This article represents clinical case of combined minimally-invasive therapy of gallstone disease complications, such as bile duct stones and jaundice in a patient with multiple allergy and intolerance of iodine-containing contrast. It describes of diagnostics and surgical sequence in non-standard situation in complicated retrograde and laparascopic approach to biliary tract.

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.

Cholelithiasis ranks third in the prevalence of diseases among the adult population. Such a complication as choledoc1holithiasis occurs in up to 33% of patients suffering from GI. Modern transpapillary methods of treatment of choledocholithiasis help to reduce the complications of retrograde interventions on the biliary tract and increases the frequency of favorable outcomes of the disease, returning patients to social activity.

Early post-transplant biliary complications are one of the most serious problems after orthotopic liver transplantation (OLT), their frequency varies from 10 to 35 %. Among them the most frequent are inconsistencies (from 7 to 25%) and strictures (from 4 to 9%) in the anastomosis area. Complete detachment of the edges of the biliary anastomosis area is usually the least amenable to endoscopic treatment; therefore, open surgical intervention from the laparatomic access should be strongly recommended. This article presents a rare clinical case of oral endoscopic transpapillary video cholangioscopy using Spy-glass system in a patient after orthotopic liver transplantation with complete diastasis of the biliary anastomosis edges. Use of Spy-glass video system allows performing direct visualization of the biliary tracts including small caliber, which provides an opportunity to carry out string-con-ductor even with complete diastasis of the anastomosis margins.

In clinical practice, various diseases of the organs of the biliary system are quite common. Therefore, examination of the biliary ducts is often necessary for adequate diagnosis and treatment of patients with biliary pathology. The technical advances in flexible endoscopy in recent years have led to the development of endoscopic retrograde cholangiopancreatography (ERCP). For the first time the method of oral cholangioscopy was described in the 70s. and has gained popularity in recent years. Oral cholangioscopy is an interesting technique because a direct view of the lumen of the bile duct system allows diagnostic and interventional procedures to be performed with greater accuracy than is possible with other endoscopic and radiological methods. With the improvement of cholangioscopy, it became possible to carry out medical procedures.