Introduction

Hydatid cyst of the liver is a parasitic disease caused by the development of the taenia Echinococcus Granulosus. Fistulization in the bile duct is one of the most frequent complications. Endoscopic treatment is necessary because of the risks associated with surgery.

Aims & Methods

Aims: To evaluate the impact of endoscopic ERCP in the diagnosis and Therapeutic management of ruptured liver hydatid cysts in the bile ducts.
Methods: 60 patients with a hydatid cyst fistulized in the bile ducts were included retrospectively over a period of 20 years, from January 2002 to September 2022. Overall success was defined by definitive vacuity of the main bile duct.
The results were analysed by JAMOVI 2.0

Results

Among the ERCPs performed in our department during the study period, 4.6%(n=60) were for a hepatic hydatid cyst communicating with the bile ducts.
Median age of our patients was 46.1±14.8 with a sex ratio of 2.
ERCP was indicated for acute cholangitis in 44.9% and persistent external biliary fistula in 34%. Median bile duct diameter was 10[7-14]mm and median cyst diameter was 35[27-47].Sphincterotomy was performed in 96% of patients allowing extraction of hydatid fluid by balloon or Dormia in 87.8%.
Nevertheless, 24% required naso-biliary drainage and 8% benefited from biliary prosthesis placement. Overall success rate was 93,3% (n=56) while 4 patients (6,7%) developed some complications.
This technique helped with the disappearance of jaundice after 5 to 10 days.

Conclusion

Our study confirms that endoscopic treatment of ruptured hydatid cyst in the bile ducts is an effective therapeutic alternative, with a low rate of immediate complications and a good long-term evolution.

Introduction

Hepatic hydatid cyst (HHC) is a parasitic disease caused by the development of the tapeworm Echinococcus granulosus. Fistulization into the biliary tract is one of its most common complications. Endoscopic treatment is preferred due to the risks associated with surgery. This study aims to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnostic and therapeutic management of HHC ruptured into the biliary tract.

Aims & Methods

This is a retrospective, descriptive, and analytical study conducted from January 2002 to August 2021, including 50 patients with HHC fistulized into the biliary tract. All patients underwent ERCP combined with endoscopic biliary sphincterotomy. Overall success was defined as complete clearance of the main bile duct. Statistical analysis was performed using SPSS version 24.0.

Results

Among all ERCPs performed during the study period, 4.6% (n=50) were for a hepatic hydatid cyst communicating with the biliary tract. The mean age of patients was 46.1 ± 14.8 years, with a male predominance (66%; male-to-female ratio = 1.94).
ERCP was performed preoperatively in 52.2% of cases and postoperatively in 47.8%.
The main indications were acute cholangitis (44.9%) and persistent external biliary fistula (34%).
The median diameter of the common bile duct was 10 mm [7–14], and the median cyst diameter was 35 mm [27–47].
Sphincterotomy was performed in 96% of cases, allowing hydatid material extraction using a balloon or Dormia basket in 87.8% of cases. A nasobiliary drain was required in 24% of patients, and biliary stent placement was performed in 8%.
The overall success rate was 96% (n=46). Immediate complications occurred in 8% (n=4): one case of hemobilia and three cases of marginal bleeding.
Clinical improvement included jaundice resolution within 5 to 10 days and closure of the external biliary fistula within 10 days.

Conclusion

Our study confirms that endoscopic management of ruptured hepatic hydatid cysts into the biliary tract is an effective therapeutic alternative, with a low rate of immediate complications (8%) and favorable long-term outcomes.

Introduction

Endoscopic biliary sphincterotomy is an effective treatment for common bile duct stones. However, its success can be compromised by the presence of large stones or extensive choledochal lithiasis.
The aim of this study was to evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with large obstructive stones (>15 mm) and those with one or two stones or choledochal lithiasis, and to identify factors influencing the success of endoscopic drainage and associated complications in the management of large bile duct stones.

