ENDOSCOPIC MANAGEMENT OF MIRIZZIS 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 syndro me. Patients and Methods-ERCP reports of patients presenting for endos copic management of choledocholithiasis between March 1989 and June 19 95 were reviewed. Those with cholangiographic evidence of Mirizzi's sy ndrome were selected far study. Patient records and cholangiograms wer e reviewed and follow up was recorded from the notes or by telephone c ontact 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 a s their only symptom. Twelve were referred fur surgery and 11 of these had preliminary endoscopic therapy. Thirteen have been treated solely with endoscopic therapy. Treatment in this group was aimed at relievi ng jaundice and removing stones. Stones were completely removed in thr ee patients. Nine patients have been treated with long term stents, an d one awaits extracorporeal shockwave lithotripsy of the gall bladder. Complications of treatment occurred In four of 25 after ERCP. Conclus ions-Endoscopic treatment of Mirizzi's syndrome is effective as a temp orising measure before surgery and can be definitive treatment for uns uitable surgical candidates.