Aim. To study the contribution of biliary sludge (BS) to the development of chronic pancreatitis in patients with gallbladder sludge and verified chronic pancreatitis; to evaluate the clinical efficacy and safety of hymecromone therapy according to clinical and laboratory signs, as well as dynamics of gallbladder size and contractility.Materials and methods. An open single-centre clinical trial included 30 patients with chronic pancreatitis (CP), which was diagnosed according to the Cambridge criteria. All patients received hymocromone (Odeston®) 400 mg tid for 3 weeks. An analysis of the efficacy and safety of the studied drug was performed on the 21st day of treatment based on the results of laboratory tests, abdominal ultrasound, cholecystography and endosonography of the pancreatobiliary zone, quality-of-life assessment according to the SF-36 questionnaire, the frequency and severity of adverse effects (AE).Results. CP signs were found in 6.3 % of patients with gallbladder BS. CP was significantly more frequent in patients with putty-like bile (33.3 %, χ2 = 38.21, p < 0.00001). The area of the major duodenal papilla (MDP) was below normal in 78% of patients. According to factor analysis, monotherapy with hymocromone resulted in a decrease in abdominal pain, nausea, heaviness in the abdomen and bloating. By the end of the therapy, the quality of life according to the “BP” bodily pain scale of the SF-36 questionnaire significantly increased.Conclusions. Biliary sludge (including undiagnosed forms during routine examination) was found to be a factor in the development of CP. The medical correction of biliary disorders in CP should include selective antispasmodics. Hymecromone therapy demonstrates a good level of tolerability and safety, normalizes the motor function of the biliary tract and sphincter tone over a short period of time, and relieves CP symptoms.

Aim. A clinical demonstration of the feasibility of novel superpulsed thulium fibre laser in contact intraductal lithotripsy in patients with choledocholithiasis and pancreatic lithiasis.Key points. We describe two clinically successful ablations of large biliary and pancreatic calculi using a FiberLase U2 superpulse fibre thulium laser appliance (IRE-Polus, Russia) during oral transpapillary cholangiopancreaticoscopy in patients with technically unfeasible conventional minimally invasive treatment for choledocho- and pancreatic lithiasis. A 72-yo patient was urgently admitted with acute mechanical jaundice, cholangitis and a history of endoscopic papillosphincterotomy (EPST) and bilioduodenal stenting with a plastic implant for technically impractical lithotripsy and lithoextraction. An ineffective extracorporeal lithotripsy attempt was followed on day 3 by a second retrograde intervention and endoscopic contact laser lithotripsy controlled in oral transpapillary cholangioscopy with FiberLase U2. A 50-yo patient was admitted with clinical signs of chronic calculous pancreatitis and a history of EPST, pancreatic ductotomy and plastic pancreatic stenting. The first endoscopy stage comprised the encrusted pancreatic stent removal, retrograde pancreaticography, pancreatic ductotomy, narrowed terminal Wirsung’s duct bougienage with mechanical dilators and additional balloon-assisted dilation of the excision area and pancreatic stricture. Mechanical intraductal lithotripsy was unsuccessful. Contact lithotripsy with a novel superpulsed fibre thulium laser has been rendered. The technique presented ensures a complete sanation of the duct at no mucosal damage.Conclusion. We present the fully successful first national and world experience of the superpulsed fibre thulium laser application in contact lithotripsy of large calculi in common bile and main pancreatic ducts.

