Role of ERCP in Diagnosis and Treatment of Type I Mirizzi Syndrome: A Case Series with Review of Literature

Abstract

Background/aim: Mirizzi syndrome is a rare condition complicating long-standing gallstones disease. The aim of this study is to define, through a 17 year-experience, the role of Endoscopic Retrograde Cholangiopancreatography in the diagnosis and the treatment of Mirizzi syndrome type I according to Csendes classification.

Materials and Methods: A retrospective study including patients diagnosed with Mirizzi syndrome type I, between 2002 and 2019 was conducted in the department of digestive endoscopy of our university hospital. Data collected included demographic, clinical, biological and imaging findings. Endoscopic characteristics and procedures used for treatment were collected. Statistical analysis was performed using SPSS 20.0.

Results: Type I Mirizzi syndrome was diagnosed during ERCP in 0,48% of patients with gallstone disease, the median age was 55.5 (46-69.5) without gender difference. 50% of our cases were diagnosed before surgery. Endoscopic therapeutic procedures included biliary decompression techniques using nasal bile drainage or plastic stents, balloon sweeping after selective catheterization of cystic duct and large balloon papillary dilation with double cannulation. The success rate of endoscopic management was 66,6%. Surgical treatment was performed at the same time as laparoscopic cholecystectomy in patients with lithiasic gall bladder.

Conclusions: Mirizzi syndrome remains a fascinating and rare condition complicating gallstone disease with no uniform guidelines to date. Our study emphasizes the role of ERCP as a diagnostic and therapeutic procedure in the management of type I Mirizzi syndrome.