[Endoscopic papillosphincterotomy in patients with acute cholecystitis and lesions of the common bile duct].

The authors analyse treatment of 115 patients who were admitted for acute cholecystitis with involvement of the bile ducts which manifested itself as a rule, as obstructive jaundice and cholangitis. Endoscopic papillosphincterotomy (EPST) was conducted as the first stage of treatment in 83 patients, as the second stage after cholecystectomy or laparoscopic cholecystotomy in 30, and during the surgical intervention in 2 patients. Experience shows that treatment of this contingent of patients in two stages is advisable. In emergency operations for acute cholecystitis, when the revealed abnormalities in the hepaticocholedochus cannot be corrected adequately due to the patient's severe condition or marked inflammatory changes in the region of the hepatoduodenal ligament, the operation should be completed by drainage of the common bile duct and antegrade or retrograde EPST should be performed in the post-operative period. In the presence of obstructive jaundice and acute suppurative cholangitis, when there is a high operative risk, EPST should be undertaken as an emergency intervention ensuring timely decompression and cleansing of the bile ducts. In 37.3% of patients EPST was conducted by an atypical method due to the high operative risk, as a result the efficacy of the endoscopic operation increased to 93.3%.