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Treatment of complications of hepatic hydatid disease by ERCP
O Giouleme1, N Nikolaidis, P Zezos
1Division of Gastroenterology, 2nd Propedeutic Department of Medicine, Aristotle University, Hippokration Hospital, 49 Thihis Street, Thessaloniki 55133, Greece.
Background:
The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy for preoperative and postoperative complications of hepatic hydatid disease.
Methods:
Nineteen patients underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in 1 and acute cholangitis in 4. In 14 patients treated after surgery (Group B), the indication was acute cholangitis in 6, obstructive jaundice 2, and persistent external drainage in 6 patients.
Observations:
In group A, ERCP detected hydatid vesicles within the bile duct. All patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 6 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 20 days. Among the 8 patients with postoperative obstructive jaundice or acute cholangitis, 7 had cyst remnants obstructing the bile duct and 1 had findings of sclerosing cholangitis. All underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients, with the exception of the one with sclerosing cholangitis, remained asymptomatic.
Conclusion:
Endoscopic sphincterotomy is a safe and effective treatment for biliary complications of hepatic hydatid disease.