THE ANALYSIS OF REASONS OF FAILURES TRANSPAPILLARY METHODS OF TREATMENT OF OBSTRUCTIVE JAUNDICE OF CANCEROUS GENESIS

To analyze the reasons of failed transpapillary interventions in malignant obstructive jaundice.

Single-center retrospective study of results of treatment of patients with malignant obstructive jaundice, in which an attempt of transpapillary endoscopic decompression (n=433) was done. We analyzed cases of clinical and technical failure (n=89) of endoscopic retrograde cholangiopancreatography (ERCP), demanded antegrade biliary drainage.

Analysis of cases of technical failure of endoscopic transpapillary decompression revealed following causes: inability to reach major duodenal papilla (MDP) due to stenosis of the gastric outlet - 10 (11.2%); inability to visualize MDP - 3 (3.4%); unsuccessful cannulation of the common bile duct - 26 (29.2%); high biliary stricture - 20 (22.5%); tumor proliferation in the area of MDP - 10 (11.2%); previously performed Billroth-2 gastrectomy - 5 (5.6%). Clinical failure of transpapillary stenting was detected in 15 (16.9%) patients.

Transpapillary intervention in malignant obstructive jaundice had technical success rate 82.9%, with clinical failure in 20.6% of patients. High biliary stricture was significantly more frequent in group of failed ERCP (X²=47.448, p<0.001) in comparison to the group of successful transpapillary decompression (n=8; 5.2%). Frequency of failed endoscopic biliary decompression in patients,with previous Billroth-2 gastrectomy was significantly greater than in successful ERCP group (n=1; 0.29%, p=0.002). Despite this, impaired gastroduodenal anatomy and high biliary strictures are not a contraindication for endoscopic transpapillary decompression. Failed ERCP was associated with higher mortality (X2=4.574; p=0.032). Unit providing treatment of patients with malignant obstructive jaundice should have alternative methods of biliary drainage.