Treatment of hepatic hydatid disease complications using endoscopic retrograde cholangiopancreatography procedures

Abstract

Background: Liver hydatidosis may lead to serious morbidity due to biliary complications, the management for which endoscopic sphincterotomy (ES) and biliary drainage are very efficient. We evaluated the effectiveness of endoscopic treatment for complications of hepatic hydatid disease. Methods:We retrospectively reviewed endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 2000 and December 2009 and compared laboratory findings, localization of the lesions and ERCP procedures applied between patients with and without jaundice. Results:In all, 70 ERCP procedures were performed in 54 patients (24 men, 30 wo men). Of the 70 procedures, 24 were performed to treat jaundice. All patients with biliary fistulas and jaundice were managed with endoscopic procedures. The 70 ERCP procedures included sphincterotomy only (n = 40); sphincterotomy and stent placement (n = 7); stent placement only (n = 4); sphincterotomy and membrane extraction (n = 9); sphincterotomy, membrane extraction and pus drainage (n = 5); and sphincterotomy and pus drainage (n = 5). Laboratory results improved in 3-7 days, and bile leakage ceased in 2-21 days. Conclusion:Endoscopic retrograde cholangiopancreatography is a safe and effective way to manage biliary complications of hepatic echinococcal disease. In most patients, ES is the most efficient treatment of postoperative external biliary fistulas, jaundice and accompanying cholangitis, as it enables clearing the bile ducts of hydatid remnants; ES should be performed since it accelerates the healing process by decreasing pressure in the choledochus.

The Usefulness of Endoscopic Retrograde Cholangiopancreatography at Preoperative or Postoperative Cystic ^Echinococcus Patients

“…All cases of biliary leakage ceased in 2-21 days. The most commonly performed procedure in that study was ES (23). In our study, bile leaks were closed in an average of 19 days after ERCP, which is consistent with the literature.…”

“…One study reported the management of seven patients with CE developing obstructive jaundice and cholangitis after surgery, who were treated by ERCP. Within 36 hours of ES and clearing of the biliary tract of debris, normal bile flow was achieved and symptoms related to biliary obstruction were resolved (23). In our series, ERCP was performed in three patients in the postoperative period for biliary obstruction.…”

Biliary fistula after liver hydatid cyst surgery: Is it a predictable complication?

“…Today, endoscopic interventions are the mainstay of treatment in patients with unclosed or high-flow fistulas. It is believed that endoscopic sphincterotomy causes the early closing of the fistula by lowering intrabiliary pressure [13]. There is no definite conclusion about the timing of the endoscopy.…”

The Role of Perioperative Endoscopic Retrograde Cholangiopancreatography and Biliary Drainage in Large Liver Hydatid Cysts

“…Although many new treatment procedures are now in use, the postoperative complication rate still remains very high [19, 23, 30, 31]. The most frequent serious postoperative complications are prolonged persistence of a residual cystic cavity, cystic cavity infections, biliary peritonitis, and biliary fistulas.…”