Endoscopic retrograde cholangiopancreatography for the management of biliary fistula following liver hydatid cyst related surgery or radiological interventions

Table 1 General characteristics and management of the study population

Total patients	n = 88
Gender (female), n (%)	50 (57)
Median age (range; years)	33 (8-83)
Comorbidities, n (%)
Diabetes mellitus	6 (6.8)
Arterial hypertension	4 (4.5)
Coronary artery disease	1 (1.1)
Celiac disease	1 (1.1)
Thalassemia major	1 (1.1)
Gordon syndrome	1 (1.1)
Polycystic kidney disease	1 (1.1)
Median cyst size (cm)	9.5 (4-23)
Gharbi classification, n (%)
Type 1	10 (11)
Type 2	36 (41)
Type 3	31 (35)
Type 4	11 (13)
Cyst characteristics, n (%)
Single cyst	65 (74)
Right lobe	70 (62)
Intervention type (surgery)	72 (82)
Daily fistula output (> 400 mL)	42 (48)
ERCP time (< 10 days), n (%)	38 (43)
Mode of ERCP, n (%)
ES + biliary stenting	73 (83)
ES alone	15 (17)
Number of ERCP procedures, n (%)
1	66 (75)
2	17(19)
3	4 (5)
4	1 (1)
All complications, n (%)
Pancreatitis (mild)	5 (6)
Bleeding (mild)	4 (5)
Infection/cholangitis (non-severe)	4 (5)
Discharge (days), n (%)
1	56 (64)
2	18 (20)
> 3	14 (16)
Median fistula closure time (range; days)	17 (8-93)

ERCP: Endoscopic retrograde cholangiopancreatography; ES: Endoscopic sphincterotomy.

Table 2 Univariate and multivariate analysis of variables associated with early leakage closure

Variable	Univariate analysis		Multivariate analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Gender
Male	1
Female	1.23 (0.53-2.87)	0.625
Size (cm)
> 9.4	1
< 9.4	1.19 (0.51-2.75)	0.683
Number of cyst
Single	1
Multiple	1.00 (0.38-2.60)	0.991
Garbi classification
1	1
2	1.40 (0.34-5.70)	0.639
3	0.63 (0.160-2.65)	0.530
4	0.571 (0.100-3.27)	0.530
ERCP intervention type
EST	1		1
EST + BD	4.58 (1.19-17.63)	0.027	5.27 (1.30-21.37)	0.020
Fistula flow rate
High	1		1
Low	3.11 (1.29-7.44)	0.011	3.43 (1.37-8.55)	0.008
ERCP complication
Present	1
Absent	1.108 (0.297-4.125)	0.879
Intervention type
PAIR	1
Surgery	1.11 (0.378-3.30)	0.841
Localization of leakage
Right intrahepatic	1
Left intrahepatic	1.13 (0.443-2.89)	0.794
Postoperative hospital stays (day)
> 5	1
< 5	1.0 (0.433-2.30)	1.000
ERCP time (day)
> 10	1
< 10	1.026 (0.441-2.38)	0.953

OR: Odds ratio; 95%CI: 95% confidence interval; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy; BD: Balloon dilation; PAIR: Puncture, aspiration, injection, re-aspiration.