Endoscopic management of Mirizzi's syndrome

BACKGROUND: The accepted management of Mirizzi's syndrome is surgical, but endoscopic and percutaneous management have been described. AIM: To review our experience of endoscopic intervention for Mirizzi's syndrome. PATIENTS AND METHODS: ERCP reports of patients presenting for endoscopic management of choledocholithiasis between March 1989 and June 1995 were reviewed. Those with cholangiographic evidence of Mirizzi's syndrome were selected for study. Patient records and cholangiograms were reviewed and follow up was recorded from the notes or by telephone contact with patients, their relatives, or doctors. RESULTS: Twenty five patients had Mirizzi's syndrome. Sixteen were female and their median age was 67 years (range 28-91). Ten presented with painless jaundice, nine with painful jaundice, four with cholangitis, and two had pain as their only symptom. Twelve were referred for surgery and 11 of these had preliminary endoscopic therapy. Thirteen have been treated solely with endoscopic therapy. Treatment in this group was aimed at relieving jaundice and removing stones. Stones were completely removed in three patients. Nine patients have been treated with long term stents, and one awaits extracorporeal shockwave lithotripsy of the gall bladder. Complications of treatment occurred in four of 25 after ERCP. CONCLUSIONS: Endoscopic treatment of Mirizzi's syndrome is effective as a temporising measure before surgery and can be definitive treatment for unsuitable surgical candidates.