RU-2861631-C1 - METHOD FOR ENDOSCOPIC TREATMENT OF CHOLEDOCHOLITHIASIS

RU2861631C1RU 2861631 C1RU2861631 C1RU 2861631C1RU-2861631-C1

Abstract

FIELD: medicine; hepatobiliary surgery. SUBSTANCE: invention can be used in endoscopic treatment of choledocholithiasis. Duodenoscopy is performed followed by cannulation of the common bile duct and contrast imaging of the bile ducts. After papillosphincterotomy, a SpyScope choledochoscope is inserted into the common bile duct. A Micro-Catch nitinol basket is introduced through the channel of the choledochoscope, then under visual control the basket is guided to the concrement and its capture and lithoextraction are performed. Then the basket strings together with the handle are removed from the outer sheath of the basket, the outer sheath is advanced into segmental bile ducts and contrast imaging thereof is performed, and when concrements are visualised therein, the outer sheath of the basket is advanced beyond the concrement and the concrement is washed out. EFFECT: high efficiency, technically easy reproducibility, increased rate of successful lithoextraction, which, in turn, reduces the number of repeated interventions, hospitalisation and rehabilitation periods by performing lithoextraction using a Micro-Catch basket. 1 cl, 2 ex

Inventors

Gladyshev Dmitrii Vladimirovich
Gladyshev Andrei Dmitrievich
Vetoshkin Viacheslav Andreevich
Trusov Ivan Aleksandrovich

Dates

Publication Date: 20260506
Application Date: 20250808

Claims (1)

A method for the endoscopic treatment of choledocholithiasis, including duodenoscopy with a duodenoscope with lateral optics, cannulation of the common bile duct, contrasting of the bile ducts, papillosphincterotomy, installation of a SpyScope choledochoscope into the common bile duct, visualization of stones, insertion of a basket through the choledochoscope channel with subsequent capture of stones and lithoextraction, contrasting of segmental bile ducts for visualization of stones, with subsequent washing of the latter, characterized in that a Micro-Catch nitinol basket is inserted through the choledochoscope channel, then, under visual control, the basket is brought to the stone and its capture and lithoextraction are performed, after which the strings of the basket together with the handle are removed from the outer casing of the basket, then the outer casing is passed into the segmental bile ducts and they are contrasted, and during visualization in them The outer casing of the basket is placed behind the calculus and the calculus is washed out.

Description

The invention relates to medicine, in particular to hepatobiliary surgery, and can be used in the endoscopic treatment of choledocholithiasis. Cholelithiasis is one of the most common diseases of the biliary tract worldwide [Nikitin I.G., Volnukhin A.V. Cholelithiasis: epidemiological data, key aspects of pathogenesis and comorbidity, current therapeutic targets // Russian Medical Journal. Medical Review. - 2020. - Vol. 4. - No. 5. - P. 290-296]. In 1-2% of stone carriers, choledocholithiasis develops, which can be either primary or secondary (migration of stones from the gallbladder). In such cases, the outflow of bile is obstructed, which, in turn, can cause mechanical jaundice and cholangitis [Tazuma S. Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic) // Best practice & research Clinical gastroenterology. - 2006. - Vol. 20. - No. 6. - P. 1075-1083]. Modern treatment and diagnostic methods allow for the timely diagnosis and successful treatment of these conditions. However, treating choledocholithiasis in patients complicated by obstructive jaundice remains a challenging emergency surgical problem, as evidenced by the high incidence of complications [Russian Federation Patent 2644307]. Currently, the "gold standard" for the treatment of choledocholithiasis are endoscopic retrograde interventions, which include endoscopic retrograde cholangiopancreatography (ERCP), papillosphincterotomy, lithoextraction, mechanical lithotripsy, and bile duct stenting [National Institute for Health and Care Excellence. Gallstone Disease Overview. NICE Pathway last updated: 23 June 2021]. During ERCP, duodenoscopy is performed to visualize the major duodenal papilla (MDP), through which the bile ducts are cannulated and contrasted using a catheter. Contrast is used to determine the presence, size, and location of bile duct stones. The next step is a typical papillosphincterotomy with a standard papillotome, which can be supplemented with balloon dilation if necessary. Then, under X-ray guidance, the stones are removed using Dormia baskets and/or extraction balloons. However, the use of this traditional method of treatment and diagnosis is difficult in patients with "complex" choledocholithiasis [ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis]. "Complex" choledocholithiasis means the following conditions or their combination: large stones larger than 10-15 mm; multiple stones located in the intrahepatic bile ducts; complex-shaped stones; fixed stones; stricture below the level of the stone; stenosis of the intrapancreatic part of the common bile duct; anatomically difficult access to the major duodenal papilla; general severe condition of the patient in case of severe concomitant pathology [Endoscopic treatment of elderly patients with complex choledocholithiasis / A.I. Mikhin, S.Yu. Orlov, K.V. Vasilenko, A.V. Sazhin // Endoscopic surgery. - 2019. - T. 25, No. 1. - P. 53-60]. A known method for revision and removal of stones from the bile ducts during surgery involves advancing a flexible probe with an olive at the working end through the ducts [Catalogue of the company "AESCULAP", Germany, 1982, vol. S., p. 329]. The disadvantages of this method are its traumatic nature and labor intensity [Patent No. 2595059 C1 Russian Federation, IPC A61B 17/00. Method for treating choledocholithiasis complicated by mechanical jaundice syndrome: No. 2015122160/14: declared 10.06.2015: published 20.08.2016 / D.R. Zinatulin, Sh. M. Gainulin, G. A. Baranov [et al.]]. Since the technique is performed without visual control, there is a risk of damage to the common bile duct, which, in turn, can lead to both intra- and postoperative complications, and, in the case of complex choledocholithiasis, often does not allow for complete sanitation of the bile ducts. A method for removing stones from the bile ducts using a basket with flexible traction is known [USSR Patent No. 1445711]. The disadvantage of this method is the increased trauma during the removal of large stones, as well as the lack of direct visual control [Patent No. 2595059 C1 Russian Federation, IPC A61B 17/00. Method for treating choledocholithiasis complicated by mechanical jaundice syndrome: No. 2015122160/14: declared 10.06.2015: published 20.08.2016 / D.R. Zinatulin, Sh.M. Gainulin, G.A. Baranov [et al.]]. A known method for removing stones involves retrograde insertion of the Dormia basket into the bile ducts under X-ray control. The disadvantages of this method include increased labor intensity and trauma during the extraction of large stones, as well as the lack of direct visual control, which, in turn, can also lead to incomplete sanitation of the biliary tree and wedging of the basket with the stone during the removal of large stones [Berci G., Morgenstern L. Laparoscopic management of common bile duct stones: a multi-institutional SAGES study // Surgical endoscopy. - 1994. -