EFFECTIVENESS AND SAFETY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR POST-CHOLECYSTECTOMY BILE DUCT INJURIES IN DUHOK / IRAQ

ALI ABDULGHANI RAMADHAN; Aveen Hassan Mustafa; RAMADHAN SALAHALDEEN ISSA; HASSAN MUHSEN HASSAN

ALI ABDULGHANI RAMADHAN Department of Medicine, college of Medicine, University of Duhok.
Aveen Hassan Mustafa Department of Medical Chemistry, college of Medicine, University of Duhok,
RAMADHAN SALAHALDEEN ISSA Department of Surgery, college of Medicine, University of Duhok
HASSAN MUHSEN HASSAN University of Duhok /college of medicine

Keywords: ERCP, post-cholecystectomy, bile duct injury, Duhok

Abstract

https://doi.org/10.31386/dmj.2026.20.2.6

Background: Post-cholecystectomy bile duct injuries constitute a clinical problem with significant morbidity. Traditionally they were treated surgically but with the discovery of Endoscopic Retrograde Cholangiopancreatography (ERCP), their management has been radicalized and currently ERCP has a major role in establishing the definitive diagnosis and identifying the severity, extent and site of injury and most importantly treating the condition using endoscopically applied therapeutic interventions.

Objective: to determine the effectiveness and safety of ERCP for post-cholecystectomy bile duct injuries in Duhok – Kurdistan region - Iraq.

Patients and methods: This is a prospective study that was carried out in Azadi gastroenterology and hepatology center, Vin hospital and Jeen clinics in Duhok city-Iraq from January 2015 to January 2025. It included 103 patients with suspected post-cholecystectomy bile duct injuries based on clinical features, laboratory testing and imaging studies. ERCP was done in all patients, and the definitive diagnosis was established by the initial cholangiogram then bile duct injuries were classified by Amsterdam classification and therapeutic interventions were applied depending on the class of injury. The study included a follow up period of 3-12 months to conclude the outcomes of ERCP.

Results: Of the study population, 85 (82.5%) were females & 18 (17.5%) were males with female : male ratio being 4.7:1. The mean age was 44 years (range = 16 -72 years). The method of cholecystectomy was laparoscopic in 83 patients (80.6%) and open in 20 patients (19.4%). Abdominal pain was the most common presentation (N = 56, 54.3%). The bile duct injuries were of Amsterdam class - A in 63 (61.1%), class-B in 25 (24.3%), class-C in 10 (9.7%) and class-D in 5 (4.9%). The overall success rate for endoscopic intervention was 91.3% (N=94). The most common complication of ERCP was pancreatitis (N=10, 9.7%). No mortality was reported in this study. There was significant statistical association between the method of cholecystectomy and having class-A bile duct injury (P-value = 0.0005). There was no significant statistical association between the method of cholecystectomy and indication of cholecystectomy or success rate or complications of ERCP (P > 0.05).

Conclusion: The most common type of bile duct injury was Amsterdam class – A bile duct injury. ERCP is an effective and safe tool for the diagnosis and treatment of bile duct injuries.

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