[Endoscopic assay and surgery at chronic pancreatitis].

To assess the possibilities of endoscopic surgeries at the pathology of major duodenal papilla in patients with the painful form of chronic pancreatitis. The study involved 35 patients with the painful form of chronic pancreatitis including 19 subjects with cholecystectomy as a result of cholelithiasis, 8 subjects with alcohol-induced pancreatitis (4 of them had external pancreatic fistulas) and 8 patients with idiopathic pancreatitis. As many as 60 different X-ray and endoscopic procedures were carried out altogether: ERCPG, EPST and dissection of pancreatitis duct entrances as well as nasopancreatic drainage and stenting. ERCPG discovered the pathology of major duodenal papilla in the form of stenosis of the common bile duct entrance and/or main pancreatic duct entrance in 25 (71%) patients. At the same time, the ultrasonic examination discovered the pathology only in 7 patients (20%). EPST was performed in 20 patients of 25. The dissection of the major pancreatitis duct entrance was carried out in 16 of them; the dissection of the additional pancreatic duct was performed in 1 patient; the external pancreatic duct drainage was conducted in 5 patients; the additional pancreatic duct stenting was carried out in 1 patient. Fifteen patients (75%) felt better immediately upon the surgery. Ten patients were followed-up from 2 months to 3 years; steady amelioration was observed in 7 of them. There were complications in the form of acute pancreatitis in 3 patients after ERCPG and in 2 patients after endoscopic surgeries. There were no other complications or fatalities. For patients with the painful form of chronic pancreatitis, ERCPG is an informative and relatively safe technique enabling to discover the stenosis of the common bile duct entrance and/or main pancreatic duct entrance in 71% of cases. Endoscopic surgeries make it possible to produce an immediate positive result in 75% of cases.