K., Elmunzer B.J., Elta G. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA. 2016; 315 (12): 1250–1257. DOI: 10.1001/jama.2016.2619.Park J.S., Lee S.S., Song T.J., Park do H., Seo D.W., Lee S.K. Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures. Endoscopy. 2016; 48 (5): 447. DOI: 10.1055/s-0042-106402.Park J.S., Lee S.S., Song T.J., Park do H., Seo D.W., Lee S.K. Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures. Endoscopy. 2016; 48 (5): 447. DOI: 10.1055/s-0042-106402.Хрусталева М.В., Дехтяр М.А., Ягубян Г.К. Эндоскопические транспапиллярные методы лечения холедохолитиаза. Анналы хирургической гепатологии. 2015; 20 (4): 74–80.Khrustaleva M.V., Dekhtyar M.A., Yagubyan G.K. Endoscopic transpapillary treatment of choledocholithiasis. Annaly khirurgicheskoy gepatologii. 2015; 20 (4): 74–80. (In Russian)Шаповальянц С.Г., Паньков А.Г., Мыльников А.Г., Будзинский С.А., Орлов С.Ю. Возможности эндоскопического билиодуоденального протезирования в лечении опухолевых и рубцовых стриктур внепеченочных желчных протоков. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2008; 18 (6): 57–64.Shapoval'yants S.G., Pan'kov A.G., Mylnikov A.G., Budzinsky S.A., Orlov S.Yu. Endoscopic bilioduodenal stenting in treatment of neoplastic and fibrotic strictures of extrahepatic bile ducts. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2008; 18 (6): 57–64. (In Russian)

The authors declare that there are no conflicts of interest present.