Wu CH, Liu NJ, Yeh CN, Wang SY, Jan YY. Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography. World J Gastroenterol 2020; 26(40): 6241-6249 [PMID: 33177796 DOI: 10.3748/wjg.v26.i40.6241]
Corresponding Author of This Article
Yi-Yin Jan, MD, Attending Doctor, Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No. 5 Fu-Hsin Street, Queishan, Taoyuan 333, Taiwan. janyy@cgmh.org.tw
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 28, 2020; 26(40): 6241-6249 Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6241
Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography
Chi-Huan Wu, Nai-Jen Liu, Chun-Nan Yeh, Shang-Yu Wang, Yi-Yin Jan
Chi-Huan Wu, Nai-Jen Liu, Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
Chun-Nan Yeh, Shang-Yu Wang, Yi-Yin Jan, Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
Author contributions: Jan YY designed the research protocol; Liu NJ and Wang SY conducted the research and contributed analytic tools; Wu CH wrote the paper and analyzed the data; Yeh CN reviewed and revised the paper.
Institutional review board statement: The study was approved by the Chang Gung Medical Foundation Institutional Review Board (IRB number: 201801210B0).
Informed consent statement: Due to the retrospective design of the study, consent was waived by the ethics committee for the entire study.
Conflict-of-interest statement: The authors have no financial disclosures to declare and no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yehchunnan@gmail.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Yin Jan, MD, Attending Doctor, Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No. 5 Fu-Hsin Street, Queishan, Taoyuan 333, Taiwan. janyy@cgmh.org.tw
Received: May 16, 2020 Peer-review started: May 16, 2020 First decision: May 29, 2020 Revised: June 9, 2020 Accepted: October 1, 2020 Article in press: October 1, 2020 Published online: October 28, 2020 Processing time: 165 Days and 2.3 Hours
ARTICLE HIGHLIGHTS
Research background
Mirizzi syndrome (MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during endoscopic retrograde cholangio-pancreatography (ERCP).
Research motivation
Our study revealed that gall bladder opacification is more frequent in patients with cholecystocholedochal fistula. Pus in the common bile duct is a predictive factor for the diagnosis of MS with cholecystocholedochal fistulas, and stricture length of the common bile duct longer than 2 cm is a protective factor for cholecystocholedochal fistulas in patients with MS.
Research objectives
This study is a retrospective analysis that aimed to investigate predictive factors for patients with MS with cholecystocholedochal fistulas during ERCP before laparoscopic surgery.
Research methods
Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and analyzed.
Research results
Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas. Pus in the common bile duct and stricture length of the common bile duct longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis
Research conclusions
It is important to establish the preoperative diagnosis of a cholecystocholedochal fistula by ERCP to optimize planning for the surgical procedure in patients with MS. Gall bladder opacification is more frequent is patients with cholecystocholedochal fistula.
Research perspectives
The number of patients with MS with cholecystocholedochal fistulas were relatively small. The factors that were found in our study should also be verified in future clinical studies.
