Endoscopic Management of Mirizzi Syndrome: Experience and Outcomes From a Tertiary Care Center in Mexico

Mirizzi syndrome (MS), an infrequent yet often delayed complication of cholelithiasis, poses diagnostic and therapeutic challenges stemming from its heterogeneous presentation, propensity for fistula formation, and distortion of anatomy within Calot's triangle. Although surgery remains a reference standard, this study examines therapeutic endoscopy as a safe and effective alternative within a Mexican tertiary center, where disease burden exceeds global estimates.

We conducted a retrospective, single-center observational study (January 2022-April 2025), identifying 16 patients with MS who underwent 22 endoscopic retrograde cholangiopancreatography (ERCP) procedures (out of 914 total). Data collected included demographics, Mirizzi classification (Csendes), endoscopic approach, technical (successful biliary decompression), and clinical outcomes (avoidance of surgery/complications, resolution of cholangitis). Statistical analyses included Fisher's exact tests for categorical variables, and Mann-Whitney U tests for continuous variables, with significance set at p < 0.05. Analyses followed established methodological standards.

MS accounted for 2.4% of ERCP volume. Type I predominated (50%), followed by types IV, V, and III. The cohort's mean age fell in mid-adulthood, without apparent sex predilection. Overall, a technical success rate of 90.9% (20/22 procedures) was achieved, while clinical success was observed in 87.5% (14/16 patients). Non-surgical resolution was accomplished in 75.0% of types IV-V patients. In inferential analyses, procedure duration and fluoroscopy time, when stratified by Mirizzi type or presence of cholangitis (p ≥ 0.05), displayed no statistically significant differences. Advanced techniques, including SpyGlass cholangioscopy, showed a significant association with type IV MS (p = 0.0476). These results demonstrate an improvement as reported in previous success rates.

Therapeutic endoscopy is demonstrably effective and safe for select MS cases, effectively relieving biliary obstruction, and successfully managing cholangitis as either a bridge to eventual surgery or as a definitive standalone solution. Further studies are needed to establish standardized, evidence-based guidelines for endoscopic treatment of this complex syndrome.