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Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy.

Abstract

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.

METHODS

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.

RESULTS

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.

Authors+Show Affiliations

Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT). Electronic address: andrea.tringali@unicatt.it.Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT); Garcia de Orta Hospital, E.P.E, Gastroenterology Department, Almada, Portugal.Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT).Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit.Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT).Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT).Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit.Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma. Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629720

Citation

Tringali, Andrea, et al. "Long-term Outcomes of Endoscopic Treatment of Aberrant Hepatic Duct Injuries After Cholecystectomy." Gastrointestinal Endoscopy, 2019.
Tringali A, Massinha P, Schepis T, et al. Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. Gastrointest Endosc. 2019.
Tringali, A., Massinha, P., Schepis, T., Landi, R., Boškoski, I., Perri, V., ... Costamagna, G. (2019). Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. Gastrointestinal Endoscopy, doi:10.1016/j.gie.2019.09.043.
Tringali A, et al. Long-term Outcomes of Endoscopic Treatment of Aberrant Hepatic Duct Injuries After Cholecystectomy. Gastrointest Endosc. 2019 Oct 17; PubMed PMID: 31629720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. AU - Tringali,Andrea, AU - Massinha,Paulo, AU - Schepis,Tommaso, AU - Landi,Rosario, AU - Boškoski,Ivo, AU - Perri,Vincenzo, AU - Bove,Vincenzo, AU - Costamagna,Guido, Y1 - 2019/10/17/ PY - 2019/07/29/received PY - 2019/09/27/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - Aberrant bile duct KW - ERCP KW - benign biliary stricture KW - cholecystectomy KW - plastic stent JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. N2 - 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. METHODS: 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. RESULTS: 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31629720/Long-term_outcomes_of_endoscopic_treatment_of_aberrant_hepatic_duct_injuries_after_cholecystectomy L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)32339-9 DB - PRIME DP - Unbound Medicine ER -