[Atypical anatomical variants and anomalies of the biliary tract in patients with biliary tract and pancreatic diseases. II. Endoscopic treatment].

Results are reported of endoscopic treatment of 79 patients with atypical anatomical variants and anomalies of the bile ducts: common bile duct calculosis (54), stenosing papillo-odditis (8), indurative pancreatitis (2) and bile duct cancer (15). The following endoscopic manipulations have been performed: endoscopic sphincterotomy (72); hydrostatic balloon extraction of calculi (27); hydrostatic balloon dilatation of constricted segments (29); mechanical lithotripsy (15); nasolabial drainage (17) and endoprosthesis (15). Much more difficult was the extraction of calculi from the common bile in the event of atypical anatomical variants and anomalies of the distal portion of the common bile duct (chi 2 = 14.55; p less than 0.001). Treatment resulted in significant reduction of the bilirubin levels (t = 4.13; p less than 0.001), of AP (t = 4.47; p less than 0.001), GGTP (t = 4.07; p less than 0.001); AcAT (t = 5.75; p less than 0.001) and AlAT (t = 5.63; p less than 0.001). Complications occurred in 6 per cent of the patients (acute pancreatitis, cholangitis, hemorrhage). Mortality from endoscopic treatment was 1.3 per cent. Endoscopic methods for treatment are advised as alternative to operative treatment for patients in advanced age and high operative risk.