PREDICTIVE FACTORS FOR FAILURE OF ENDOSCOPIC TREATMENT OF POST-CHOLECYSTECTOMY BILIARY TRAUMA

Aims:

To evaluate the factors that can predict for failure of endoscopic treatment making the patient at risk for further surgery

Methods:

A retrospective study, over a period of 8 years (2008 to 2016), including 23 patients with post-cholecystectomy biliary stenosis, diagnosed either by the different imaging modalities or during ERCP. Data was collected from the records of our department. The results were obtained using T-student and Khi2 tests. Value is significant if < 0.05

Results:

The average age of our patients was 55 ± 14 years, with a female predominance (74%). The median age between cholecystectomy and the onset of clinical signs was 36. The clinical presentation was very polymorphous dominated by cholestatic jaundice (68.2%), biliary colic in 3 cases (13.6%) and cholangitis in one case (4.5%). An abdominal US was performed in all our patients showed a non-obstructive BD dilatation in most cases, calculus BD dilatation was found in 7 cases and a choledocholitiasis in only one case.

MRC was performed in 10 patients, showed biliary stenosis in 9 cases, a non stenosing choledocholitiasis in a single case. ERCP with balloon dilatation of the stenosis in 8 patients using 8 – 10 Fr balloon, placing a plastic stent in 6, and non-covered metallic stent in 1 patient. According to the classification of bismuth: 17 patients (74%), had type 1, 3 patients (13%) had type 3, 1 patient (4.3%) had type 4 and 2 patients (8.7%) had type 5. The prevalence of ERCP failure was 43.5%. Univariate results showed that the proximal level (p = 0.04) and the advanced age of stenosis (p = 0.046) were predictive factors for the risk of ERCP failure, respectively

Conclusions:

This study showed that there is a correlation between ERCP failure and the age, location of the stenosis; these results need to be confirmed by a large scale study