Aims & Methods

This was a retrospective, descriptive, and analytical study conducted over a 19-year period, from April 2006 to February 2025, in our department.
A total of 1,011 patients who underwent ERCP for common bile duct stones were included. Choledochal lithiasis was defined as the presence of more than three stones, and a large stone was defined as an obstructive stone larger than 15 mm. Patients were divided into two groups:

• Group I (n = 143): Patients with a single obstructive stone larger than 15 mm.
• Group II (n = 868): Patients with one or two stones or choledochal lithiasis.

Results

Patients with large stones (Group I) represented 14.1% (n = 143) of the cohort, while Group II included 868 patients (85.9%).
The success rate after a single catheterization was 55.2% in Group I compared to 81% in Group II (p < 0.001). Reintervention was required in 14.7% of Group I patients versus 8% in Group II (p = 0.009). Additional procedures were performed in 46.2% of cases in Group I versus 16.1% in Group II.
The overall success rate after reintervention and/or additional procedures was 88.7% in Group I versus 92.5% in Group II (p = 0.125).
Early complication rates were higher in Group I (10.5%) compared to Group II (5.1%), with a statistically significant difference between groups (p = 0.017).
Univariate analysis identified the following factors as significantly decreasing the overall success rate of endoscopic treatment: older age, acute cholangitis, bile duct stricture, and significant bile duct dilation (diameter >15 mm).
Multivariate analysis, adjusted for age, sex, surgical history, acute pancreatitis, acute cholangitis, periampullary diverticulum, bile duct diameter, and bile duct stricture, showed that only acute cholangitis (OR: 0.295; 95% CI: [0.164 – 0.532]; p < 0.001) and bile duct stricture (OR: 0.53; 95% CI: [0.922 – 1.051]; p = 0.001) were independently associated with a decreased overall success rate of endoscopic treatment.

Conclusion

Our study found no statistically significant difference in the effectiveness of endoscopic treatment between patients with large stones and those with simple lithiasis. However, the presence of acute cholangitis and bile duct strictures appears to be associated with a reduced overall success rate of endoscopic management.

Introduction

Klatskin's tumor is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications.
The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure.

Aims & Methods

This is a retrospective and analytical study of 75 patients, conducted between 2012 and 2024, including all patients admitted with Klatskin's tumor and for whom endoscopic drainage was indicated.
Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis.
Statistical analysis was performed using SPSS version 22.0 software.

Results

The average age of our patients was 62.67 +/-12 years with extremes ranging from 31 years to 93 years. Our series was characterized by a male predominance of 68% or a sex ratio of 2.12.
Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients.
Sixteen percent of patients had liver metastases.
Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases (n=24), by a metal prosthesis in 45.2% (n=34) and by nasobiliary drain in 4.1% (n=3).
Forty-seven percent of patients (n=35) had dilatation of the stenosis prior to prosthesis placement.
Causes of stenting failure were primarily related to failure of papilla catheterization, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumor.
In multivariate analysis and adjusting for age, gender, Bismuth tumor type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and Bismuth tumor type modified the outcome.
the Bismuth classification affect the success rate.
Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p<0.001]. However, tumors classified as Bismuth IV [OR=8; p<0.001] or Bismuth IIIa [OR=5; p=0.004] were associated with a risk of endoscopic treatment failure.

Conclusion

Our study suggests that the presence of metastatic hilar cholangiocarcinoma classified as Bismuth IV or Bismuth IIIa appear to be associated with failure of endoscopic biliary drainage of Klatskin's tumors, whereas endoscopic dilatation prior to prosthesis placement appears to be associated with success.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is now the gold standard for the treatment of bile duct stones. However, recurrence stones is frequent after their complete removal by endoscopic treatment.

Aims & Methods

The present study is retrospective, descriptive and analytic, including all patients who underwent ERCP for common bile duct (CBD) stones between January 2008 and January 2024.
Recurrent CBD stone was defined as the finding of a stone at least 6 months after the initial ERCP in which complete stone extraction was performed.
Factors associated with recurrent CBD stones were studied by logistic regression analysis.
Statistical analysis was performed using Jamovi software.
The aim of our study is to identify predictors of recurrent CBD stones after ERCP.

