Surgery versus endoscopy with digital single-operator cholangioscopy-guided therapy for Mirizzi syndrome: the SEIZE...

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Minimally Invasive Procedures

Background:

• Mirizzi syndrome management traditionally relies on surgery.
• No prior studies have directly compared surgical and digital single-operator cholangioscopy (dSOC)-guided treatments for Mirizzi syndrome.
• This study aims to evaluate the safety and efficacy of dSOC versus surgery.

Purpose of the Study:

• To compare the safety and outcomes of dSOC-guided treatment versus traditional surgical management for Mirizzi syndrome (Type II-IV).

Main Methods:

• A retrospective analysis of 290 patients with Type II-IV Mirizzi syndrome from January 2005 to June 2023.
• Comparison between patients treated with dSOC (n=176) and those undergoing surgery (n=114).
• Exclusion criteria included postsurgical anatomy, Type I or V Mirizzi syndrome, and prior cholecystectomy.

Main Results:

• dSOC patients were older with more comorbidities but had significantly fewer overall (10.2% vs 41.2%) and severe adverse events (1.7% vs 15.8%).
• Technical success was lower for dSOC (89.8%) versus surgery (96.5%), but reintervention rates were comparable.
• dSOC led to a reduced need for hepaticojejunostomy (8.2% vs 25.4%) and conversion to open surgery (6.0% vs 22.8%).

Conclusions:

• dSOC is an effective and safer treatment modality for Mirizzi syndrome, even in patients with significant comorbidities.
• dSOC can potentially minimize the extent of subsequent surgical interventions, including reducing hepaticojejunostomy and open conversion rates.