Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy.Gastrointest Endosc 2019GE
BACKGROUND AND AIMS
Right aberrant hepatic ducts are an anatomical variant with a clinical relevance due to the risk of their injury during cholecystectomy. The treatment options for aberrant hepatic ducts injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions.
Patients who underwent ERCP for aberrant hepatic duct lesion were retrospectively identified. Demographic data, type of aberrant duct lesion according to Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration and number of ERCPs) and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations.
Between January 1996 and March 2019, 32 patients (78% female, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had a Strasberg type B lesion, 11 type C, 8 Type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents/patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1/6 (17%) type B Strasberg patient achieved patency. In 10/11 (91%) of the type C Strasberg patients, it was possible to achieve duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29/32 (91%) patients are asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis and 1 reported episodic biliary colic without an increase of LFTs, successfully managed with a low-fat diet CONCLUSIONS: An endoscopic approach to aberrant hepatic duct lesion after cholecystectomy can be considered an effective first-line therapy.