Aim. To demonstrate our own experience of performing transfistula cholangioscopy and removing bile duct stones.Materials and Methods. From 2017 to 2019, 230 patients with functioning external biliary drains underwent antegrade transfistula cholangioscopy. Preliminary dilatation and straightening of the fistulous tract were required in 37 patients.Results. Bile duct stones were detected in 158 (68.7%) patients. During transfistula cholangioscopy, stones were removed from all patients. In 68 cases with large choledocholithiasis, it was necessary to perform contact lithotripsy. To this end, staged treatment and two hospitalizations were required in five cases. Adequate transfistular access to the bile ducts was formed during the first hospital stay; during the second, after hardening of the access walls, the stones were removed. The overall complication rate was 3.8%, including grade III–IV complications (1.9%) according to the Clavien–Dindo classification. Mortality was 0.4%.Conclusion. Transfistula cholangioscopy increases the reliability of stone detection in the bile ducts, permits removing them without mandatory dissection of the major duodenal papilla, and creates favorable conditions for a more accurate assessment of its functional state. When patients with functioning biliary drains and unresolved bile duct diseases are placed in a specialized medical center, they can be provided with high-quality care. Additionally, it creates rational conditions for the use of the highly effective methods of endobiliary diagnosis and treatment.

Background. Primary reconstructive operations aimed at restoring the passage of bile are rather complicated due to the cicatricial process and in 1530% lead to a distant recurrence of the disease. Aim. To present the results of combined X-ray surgery and endoscopic transfistula antegrade interventions in the treatment of benign bile duct strictures. Material and methods. For the period from 2011 to 2019 31 patients with benign bile duct strictures were treated in the surgical departments of the City Clinical Hospital No. 14 in Yekaterinburg. The mean age of the patients was 60.312.7 years, the comorbidity index was 2.6. As follows from the presented data, in 13 patients the stricture developed in the area of biliodigestive anastomoses. Another 17 patients had stricture after surgery for cholelithiasis. In 1 case, there was a persistent narrowing of the lumen of the choledochus against the background of indurative pancreatitis. In 25 (80.6%) cases, the first step was percutaneous transhepatic cholangiostomy under ultrasound guidance. Another 6 (19.4%) patients had a T-shaped drainage of the choledochus. Results. For the treatment of strictures of the bile ducts, 97 operations were performed: an average of 3.1 operations per 1 patient. Lithoextraction with a wire basket was performed in 17 patients with calculi. 5 patients with stones larger than 10 mm required contact lithotripsy. Stricture was confirmed in 25 patients. Balloon dilatation was performed in 21 cases. In 8 cases, dilatation was supplemented with papillosphincterotomy. In 6 patients with deformation of the anastomosis zone, framed drainage was installed for 12 months. In 3 patients, bilioduodenal stenting with a nitinol stent was performed. It was not possible to recanalize the stricture in 4 (13%) cases. Complications were registered in 1 (3.2%) patient (IIIB degree according to ClavienDindo). Conclusion. Transfistula cholangioscopy is an effective endoscopic technology in the treatment of patients with benign bile duct strictures.

The present paper describes clinical observation of successful treatment of a patient with chronic calcifying pancreatitis complicated by an external pancreatic fistula. Abdominal surgery after laparotomy and cholecystectomy had to be limited to bursoomentostomy due to the bleeding tissues and severe blood loss. Combined endoscopic intervention through the external pancreatic fistula was used for the treatment. The performed interventions included stone extraction in Wirsung’s duct, dilation and stenting of the distal stricture of the pancreatic duct. The fistula closed, a pain-free period lasted for 3 years. Similar transfistula interventions were performed in 7 patients with chronic pancreatitis and external pancreatic fistulas, lithiasis in Wirsung's duct (n = 5) and pancreatic duct strictures (n = 6). A total of 17 procedures were performed, 7 of 8 fistulas were closed. Complications developed in 3 observations, no lethal outcome was registered.Conclusion. Transfistula interventions in pancreatic ducts with combined X-ray guidance, oral and transfistula endoscopy can be used to remove stones, dilate strictures and restore natural passage of pancreatic secretions as an independent treatment or preparation for planned abdominal surgery.