Results

Among 1151 patients who underwent ERCP for lithiasis pathology, 88 patients or 7.7% had recurrent CBD stone.
Mean age of the patients was 64.5 +/-13.4 years, with extremes ranging from 22 to 94 years. Sex ratio (M/F) was 0.69, with a female predominance of 59.1%.
20.5% of patients presented with acute angiocholitis and 6.8% with acute pancreatitis.
A periampullary diverticulum was found in 5.7% of patients (n=5).
In univariate analysis, the risk factors for recurrent CBD stone were: older age (OR :37; IC95% : [10,7- 127,2] ; p<0,001), female gender ( OR :9,9 ;IC95% : [4,49-22,04] ; p<0,001), CBD diameter > 15 mm (OR : 7,36 ;IC95% : [5,51-9,8] ; p<0,001), presence of angiocholitis ( OR : 2.06 ;IC95% : [1,12-3,8] ; p=0,02), number of CBD stones (OR :8,61; IC95% : [6,51-11,39] ; p=0,018), size of CBD stones (OR :2,51 ;IC95% : [1,43-4,39] ; p=0,001), while enlargement EST (OR :0,18; IC95% : [0,08-0,44] ; p<0,001) was a protective factor.
After multivariate analysis, and adjusting for the factors studied, only older age (OR:1.96; CI95%: [1.94-2.93]; p=0.001), number of CBD stones (OR: 1.99; CI95%: [1,2-3,4] ; p=0,037) and size of CBD stones (OR :4,06; IC95% : [3,51-6,72] ; p=0,003) were risk factors, and enlargement EST (OR :0,31; IC95% : [0,11-0,85] ; p=0,024) was protective factor.

Conclusion

In our study, the predictive factors for recurrent CBD stones were advanced age, the presence of impaction and a large stone.

Introduction

Evaluate the predictive factors of failure rate of clearing the biliary system from stones at the initial ERCP.

Aims & Methods

This is a retrospective descriptive and analytical study from September 2004 to September 2023.
All patients with bile duct stones, who underwent ERCP with endoscopic sphincterotomy and stone extraction by standard techniques (extraction balloon or Dormia basket) were included in this study.

Results

A total of 1080 ERCPs were performed to extract biliary duct stones .

The mean age was 58.9 +/- 14.4 years and 59.5% were females.
The mean diameter ofthe Bile duct was 13.4+/- 4.31 mm. The presence of a biliary stricture in 6.3%.
The primary vacuity rate was 75.1%. Supplementary techniques were used in 22.7% of cases.
On univariate analysis, the predictive factors for failure after use of standard techniques were: age(OR: 0.9;CI95%:-0.03- -0.01;p<0.001); gender(OR:0.7;CI95%:-0.5--0.02;p=0.036); previous cholecystectomy (OR:1.3,CI95%:0.02-0.6;p=0.035);presence of angiocholitis(OR: 0.4; CI95%:-1.1- -0.4;p<0.001); dilatation of the CBD >15mm (OR:0,8,CI95%:-0.2-0.1;p<0.001), biliary stricture (OR:0.3;CI95%:-1.7--0.7;p<0.001) and the presence of impacted and/or large stone (OR:0.1;CI95%:-2--1;p<0.001).
On multivariateanalysis, only the presence of angiocholitis (OR:1.9;CI95%: 0.2-1;p=0.001),impacted and/or large stone (OR:2.5;CI95%:0.5-1.3;p<0.001), dilatation ofthe CBD >15mm (OR:0.88;CI95%:-0.17- -0.07;p<0.001), and biliary stricture(OR:2.9;CI95%:0.4-1.7;p=0.002) were significantly associated with failure ofthe primary CBD vacuity rate.
The overall vacuity rate after using the supplementary techniques was 92.4%.

Conclusion

In our study, predictivefactors for failure of the primary CBD vacuity rate were the presence ofangiocholitis, impacted and/or large stone, dilatation of the CBD (>15mm)and biliary stricture.