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Treatment of complications of hepatic hydatid disease by ERCP: our experience
C Sciumè1, G Geraci, F Pisello
1Azienda Ospedaliero-Universitaria Policlinico Paolo Giaccone, Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo, Sezione di Chirurgia Generale ad Indirizzo Toracico, Università degli Studi di Palermo.
Background:
The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy and positioning of naso-biliary drain or biliary endoprosthesis for preoperative and postoperative complications of hepatic hydatid disease (fistuias, compressioni cholestasis, rupture in biliary tree).
Methods:
During the period 1994-2003, 22 patients (12 male and 10 female, mean age 55.4 years, range 16-65 yrs) underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in ali, associated with acute cholangitis in 4 (80%) and acute pancreatitis in 1 (20%). In 17 patients treated after surgery (Group B), the indication was acute cholangitis in 6 (36%), obstructive jaundice 3 (17%), and persistent external drainage in 8 patients (47%).
Observations:
In group A, ERCP detected hydatid vesicies within the bile duct in all patients. Ali patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 8 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 25 days (in 4 patients with low-flow fistula was positioned nasobiliary drain to repeat cholangiogram) or in 4-6 weeks (in 4 patients with high-flow fistula was positioned biliary endoprosthesis). In 2 of 8 patients (25%) with postoperative external biliary fistulas was observed choledocholitiasis (resolution with ERCP). Ali the 9 patients with postoperative obstructive jaundice or acute cholangitis, had cyst remnants obstructing the bile duct. Surgical reintervention was avoided in all patients in group B: all underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients remained asymptomatic.
Conclusion:
Endoscopic sphincterotomy with positioning of naso-biliary drain or biliary endoprosthesis is a safe and effective treatment for preoperative and postoperative biliary complications of hepatic hydatid disease.
