Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.Abbreviations: CBDS = common bile duct stones, CI = confidence interval, CNS = central nervous system, EPBD = endoscopic papillary balloon dilatation, EST = endoscopic sphincterotomy, GBS = gall bladder with stones, OR = odds ratio, PAD = periampullary diverticulum.

Patient: Female, 76-year-old Final Diagnosis: Left hepatic cyst hidatic fistula to gall bladder Symptoms: Biliary colic • icterus • Sepsis Medication: — Clinical Procedure: Multidiscipliner treatment Specialty: Surgery Objective: Rare disease Background: Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. Case Report: A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. Conclusions: We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Committee with the decision numbered 2013-KAEK-64. All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Bu çalışma Sağlık Bakanlığı İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu tarafından 11.03.2020 tarihinde 2013-KAEK-64 sayılı kararla onaylanmıştır. İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

How to cite: Ballı E, Akay T, Yılmaz S. Comparison of the procedure results of ectopic papillae encountered during ERCP procedure with the procedure results of papillae with normal localization.

Introduction: Hydatid disease is a zoonosis that generally arises from echinococcus granulosus. Abdominal pain, cholangitis and jaundice may develop as a result of spontaneous rupture of the liver cyst into the biliary tract. Rarely, in some of these cases, pancreatitis may develop as a complication of hydatid cysts and there is no clear consensus on treatment options in patients with diffuse bile duct obstruction that occurs with a necrotizing pancreatitis clinic. The present study aims to establish a common consensus in patients presenting with liver cyst hydatid pancreatitis and jaundice clinic. Materials and Methods: In a retrospective, clinical-based multicenter study, ERCP and minimally invasive approaches are presented in the treatment of four patients who developed liver bile duct obstruction and necrotizing pancreatitis from the liver hydatid cyst. Results: All patients had abdominal pain and jaundice. Acute pancreatitis was detected in all cases using computed tomography. All patients underwent endoscopic sphincterotomy. Infected cystic material and germinal membranes were removed from the biliary tract. With endoscopic sphincterotomy, necrotizing pancreatitis clinic improved rapidly in three patients, while one patient progressed to necrotizing pancreatitis. All patients underwent laparoscopic cystectomy and cholecystectomy in combination. In patients who were followed up for necrotizing pancreatitis, the wall formation (encapsulation) period of necrosis was waited, and four weeks later, percutaneous drainage was applied to the walled necrosis areas. While the patients were discharged, Andazol® treatment was applied during the 6-month follow-up period. Conclusion: One of the complications of ERCP is that it may increase the severity of pancreatitis. However, ERCP is the most important endoscopic intervention for the treatment of pancreatitis filled with common bile duct hydatid cyst to ensure safe and effective biliary tract drainage in the early period. In addition, percutaneous drainage provides safe and rapid recovery in necrotizing pancreatitis complications when the wall of necrosis phenomenon is expected.