SUCCESSFUL APPLICATION OF PERORAL TRANSPAPILLARY CHOLANGIOSCOPY, CHOLECYSTOSCOPY, ELECTROHYDRAULIC LITHOTRIPSY FOR REMOVING LARGE CONCREMENTS FROM CHOLEDOCH AND GALL BLADDER AT MIRRIZZIS SYNDROME

Abstract

The article presents a case of the country’s first successful experience of endoscopic resolution of multiple choledocholithiasis and cholecystolithiasis using the technique of oral transpapillary cholangioscopy and contact electrohydraulic lithotripsy. Patient R., 67 years old with a diagnosis of cholelithiasis, choledocholithiasis, obstructive jaundice, underwent a typical endoscopic papillosphincterotomy, however, a standard lithoextraction, as well as the capture of calculi with a mechanical lithotripter, were technically impossible due to the size of stones and their tight fixation to the wall of the bile duct. Thus, the operational diagnosis was formulated as gallstone disease, CCC, multiple large choledocholithiasis, complicated by the formation of a cholecystocholedochial fistula (type III Mirrisi). After 5 days from the primary operation, the patient was scheduled for a second intervention in order to sanitize the biliary tree in the amount of ERCH; oral transpapillary cholangioscopy; contact electro-hydraulic lithotripsy of common bile duct calculi and biliary stenting. As a result, using the following equipment and instruments: duodenoscope - PENTAX ED-3490TK 4.2, cholangioscope - SpyGlass DS II (Boston Scientific), electrohydraulic lithotripter - Autolith Touch (Boston Scientific), conducting strings - Jagwire 0 / 035in (0.89mm), Dreamwire 0.035in (0.89mm) (Boston Scientific), dilatation balloon - CRE Wireguid-ed 8mm diameter, 5.5cm length (Boston Scientific), revision balloon - Extractor Pro RX 15mm / 18mm (Boston Scientific), mechanical lithotripter - Trapezoid RX (Boston Scientific) it was possible to successfully crush the calculi of the common bile duct, as well as to fragment the stones directly in the lumen of the gallbladder with complete sanitation of the biliary tract and rid the patient of cholecystectomy.