Objective. Retrospective analysis of the treatment of complications after endoscopic retrograde transpapillary interventions. Material and methods. There were 5701 endoscopic retrograde interventions for the period from 01.01.2008 to 01.01.2019. Overall incidence of complications was 1.5%, mortality rate – 0.24%. Bleeding after endoscopic papillosphincterotomy developed in 13 (0.22%) cases, acute postoperative pancreatitis in 49 (10.85%) cases, ERCPassociated perforation in 24 (0.42%) patients. Results. Endoscopic approach (epinephrine injection into the edges of major duodenal papilla and cautery) was usually effective for bleeding after endoscopic retrograde cholangiopancreatography. Massive intraoperative bleeding required surgical treatment in one case with favorable outcome. There were no cases of recurrent bleeding. One patient died due to severe bleeding in 3 days after surgery. ERСP-associated (“retroduodenal”) perforation occurred in 24 (0.42%) patients. Endoscopic treatment was undertaken in 16 cases and was effective in 15 (93.75%) cases. Overall mortality among patients with ERCP-induced perforation was 20.8%. An attempt of pancreatic duct stenting for postoperative pancreatitis was made in 30 cases; successful procedure was in 28 (93.3%) cases. Surgery resulted recovery in 26 (86.7%) patients. Progression of acute postoperative pancreatitis followed by death occurred in 2 cases despite successful pancreatic duct stenting. Mortality rate was 25%. Conclusion. Treatment of ERCP-associated complication is lengthy, time-consuming and expensive. Timely diagnosis and assessment of severity of complications is essential. It is necessary to determine an adequate surgical approach. Everyone should keep in mind all possible risk factors, clearly define the indications for ERCP and follow the technique of the procedure strictly in order to reduce complication rate. In our opinion, endoscopic approach is advisable for post-ERCP complications, because conventional surgery results higher postoperative mortality, increased duration and cost of treatment.

Ñîâðåìåííûå òåõíîëîãèè ëå÷åíèÿ ðóáöîâûõ ñòðèêòóð aeåë÷íûõ ïðîòîêîâ Цель. Оценить возможности и отдаленные результаты эндоскопического транспапиллярного лечения послеоперационных стриктур билиарного тракта. Материал и методы. 83 больным с рубцовым поражением желчных протоков предпринята попытка эндоскопической транспапиллярной коррекции. У всех больных стриктуры являлись результатом ятрогенных повреждений желчевыводящих протоков. Стриктура типа «−1» была у 3 больных, «0»-у 18 (21,7%), «+1»у 37 (44,6%) и « +2»-у 25 (30,1%) больных. Результаты. Эндоскопическое транспапиллярное стентирование стриктуры было технически выполнимо в 64 (77,1%) наблюдениях и у всех больных явилось окончательным методом лечения, длительность которого составила от 8 до 46 мес. Интервал между эпизодами редренирования составлял 3-4 мес. Протезирование двумя стентами было выполнено у 29 (45,3%) больных, тремя-у 9 (14,1%), четырьмя и пятью-у 2 (3,1%) и 1 (1,6%) больного соответственно. У 19 (22,9%) из 83 больных попытки ретроградного стентирования протоков не удались: у 13 (62%) из 21 больного со стриктурами типов «−1» и «0» и у 6 (9,7%) из 62 больных со стриктурами типов «+1» и «+2», p < 0,01. 16 из 19 больных были в дальнейшем оперированы. Отдаленные результаты прослежены у 49 (76,5%) больных в сроки от 1 до 20 лет: у 3 больных со стриктурами типов «−1» и «0» и у 46 больных со стриктурами типов «+1» и «+2». Хорошими они признаны у 42 (85,7%), удовлетворительными-у 4 (8,2%), неудовлетворительными-у 3 (6,1%) больных. Заключение. Эндоскопическое транспапиллярное стентирование рубцовых послеоперационных стриктур желчных протоков технически выполнимо и позволяет добиться стабильного положительного результата более чем у 90% больных со стриктурами типов «+1» и «+2». Техническая возможность стентирования и положительные результаты достигнуты в 33% наблюдений при стриктуре типа «−1» и в 39% при типе «0». Неудовлетворительные отдаленные результаты наблюдались у 6% больных и были связаны с высоким уровнем стриктуры и ее протяженностью. Клю че вые сло ва: рубцовые стриктуры желчных протоков, послеоперационные стриктуры, эндоскопическая ретроградная холангиография, эндоскопическое стентирование, билиарная гипертензия.