TITLE:
What Is the Role of Endoscopic Retrograde Cholangio-Pancreato-Grahy in the Management of Hepatic Hydatid Disease Complications?
AUTHORS:
Hakima Abid, Ghita Ousseur, Nada Lahmidani, Mounia El Yousfi, Noureddin Aqodad, Mohammed El Abkari, Adil Ibrahimi, Dafr Allah Benajah
KEYWORDS:
Hydatid Cyst, Intrabiliary Rupture, Complications, Endoscopic Retrograde Cholangiopancreatography, Endoscopic Sphincterotomy
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.10 No.5,
May
27,
2020
ABSTRACT: Liver hydatid cyst is a parasitic disease that is endemic
in Morocco. Its gravity is essentially due to its complications, such as
Intrabiliary rupture. The aim of our study was to evaluate the role of
endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic
sphincterotomy in the management of intrabiliary rupture of hydatid disease of
the liver. Materials and Methods: This is a retrospective study in the
department of Gastroenterology in the University Hospital Hassan II of Fez over
a period of 12 years from March 2005 to October 2017. All patients admitted for
hepatic hydatid disease and who received ERCP were included. We analyzed the
success rate of catheterization of the common bile duct (CBD), the successful
clearance of the bile duct and the complications. Results: 2860 patients had
received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112
of which had intrabiliary disruption of hepatic hydatid and 39 patients were
admitted for sphincteromy for reversal of the flow after surgery of hydatid
cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio
F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and
26% of cases were operated for KHF fistulized in the bile ducts with
persistence of a large biliary flow in post-operative (39 cases). The success
of initial catheterization of the commun bile duct was achieved for 138
patients (91%) or obtained secondarily after precut for 13 patients. The
evacuation of hydatid membranes was carried out in 51% of them (N = 78); twenty
two (14.5%) patients had one or more calculations with or without hydatid
membranes. A case of gastrointestinal bleeding post ERCP was observed. All the
patients followed evolved well in the long term except for two patients who
presented in few months after the first ERCP severe cholangitis which required
the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management of hydatid cyst remains a dominant
position, with a very satisfactory success rate and an acceptable rate of
morbidity and mortality.