ENDOSCOPIC REMOVAL OF STONES FROM THE CHO LEDOCHUS - ARE THERE DEBATABLE QUESTIONS IN THIS PROBLEM

The article generalizes experience (1986-1991) in the treatment of 246 patients with choledocholithiasis with the performance of endoscopic papillosphincterotomy. Most patients (61%) were over 60 years of age, many had serious concomitant diseases. among patients with occlusion o f the bile ducts, 53.6% had obstructive purulrnt cholangitis, 53.6% ha d acute biliary pancreatitis, and 30.9% had acute cholecystitis. Typic al as well as atypical cannulation EPST was applied. To exclude an X-r ay load on the patient and doctor, the orifices of the terminal part o f the common bile duct and of the main pancreatic duct were identified in most patients by an elaborated method of cannulation with aspirati on control without preliminary contrast X-ray examination. after EPST the concrements were removed completely in 194 and partly in 52 patien ts. Complications occurred in 35 patients (bleeding in 5, acute pancre atitis in 8, acute cholangitis in 6, acute cholecystitis in 8, perfora tion of the duodenum in 1, and wedging of Dormia's baskcet in 8 patien ts. Eight patients died after EPST from unresolved purulent cholangiti s and multiple cholangitic abscesses of the liver. The lave-term resul ts were studied in follow-up periods of 12 months to 7 years. Recurren t cholelithiasis was encountered in 2 patients. On the basis of the ac cumulated experience we believe EPST to be the method of choice in the management of: residual and recurrent choledocholithiasis, patients w ith cholecystocholedocholithiasis and operation risk factors, patinets with acute biliary pancreatitis and acute obstructive cholangitis.