Choledochoduodenal Fistula : A Clinical Analysis of 97 Patients Diagnosed by ERCP

Park, Sill Moo; Yoo, Byung Chul; Park, Joong won; Kim, Hyung Joon; Kim, Jae Gyu

Abstract

BACKGROUND AND AIMS: Choledochoduodenal fistula (CDF) is occasionally found during endoscopic retrograde cholangiopancreatography (ERCP). Cholelithiasis is suspected to be the leading cause in some endemic areas like Korea but there was little data available about cases of CDF. Therefore, we analysed the clinical characteristics of 97 cases of CDF diagnosed by ERCP.
METHODS
In 1,148 ERCP studies of our hospital from 1993 to 1996, we had observed 97 CDF found on the papilla of Vater or in the upper portion of that. The records of 97 patients with CDF were retrospectively reviewed. Their clinical features and ERCP findings were analysed and compared in the aspect of CDF types.
RESULTS
The prevalence of CDF was 8.4% and the mean age was 55.1+/-12.1 years. Sixty-two patients (27 male, 35 female) were type I CDF, 32 patients (12 male, 20 female) were type II CDF, and 3 patients (1 male, 2 female) were type Ill CDF. The most common complaint of 97 patients was epigastric pain (86.6%) and only 56 patients (57.7%) had a history of acute cholangitis. Only 17 (17.5%) had a history of CBD exploration, and a history of which exert no influence on the type of CDF statistically (p>0.05). There was no significant difference of blood chemistry results between type I, II, and III CDF. Fifty-seven (58.8%) patients had intrahepatic bile duct stones, 39 (40.2%) had CBD stones, and 7 (7.2%) had gallstones; only 4 cases were not associated with gallstone diseases. Two cases of type III CDF were associated with both duodenal ulcer disease and gallstone diseases. The location of biliary stones, and the diameter of CBD did not influence on the type of CDF (p>0.05). Type II CDF had prominent pneumobilia, and less biliary stones than type I CDF (p<0.05).
CONCLUSIONS
The incidence of CDF in Korea is higher than in Western. Most of CDF cases serves as a chronic sequelae of chclelithiasis, especially intrahepatic bile duct stones, but about half of cases have no history of acute cholangitis. Two different clinical features between type I and II CDF are the pneumobilia and the amount of biliary stones.