Diagnosis of Non-Tumor Stenosing Lesions of the Major Duodenal Papilla Using Endoscopic Ultrasonography

Abstract

Aim: to evaluate the possibilities of endoscopic ultrasonography in the diagnosis of benign stenosis of the major duodenal papilla and improve its results, including by identifying and objectifying the criteria of the disease.Materials and methods. The results of the examination and treatment of 2146 patients treated at the Kursk Regional Multidisciplinary Clinical Hospital in the period from 2015 to 2022, who underwent transpapillary interventions and/or endoscopic ultrasonography on the basis of the endoscopy department, are presented. A therapeutic and diagnostic algorithm for the management of patients with dilation of the common bile duct has been introduced into clinical practice, based on the developed criteria for stenosis of the major duodenal papilla (MDP), for which endoscopic ultrasonography was used in combination with the methodology of synthesis of hybrid fuzzy decision rules.The algorithm was implemented in a group of patients, which included 217 people.Results. Using the developed endosonographic criteria for MDP stenosis and the methodology for the synthesis of fuzzy decision rules, a production decision rule for the diagnosis of MDP stenosis was determined with a decision made according to a threshold set by experts at the level of 0.9. Guided by the selected information sources, 134 (61.7 %) patients with dilated common bile duct were diagnosed with MDP stenosis, requiring minimally invasive treatment aimed at relief of biliary hypertension and indications for endoscopic papillosphincterotomy were determined. In 83 cases of MDP stenosis, it was decided to abandon transpapillary interventions with subsequent follow-up of patients. Minimally invasive treatment using retrograde and antegrade techniques was performed in 134 patients. Complications were noted in 6 (4.4 %) patients, which is comparable to the number of complications with transpapillary interventions performed in patients without MDP stenosis. When monitoring 54 patients for one to three years, 85.2 % of patients showed regression of clinical, laboratory and instrumental symptoms of biliary hypertension.Conclusions. The combination of endoscopic ultrasonography with fuzzy logic technologies based on hybrid artificial intelligence made it possible to objectify the diagnosis of MDP stenosis and optimize indications for transpapillary interventions.

Keywords

• endoscopic ultrasonography
• fuzzy decision rules
• stenosis of the major duodenal papilla
• endoscopic papillosphincterotomy