Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6241
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
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).
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.
This study is a retrospective analysis that aimed to investigate predictive factors for patients with MS with cholecystocholedochal fistulas during ERCP before laparoscopic surgery.
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.
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
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.
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.