Endoscopic retrograde cholangiopancreatography in hepatic alveolar echinococcosis.
OBJECTIVE
Hepatic alveolar echinococcosis (HAE) involves both the vascular and biliary structures of the liver. Endoscopic retrograde cholangiopancreatography (ERCP) is said to be an alternative for the diagnosis and treatment of biliary complications of HAE. We present here our experience with ERCP in HAE.


METHODS
We followed 13 patients who underwent ERCP for the treatment of biliary complications of HAE in the endoscopy unit of our clinic at Ataturk University School of Medicine, Erzurum between January 2002 and June 2008.


RESULTS
Eight men and five women were followed up. Mean age was 43.2 (24-64 years). All patients had non-resectable HAE. Indications for ERCP were biliary fistula in seven patients, obstructive jaundice in five patients and cholangitis in one patient. Endoscopic sphincterotomy (ES) was carried out in 12 patients, and in one patient with biliary leakage, a stent was inserted into the right hepatic branch. ERCP findings were dilated common bile duct, irregular narrowing and distortion of the common bile duct and common hepatic duct, communication with the cystic cavity or biliocutaneous fistula and complete disappearance of the biliary tree above the level of the common hepatic duct or hepatic bifurcation. In patients with biliary leakage, biliary drainage decreased only in two patients after ERCP and in patients with obstructive jaundice, the high bilirubin levels decreased in only one patient.


CONCLUSIONS
ERCP showed structural changes of the external biliary tract and ES has a limited effect on these changes and stents can be used in selected cases.
Ozturk
Gurkan
G
Department of General Surgery, Ataturk University School of Medicine, Erzurum, Turkey. gurkanoztrk@yahoo.com
Polat
Kamil Yalcin
KY
Yildirgan
Mehmet Ilhan
MI
Aydinli
Bulent
B
Atamanalp
Sabri Selcuk
SS
Aydin
Unal
U
D000328:Adult; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000469:parasitology / Q000601:surgery; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000469:parasitology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000469:parasitology / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000469:parasitology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult