ERCP experience in patients with choledochoduodenostomy: diagnostic findings and therapeutic management

Demirel, Bilge; Kekilli, Murat; Önal, İbrahi̇m Koral; Parlak, Erkan; Dışıbeyaz, Selçuk; Kaçar, Sabite; Kılıç, Zeynep; Şaşmaz, Nurgül; Şahın, Burhan

doi:10.1007/s00464-010-1313-6

Cited by 15 publications

(7 citation statements)

References 17 publications

(13 reference statements)

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“…Therefore the part of the CBD distal from the CDD anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris [ 1 ]. Sump syndrome was first described in 1976, with a wide prevalence ranging from 2.5 to 15.7% after CDD [ 8 , 9 , 10 , 11 ]. Nowadays, CDD is widely replaced by ERCP [ 12 ], but we are still faced with its consequences and long-term complications in elderly patients due to global migration of people to the United States from developing and underdeveloped countries where ERCP is still not being used as a standard procedure.…”

Section: Discussionmentioning

confidence: 99%

Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

Abraham

Thomas

Srivastava

2017

Case Rep Gastroenterol

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Biliary sump syndrome is a rare condition. It is seen as a rare long-term complication in patients with a history of a side-to-side choledochoduodenostomy. In the era before endoscopic retrograde cholangiopancreatography, side-to-side choledochoduodenostomy was a common surgical procedure for the management of biliary obstruction. In the setting of a side-to-side choledochoduodenostomy, the bile does not drain through the distal common bile duct anymore. Therefore, the part of the common bile duct distal from the choledochoduodenostomy anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a 64-year-old man with a history of side-to-side choledochoduodenostomy who presented with manifestations of cholangitis. An endoscopic retrograde cholangiopancreatography confirmed a diagnosis of sump syndrome. The etiology, clinical manifestations, and treatment of biliary sump syndrome are discussed in this article.

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Section: Discussionmentioning

confidence: 99%

Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

Abraham

Thomas

Srivastava

2017

Case Rep Gastroenterol

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“…Management of the syndrome has been successfully accomplished by endoscopic intervention. 35,36 Biliary stasis has been implicated as an important factor in the formation of primary duct stones. 17 The pathogenesis of the stone must be considered for treatment and alleviation of biliary stasis should be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Current assessment of choledochoduodenostomy: 130 consecutive series

Okamoto

Miura

Itakura

et al. 2017

annals

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Introduction Cholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but its acceptance remains debated because of the risk of reflux cholangitis and sump syndrome. The aim of this study was to assess the current features and outcomes of patient undergoing CDD. Patients and methods We retrospectively analysed the surgical results of consecutive 130 patients treated by CDD between 1991 and 2013 and excluded five cases with a malignant disorder. Indications for surgery included endoscopic management where stones were difficult or failed to pass and primary common bile duct stones with choledochal dilatation. Incidences of reflux cholangitis, stone recurrence, pancreatitis or sump syndrome were investigated and the data between end-to-side and side-to-side CDD were compared. Results Reflux cholangitis and stone recurrence was 1.6% (2/125) and 0% (0/125) of cases by CDD. There is no therapeutic-related pancreatitis in CDD. Sump syndrome was not also observed in side-to-side CDD. Conclusions This study is a first comparative study between end-to-side and side-to-side CDD. The surgical outcomes for CDD treatment of choledocholithiasis were acceptable. The incidence of reflux cholangitis, stone recurrence, pancreatitis and sump syndrome was very low.

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“…Nowadays CDD is widely replaced by ERCP [ 1 ], but we are still faced with its consequences and long-term complications in elderly patients. Sump syndrome was first described in 1976, and a diverse prevalence ranging from 2.5 to 15.7% after CDD has been reported [ 2 , 3 , 4 , 5 ]. Sump syndrome is not precisely defined, but it results from accumulation of lithogenic bile, debris or calculi as well as refluxed duodenal contents in the distal CBD, leading to biliary and/or pancreatic complications.…”

Section: Discussionmentioning

confidence: 99%

Mind the Sump! - Diagnostic Challenge of a Rare Complication of Choledochoduodenostomy

Zeuge

Fehr

Meyenberger

et al. 2014

Case Rep Gastroenterol

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Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). Frequently only pneumobilia, serving as sign for functioning biliary-enteric anastomosis, is reminiscent of the former surgery. We present the case of an 81-year-old patient with sump syndrome who presented with clinical signs of ascending cholangitis, decades after the initial CDD procedure. Finally the detailed medical history that was taken very thoroughly in combination with the presence of pneumobilia led to the suspicion of sump syndrome. Sump syndrome was diagnosed by ERCP, and after endoscopic debris extraction and antibiotic treatment the patient recovered quickly. In the ERCP era little is known about CDD and its long-term complications, especially by young colleagues and trainees. Therefore this report provides an excellent opportunity to refresh the knowledge and raise awareness for this syndrome.

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ERCP experience in patients with choledochoduodenostomy: diagnostic findings and therapeutic management

Abstract: We have reported one of the largest groups of patients with CD in the literature and showed that ERCP is a very important diagnostic and therapeutic tool for the management of biliary problems after CD.

Cited by 15 publications

References 17 publications

Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

Current assessment of choledochoduodenostomy: 130 consecutive series

Mind the Sump! - Diagnostic Challenge of a Rare Complication of Choledochoduodenostomy

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