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©2014 Baishideng Publishing Group Inc. All rights reserved.
Late biliary complications in human alveolar echinococcosis are associated with high mortality
Pascal Frei, Benjamin Misselwitz, Meher K Prakash, Alain M Schoepfer, Bettina M Prinz Vavricka, Beat Müllhaupt, Michael Fried, Kuno Lehmann, Rudolf W Ammann, Stephan R Vavricka
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
Alain M Schoepfer, Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
Kuno Lehmann, Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
Stephan R Vavricka, Division of Gastroenterology and Hepatology, Stadtspital Triemli, 8063 Zurich, Switzerland
Author contributions: Frei P, Ammann RW and Vavricka SR designed the study; Frei P, Prinz Vavricka BM, Ammann RW and Vavricka SR aquired the data; Frei P, Misselwitz B, Prakash MK, Schoepfer AM and Vavricka SR analyzed the data; Frei P, Schoepfer AM and Vavricka SR drafted the manuscript; Schoepfer AM, Prinz Vavricka BM, Müllhaupt B, Fried M and Lehmann K revised the manuscript; all authors approved the final version of the manuscript.
Supported by The Foundation for Medical Research and Development (Winterthur, Switzerland), the Gebert-Ruef Foundation (Zurich, Switzerland); the Baugarten-Foundation (Zurich, Switzerland); the OPO-Foundation (Zurich, Switzerland); the Caritative Foundation Gerber-ten Bosch (Zurich Switzerland); the UBS (Zurich, Switzerland) acting on behalf of a major anonymous sponsor; andSwiss National Science Foundation Grants NO. 320000-114009/3 and NO. 32473B_135694/1 (Vavricka SR)
Correspondence to: Stephan R Vavricka, MD, Division of Gastroenterology and Hepatology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063 Zurich, Switzerland. stephan.vavricka@usz.ch
Telephone: +41-44-4661317 Fax: +41-44-4662903
Received: May 31, 2013
Revised: September 21, 2013
Accepted: October 19, 2013
Published online: May 21, 2014
AIM: 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).
CONCLUSION: 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.
