Surgery versus endoscopy with digital single-operator cholangioscopy-guided therapy for Mirizzi syndrome: the SEIZE study

Michiel Bronswijk; Joachim Tengan; Paolo Giorgio Arcidiacono; Marco J. Bruno; Jahnvi Dhar; Christian Gerges; Vikas Gupta; Marcus Hollenbach; Gavin Johnson; Sundeep Lakhtakia; Willem J. Lammers; Jones A. O. Omoshoro-Jones; Apostolis Papaefthymiou; Enrique Pérez-Cuadrado-Robles; D. Nageshwar Reddy; Gideon Saelman; Jayanta Samanta; Giuseppe Vanella; Alexander Waldthaler; Roy L.J. van Wanrooij; Jan Fritjof Willemsen; Babs M. Zonderhuis; Rastislav Kunda; George Webster; Schalk Van der Merwe; on behalf of the SEIZE collaboration

doi:10.1055/a-2624-2580

Endoscopy, Table of Contents

Endoscopy
DOI: 10.1055/a-2624-2580

Original article

Surgery versus endoscopy with digital single-operator cholangioscopy-guided therapy for Mirizzi syndrome: the SEIZE study

Michiel Bronswijk ‡^‡

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

²Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, Belgium

,

Joachim Tengan ‡^‡

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Paolo Giorgio Arcidiacono

³Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Marco J. Bruno

⁴Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

,

Jahnvi Dhar

⁵Departments of Gastroenterology and Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

,

Christian Gerges

⁶Department of Interventional Gastroenterological Endoscopy, University Hospital Essen, Essen, Germany

,

Vikas Gupta

⁵Departments of Gastroenterology and Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

,

Marcus Hollenbach

⁷Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig and Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany

,

Gavin Johnson

⁸Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK

,

Sundeep Lakhtakia

⁹Asian Institute of Gastroenterology, Hyderabad, India

,

Willem J. Lammers

⁴Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

,

Jones A. O. Omoshoro-Jones

¹⁰Surgery Department, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa

¹¹General and Hepatopancreatobiliary Surgery, Chris Hani-Baragwanath Academic Hospital, Soweto, South Africa

,

Apostolis Papaefthymiou

⁸Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK

,

Enrique Pérez-Cuadrado-Robles

¹²Department of Gastroenterology, Georges-Pompidou European Hospital, APHP Centre, University of Paris Cité, Paris, France

,

D. Nageshwar Reddy

⁹Asian Institute of Gastroenterology, Hyderabad, India

,

Gideon Saelman

¹³Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

,

Jayanta Samanta

⁵Departments of Gastroenterology and Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

,

Giuseppe Vanella

³Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Alexander Waldthaler

¹⁴Department of Upper Abdominal Diseases, Karolinska University Hospital and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden

,

Roy L.J. van Wanrooij

¹⁵Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands

,

Jan Fritjof Willemsen

¹⁴Department of Upper Abdominal Diseases, Karolinska University Hospital and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden

,

Babs M. Zonderhuis

¹³Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

,

Rastislav Kunda

¹⁶Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Brussels, Belgium

¹⁷Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

,

George Webster

⁸Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK

,

Schalk Van der Merwe

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

on behalf of the SEIZE collaboration

(

Luca Aldrighetti

¹⁸Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

¹⁹Vita-Salute San Raffaele University, Milan, Italy

,

Federica Cipriani

¹⁸Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

¹⁹Vita-Salute San Raffaele University, Milan, Italy

,

Simon M. Everett

²⁰Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

,

James Gauci

²⁰Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

,

Wim Laleman

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Arnaud Lemmers

²¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libre de Bruxelles (ULB), Brussels, Belgium

,

Sohaib Ouazzani

²¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libre de Bruxelles (ULB), Brussels, Belgium

,

Jan-Werner Poley

²²Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands

,

Frédéric Prat

²³Gastroenterology Unit, Hôpital Cochin (AP-HP), Paris, France

,

Gilbert Rahe

⁶Department of Interventional Gastroenterological Endoscopy, University Hospital Essen, Essen, Germany

,

Hannah Van Malenstein

¹Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

,

Koen Vermeiren

²⁴Department of General and Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium

,

Juan Vila

²⁵Endoscopy Unit, Hospital Universitario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

)› Author Affiliations

Abstract

Background The management of Mirizzi syndrome has been primarily surgical, but there are no comparisons between surgical and digital single-operator cholangioscopy (dSOC)-guided treatment. The objective of this study was to compare the safety and other outcomes of the two approaches.

Methods A large multicenter international retrospective analysis was conducted comparing dSOC and surgery in patients with type II–IV Mirizzi syndrome between January 2005 and June 2023. Patients with postsurgical anatomy, Mirizzi type I or V, or previous cholecystectomy were excluded.

