Endoscopic Transpapillary Interventions.
Endoscopic Transpapillary Interventions.
The aim of the research has become to create a sphincterotome and a method that takes into
 account the anatomical structure of the sph Oddi. The disadvantages of pull-type
 sphincterotome led to develop a new sphincterotome. The characteristic features of new
 antegrade sphincterotome are: it is inserted ready to use; the direction of cutting is
 strictly determined; fully controlled depth of the cut. Thanks to shaping as it hook the
 sphincterotome has been extracted cutting the circular layer only. The cutting wire is
 located between two teflon catheters preventing the longitudinal muscle layer from being
 damaged. The distance between the catheters determines the depth of the cut. Endoscopic
 transpapillary antegrade sphincterotomy developed by Dr. Dovbenko -(ASD) performance in such
 case allowed: to manage the papillary stenosis; to treat complicated form of gallstone
 disease; In research group this method allowed to avoid cholecystectomy in 71,2 % of cases
Sph of Oddi consists of a circular inner muscle layer and a longitudinal outer muscle layer.
 The circular layer does not depend on the duodenum. The longitudinal layer passes from the
 wall of the duodenum and separates ascending and descending parts superimposing over its
 circular layer. The arrangement of these layers towards each others is constant. Mostly ERCP
 complications are caused by the interventions in major papilla and remain at a high level of
 frequency up to 23 % Cutting all the layers of duodenum leads to bleeding up to 3 %. The
 perforation might happened up to 1 % Destruction of the opening mechanism after
 sphincterotomy leads to develop of reflux cholangitis, acute cholecystitis. It is possible to
 avoid further cholecystectomy only in 10% of patients. Incapability of performing the
 retrograde sphincterotomy in patients with extended papillary stenosis led to the creation of
 a new method - ASD. Retrograde and antegrade sphincterotomies are analysed. 750 patients
 underwent ASD within 7 years 65 % in urgent cases . Relative risk of complication after ASD
 performing 3 times less. Taking into consideration possible post-ASD inner edema, plastic
 biliary/pancreatic stent(s) are required during 5-10 days after. Standard methods for post
 ERCP pancreatitis prevention must be applied in all cases. The new method performed some
 selective. First of all young patient with alone stone in the common bile duct, women after
 after childbirth. secondly, elderly patient were cured by ASD. And as well as a group of
 patients with severe comorbid diseases, such as renal failure, acute myocardial infarction.
 In our research, in two patients with AIDS was performed ASD. They were on special treatment
 after being diagnosed with HIV-infection, within 2 years. It was SSC. Papillary stenosis and
 cholangiolithiasis were cured successfully. The use of ASD with preservation of the closure
 function of the sph. Oddi allowed to avoid cholecystectomy in 71.2%. ASD can be performed new
 design of sphincterotome. It takes into account the anatomical structure of sph. Oddi and is
 recommended as an alternative to standard sphincterotomy, balloon dilatation and drainage
 interventions (RR 0,55 [95%CI 0,18 to 1,67]. ASD must be performed by an endoscopist with
 experience in transpapillary intervention.
Inclusion Criteria:

 Clinical diagnosis of Gallstone Disease. Must have anatomy of the esophagus of the stomach
 and duodenum for the introduction of a duodenoscope to the major duodenal papilla.

 Exclusion Criteria:

 The acute form of viral hepatitis of any etiology. Acute decompensated heart failure
 complicated by respiratory failure.