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Published on: May 23, 2025
Endoscopic therapy of hepatic hydatid cyst disease in preoperative and postoperative settings
Bahattin Cicek1, Erkan Parlak, Selcuk Disibeyaz
1Department of Gastroenterology, Yuksek Ihtisas Hospital, Sihhiye, Ankara 06100, Turkey.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) effectively diagnoses and manages biliary complications from hepatic hydatid cysts. This safe procedure offers successful treatment for leaks and remnants, with minimal complications.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Hepatic hydatid cyst disease can lead to serious biliary complications.
- Communication between cysts and the biliary tree presents diagnostic and therapeutic challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in managing biliary complications of hepatic hydatid cysts.
- To analyze ERCP's role in both preoperative and postoperative settings.
Main Methods:
- Retrospective analysis of patients undergoing ERCP for biliary complications of hydatid cysts over a 2-year period.
- Data collection included patient groups (preoperative/postoperative), presenting symptoms, indications for ERCP, and treatment outcomes.
Main Results:
- In the preoperative group (n=41), jaundice, biliary colic, and cholangitis were common. Treatment involved sphincterotomy, remnant extraction, and nasobiliary drainage, with 2 patients treated definitively by ERCP.
- In the postoperative group (n=69), biliocutaneous leaks and cholangitis were primary indications. Endotherapy was successful for leaks/remnants; long-term stenting was needed for stenosis.
- ERCP demonstrated a high success rate with minimal complications, including mild pancreatitis and self-limited hemorrhage.
Conclusions:
- ERCP is an effective and safe diagnostic and management tool for biliary complications associated with hepatic hydatid cyst disease.
- The procedure offers successful therapeutic interventions for various complications, improving patient outcomes.
Abstract:
The most common and serious complication of hepatic hydatid cyst disease is the communication between the cyst and the biliary tree. The diagnosis and treatment of this condition poses various difficulties. Data from patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for hydatid cysts communicating with the bile ducts either in the preoperative or postoperative setting over a 2-year period have been analyzed. In the preoperative group (n=41), jaundice (n=18), biliary colic (n=11), and cholangitis (n=10) were the most common presentations. On the other hand, the most common indication for ERCP in the postoperative group (n=69) was biliocutaneous leaks (n=60) and cholangitis (n=9). All but 2 patients in the preoperative group were treated by endoscopic sphincterotomy and/or extraction of hydatid cyst remnants followed by the placement of nasobiliary drainage catheter for the patients who had filling defects on cholangiogram. Subsequently, these patients were referred for surgery. ERCP was a definitive treatment for the remaining 2 patients. Endotherapy was successful for the patients who developed leak or had cyst remnants following surgery, whereas long-term biliary stenting was required for those who developed bile duct stenosis. There was no ERCP-associated complication, except mild pancreatitis in a single patient and self-limited hemorrhage in 2 patients. ERCP is an efficacious and safe method for the diagnosis and management of biliary complications associated with hydatid cyst disease.
