ENDOSCOPIC TRANSPAPILLARY ANTEGRADE SPHINCTEROTOMY

ERCP has become the "Gold" standard in the diagnostics and management of pancreaticobiliary diseases. The possibilities in treating the entire spectrum of diseases of this zone are increasing. However, the level of major complications of ERCP remains high (from 5.4% to 23.0% and the overall mortality from 0.1 to 1%). The vast majority of them related to interventions on the sph Oddi. 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. Sph. Oddi consists of a longitudinal and circular smooth muscle layers. Circular muscle fibers form the pancreatic and duodenal parts. Anatomical justification was cutting of only the circular layer of sph Oddi by special sphincterotome. Papilary stenosis and stenosis terminal part of common bile duct due to damage only circular layer sph Oddi. Anterograde direction and hooked form of sphincterotome (endoscopic antegrade sphincterotomy- EASD) allows to capture only need layer and control depth. Also EASD was performed patient with SOD (I-III) with preservation of the longitudinal muscular layer sph Oddi and septum of papilla. 273 patient underwent EASD within 7 years (age is 44.3 ± 12.7 years, 43.8% male, 65,7% in urgent cases). Postoperative bleeding and perforation wasn't. 5 (1,83%) cases of postEASD pancreatitis manifested by increased blood enzymes and abdominal pain, successfully cured medication for 3 days. The use of EASD with preservation of the closure function of the sph. Oddi allowed to avoid cholecystectomy in 71.2%. ASD can be performed with a standart or a 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]). EASD must be performed by an endoscopist with experience in transpapillary intervention.