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Endoscopic retrograde cholangiopancreatography in ruptured liver hydatid cyst
Mohamed Borahma1, Rajaa Afifi2, Imane Benelbarhdadi2
1Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco. borahmamed@gmail.com.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) effectively treats biliary fistulas caused by ruptured hepatic hydatid cysts. This minimally invasive approach offers a high healing rate, avoiding risky surgeries for this complication of hydatid disease.
Area of Science:
- Hepatology
- Gastroenterology
- Parasitology
Background:
- Hepatic hydatid cyst disease can lead to serious complications, including communication with the biliary tree.
- Surgical treatment of biliary fistulas resulting from hydatid cysts carries significant risks of morbidity and mortality.
Purpose of the Study:
- To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in managing biliary fistulas secondary to ruptured hepatic hydatid cysts.
- To assess the outcomes of minimally invasive endoscopic interventions for intrabiliary hydatid cyst rupture.
Main Methods:
- Retrospective review of clinical, laboratory, and imaging data for 16 patients with intrabiliary rupture of hepatic hydatid cysts.
- Diagnostic confirmation using radiology and ERCP.
- Therapeutic interventions included endoscopic sphincterotomy, balloon or Dormia basket extraction, stenting, and nasobiliary drainage.
Main Results:
- Endoscopic retrograde cholangiopancreatography (ERCP) was performed for diagnosis and treatment.
- Hydatid materials were extracted using balloons (n=11) or Dormia baskets (n=5).
- Biliary drainage was achieved via nasobiliary drainage (n=1) or stenting (n=1).
- Fistula healing occurred in 80% of patients within a median of 6 weeks post-endoscopic treatment.
Conclusions:
- Endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment for hepatic hydatid cysts with biliary fistula.
- Minimally invasive endoscopic management offers a successful alternative to surgery for this complication.
- ERCP facilitates extraction of hydatid material and biliary drainage, leading to high healing rates.
Abstract:
One of the most common and serious complications of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistula is associated with high morbidity and mortality. We retrospectively reviewed the effectiveness of endoscopic treatment of ruptured hydatid cyst into intrahepatic bile ducts. Diagnosis of intrabiliary rupture of hydatid cyst was mostly suspected by acute cholangitis, jaundice, pain, and/or persistent external biliary fistula after surgery. The diagnosis was confirmed by radiology and endoscopic retrograde cholangiopancreatography (ERCP) findings. We retrospectively reviewed clinical, laboratory, imagery, and ERCP findings for all patients. The therapeutic methods performed were endoscopic sphincterotomy, extraction by balloon or Dormia basket, stenting, or nasobiliary drainage. Sixteen patients with ruptured hepatic hydatid cyst into bile ducts were seen in 9 years. Nine of 16 patients had a surgical history of hepatic hydatid cyst and three patients had a percutanous treatment history. We carried out ERCP with sphincterotomy and extraction of hydatid materials (extraction balloon n = 11; Dormia basket n = 5) or biliary drainage (nasobiliary drainage n = 1; biliary stenting n = 1). The fistula healed in 80 % of patients with a median time of 6 weeks [range, 1-12] after endoscopic treatment. ERCP was an effective method of treatment for hepatic hydatid cyst with biliary fistula.