Results 290 patients were included (dSOC, n = 176; surgery, n = 114). At baseline, patients undergoing dSOC were older P = 0.006) and exhibited more co-morbidities. While technical success was lower with dSOC (89.8 % vs. 96.5 %; P = 0.04), the need for reintervention was comparable after a median follow-up duration of 741.5 days (interquartile range [IQR] 320–1781) vs. 346 days (IQR 67–1220; P = 0.009). Overall adverse events (10.2 % vs. 41.2 %; P < 0.001) and severe adverse events (1.7 % vs. 15.8 %; P < 0.001) occurred less frequently with dSOC, findings that were confirmed with propensity score-matching. A lower need for hepaticojejunostomy (8.2 % vs. 25.4 %; P = 0.006) and lower rate of conversion to open surgery (6.0 % vs. 22.8 %; P = 0.009) were observed in patients undergoing elective cholecystectomy following dSOC compared with the primary surgery group.

Conclusions Our study demonstrates that the use of dSOC for Mirizzi syndrome is effective, showing superior safety despite being used to treat patients with more underlying co-morbidities. dSOC seems valuable in downgrading the extent of subsequent surgery, by potentially reducing the need for hepaticojejunostomy and conversion to open surgery.

Full Text

References

References
1 Kehr H. Die in meiner Klinik geübte Technik der Gallensteinoperationen mit einem Hinweis auf die Indikationen und die Dauererfolge: Auf Grund eigener, bei 1000 Laparotomien gesammelter Erfahrungen. Munich: ; 1905. xxiv 395
2 Klekowski J, Piekarska A, Góral M. et al. The current approach to the diagnosis and classification of Mirizzi syndrome. Diagnostics 2021; 11: 1660
3 Chen H, Siwo EA, Khu M. et al. Current trends in the management of Mirizzi syndrome: A review of literature. Medicine (Baltimore) 2018; 97: e9691
4 Csendes A, Díaz JC, Burdiles P. et al. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 1989; 76: 1139-1143
5 Beltrán MA. Mirizzi syndrome: history, current knowledge and proposal of a simplified classification. World J Gastroenterol 2012; 18: 4639-4650
6 Senra F, Navaratne L, Acosta A. et al. Laparoscopic management of type II Mirizzi syndrome. Surg Endosc 2020; 34: 2303-2312
7 Yonetci N, Kutluana U, Yilmaz M. et al. The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int 2008; 7: 520-524
8 Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 2008; 32: 2237-2243
9 Shirah BH, Shirah HA, Albeladi KB. Mirizzi syndrome: necessity for safe approach in dealing with diagnostic and treatment challenges. Ann Hepatobiliary Pancreat Surg 2017; 21: 122-130
10 Wehrmann T, Riphaus A, Martchenko K. et al. Intraductal ultrasonography in the diagnosis of Mirizzi syndrome. Endoscopy 2006; 38: 717-722
11 Mishra MC, Vashishtha S, Tandon R. Biliobiliary fistula: preoperative diagnosis and management implications. Surgery 1990; 108: 835-839
12 Kumar A, Senthil G, Prakash A. et al. Mirizzi's syndrome: lessons learnt from 169 patients at a single center. Korean J Hepatobiliary Pancreat Surg 2016; 20: 17-22
13 Seah WM, Koh YX, Cheow PC. et al. A retrospective review of the diagnostic and management challenges of Mirizzi syndrome at the Singapore General Hospital. Dig Surg 2018; 35: 491-497
14 Tsuyuguchi T, Saisho H, Ishihara T. et al. Long-term follow-up after treatment of Mirizzi syndrome by peroral cholangioscopy. Gastrointest Endosc 2000; 52: 639-644
15 Issa H, Bseiso B, Al-Salem AH. Successful laser lithotripsy using peroral SpyGlass cholangioscopy in a patient with Mirizzi syndrome. Endoscopy 2011; 43 Suppl 2: E166-E167
16 Kim DC, Moon JH, Choi HJ. et al. Successful endoscopic treatment for Mirizzi syndrome type II under direct peroral cholangioscopy using an ultraslim upper endoscope. Endoscopy 2014; 46 (Suppl. 01) E103-E104
17 Salgado-Garza G, Hernandez-Arriaga P, Gonzalez-Urquijo M. et al. Single-operator cholangioscopy and electrohydraulic lithotripsy for the treatment of Mirizzi syndrome. Ann Med Surg (Lond) 2021; 62: 274-277
18 Pawa R, Dorrell R, Pawa S. Endoscopic management of cystic duct stones and Mirizzi's syndrome: experience at an academic medical center. Endosc Int Open 2022; 10: E135-E144
19 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 571-576 discussion 576-578
20 Dimou FM, Adhikari D, Mehta HB. et al. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 2016; 160: 691-698

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Supplementary material