The Role of Endoscopic Retrograde Cholangiopancreatography in the Preoperative Diagnosis of Mirezzi Syndrome
Year: 2025
Type: article
Study design: Observational Study
Abstract: Summary. Introduction. Mirizi syndrome is a complex and rare complication of gallstone disease that occurs due to compression of the common bile duct by calculi localized in the gallbladder neck or bile duct. Such obstructive lesions can lead to progressive mechanical jaundice, cholangitis, liver failure, and, in severe cases, to the formation of cholecysto-duodenal fistulas. To date, the diagnosis of Mirizi syndrome remains a difficult task, as its clinical picture can mimic choledocholithiasis or malignant lesions of the bile ducts. Endoscopic retrograde cholangiopancreatography is one of the most effective methods for detecting this pathology, as it allows not only to assess the condition of the bile ducts but also to determine the degree of their compression and damage. Due to its high information content, endoscopic retrograde cholangiopancreatography allows to differentiate Mirizi syndrome from other biliary pathologies, such as choledocholithiasis, strictures or tumor processes. In addition, in some cases, endoscopic retrograde cholangiopancreatography can be used as a therapeutic method to perform papillosphincterotomy, remove calculi, or stent the bile ducts in case of severe stenosis. Thus, the use of endoscopic retrograde cholangiopancreatography in Mirizi syndrome is an important tool for accurate preoperative diagnosis, selection of optimal surgical tactics and reduction of the risk of complications in the postoperative period. Objective of the study. To determine the sensitivity of endoscopic retrograde cholangiopancreatography at the stage of preoperative diagnosis of Mirizi syndrome and to identify the most significant signs for the diagnosis of Mirizi syndrome. Materials and Methods. The results of 1126 endoscopic retrograde cholangiopancreatography performed at the Kharkiv Clinical Hospital for Railway Transport No. 2 from 1997 to 2025 were analyzed, signs of Mirizzy syndrome during endoscopic retrograde cholangiopancreatography were detected in 144 (12.8%) patients. Of the 144 patients with signs of Mirizzy syndrome, 82 (56.9%) patients were confirmed to have Mirizzy syndrome intraoperatively. Among them, there were 108 (75%) women and 36 (25%) men, and the age of patients ranged from 37 to 80 years (mean (66±1) years). To analyze the sensitivity of certain signs during preoperative endoscopic retrograde cholangiopancreatography for suspected Mirizi syndrome, the diagnostic sensitivity index was used. Results. During the endoscopic retrograde cholangiopancreatography, the following signs were detected for which the diagnostic sensitivity was calculated external compression of the common bile duct or common hepatic duct at the level of the gallbladder or bile duct (63.8%), narrowing or intermittent contrast, partial release of contrast agent into the gallbladder (40%), wide transition of contrast between the gallbladder and the common hepatic duct (40%), significant defect in the area of fistula, uneven contours of the duct and its fusion with the gallbladder (80%), additional contrast in the duodenal lumen (100%). Conclusions. Endoscopic retrograde cholangiopancreatography allows to establish the presence of Mirizi syndrome at the preoperative stage with a moderate (56.9%) degree of probability. The probable endoscopic signs of Mirizi syndrome are a significant defect in the fistula area, uneven contours of the duct and its fusion with the bladder (80%); external compression of the common bile duct or the common hepatic duct at the level of the gallbladder or bile duct (63.8%); additional contrast in the duodenum or colon (100%). The information obtained about the high probability of the presence of Mirizi syndrome at the preoperative stage allows you to correctly plan the possible options for the scope and tactics of surgical intervention.
Source: Kharkiv Surgical School
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4410599114