Outcomes of endoscopic retrograde cholangiopancreatography in patients with situs inversus viscerum

Abstract

Background/Aims: Situs inversus viscerum (SIV) is a congenital condition defined by left-to-right transposition of all visceral organs. This anatomical variant has caused technical challenges in endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP in patients with SIV are limited to case reports of unknown clinical and technical success rates. This study aimed to evaluate the clinical and technical success rates of ERCP in patients with SIV. Methods: Data from patients with SIV who underwent ERCP were retrospectively reviewed. The data were collected by querying the nationwide Veterans Affairs Health System database for patients diagnosed with SIV who underwent ERCP. Patient demographics and procedural characteristics were collected. Results: Eight patients with SIV who underwent ERCP were included. Choledocholithiasis was the most common indication for ERCP (62.5%). The technical success rate was 63%. Subsequent ERCP with interventional radiology-assisted rendezvous has increased the technical success rate to 100%. Clinical success was achieved in 63% of cases. Among cases of subsequent rendezvous ERCP after conventional ERCP failure, clinical success was achieved in 100%. Conclusions:The clinical and technical success rates of ERCP in patients with SIV were both 63%. In patients with SIV in whom ERCP fails, interventional radiology-assisted rendezvous ERCP can be considered.

Adaptability in the Midst of Anatomical Challenges: A Case of Situs Inversus Totalis in Laparoscopic Cholecystectomy

“…Performing the surgery using an open approach or converting to an open approach is always an option in cases where there is severe inflammation, unforeseen obstructions that require better visualization, extensive adhesions, and anatomical variations that were not accounted for [5]. Preoperative ERCPs can be ordered to help prevent conversion to open surgeries, yielding a 63% success rate; however, they are not commonly ordered unless otherwise indicated [10].…”

“…With everything opposite of the standard "usual," the diagnosis and management of SIT patients are higher on the difficulty index versus patients without SIT [2]. When indicated, surgeons should proceed with the elective procedure and may choose to supplement their pre-surgical planning with the utilization of imaging studies such as CT, endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) [10]. Though vascular variations may exist, SIT patients typically only differ from normal patients in regard to anatomic mirroring [11].…”