title: Late biliary complications in human alveolar echinococcosis are associated with high mortality.
abstract: OBJECTIVE
  To evaluate the incidence of late biliary complications in non-resectable alveolar echinococcosis (AE) under long-term chemotherapy with benzimidazoles.
  
  
  METHODS
  Retrospective analysis of AE patients with biliary complications occurring more than three years after the diagnosis of AE. We compared characteristics of patients with and without biliary complications, analyzed potential risk factor for biliary complications and performed survival analyses.
  
  
  RESULTS
  Ninety four of 148 patients with AE in Zurich had non-resectable AE requiring long-term benzimidazole chemotherapy, of which 26 (28%) patients developed late biliary complications. These patients had a median age of 55.5 (35.5-65) years at diagnosis of AE and developed biliary complications after 15 (8.25-19) years of chemotherapy. The most common biliary complications during long-term chemotherapy were late-onset cholangitis (n = 14), sclerosing cholangitis-like lesions (n = 8), hepatolithiasis (n = 5), affection of the common bile duct (n = 7) and secondary biliary cirrhosis (n = 7). Thirteen of the 26 patients had undergone surgery (including 12 resections) before chemotherapy. Previous surgery was a risk factor for late biliary complications in linear regression analysis (P = 0.012).
  
  
  CONCLUSIONS
  Late biliary complications can be observed in nearly one third of patients with non-resectable AE, with previous surgery being a potential risk factor. After the occurrence of late biliary complications, the median survival is only 3 years, suggesting that late biliary complications indicate a poor prognostic outcome.
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Meher K
authors.initials: MK
authors.lastname: Prakash
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Bettina M
authors.initials: BM
authors.lastname: Prinz Vavricka
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Kuno
authors.initials: K
authors.lastname: Lehmann
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Ammann
authors.affiliation: Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Rudolf W Ammann, Stephan R Vavricka, Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
mesh_terms: D000328:Adult; D000368:Aged; D000977:Antiparasitic Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D016208:Databases, Factual; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D016014:Linear Models; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000977:Antiparasitic Agents; D001562:Benzimidazoles
keywords: Alveolar echinococcosis; Biliary cirrhosis; Biliary strictures; Cholangitis; Cholestatic liver disease; Chronic liver disease; Complications; Echinococcal cysts; Prognosis