P0012 - Exploring Factors for Improved Diagnosis of Choledochal Cysts Using ERCP

Angela Troia, MD¹, Ann Kopera, DO¹, Lynette Sequeira, MD², Srikar Reddy, MD¹, Carolyn Hofley, MS³, Emily Winslow, MD¹, Walid Chalhoub, MD¹, Nadim Haddad, MD¹, Stephanie M. Woo, MD¹, Mark Real, MD^1
1MedStar Georgetown University Hospital, Washington, DC; ²Johns Hopkins Hospital, Baltimore, MD; ³Georgetown University School of Medicine, Washington, DC

Introduction: Choledochal cysts are rare cystic dilations of the biliary tree that are classified by the extent of biliary involvement. Type I cysts account for 50-85% of cases and involve fusiform dilation of the CBD, whereas other less common types involve intrahepatic and other extrahepatic dilation. Diagnosis often involves imaging of the biliary tree with either MRCP or ERCP, the latter being highly sensitive and useful in ruling out biliary obstruction that may mimic choledochal cysts. We aimed to identify factors on ERCP that may improve diagnostics and ultimately management of choledochal cysts.


Methods: This was a single-center retrospective study. Patients who were diagnosed with choledochal cyst on initial ERCP between 2008-2022 were analyzed. Of these individuals, those who underwent surgery and had corresponding surgical pathology data available were included in the study. Univariate linear regression analysis was performed to identify variables associated with prognostic factors and management outcomes of those with biopsy proven choledochal cysts. Variables included CBD dilation, IHD dilation, presence of stone, presence of stricture, surgical referral and impression, follow up ERCP, and presence of symptoms.

Results: In total 48 patients (pathology positive, n=39; pathology negative, n=9) were included in the analysis. Median age 65 years (IQR 47.5-73.3), 83.6% were female. Within the pathology positive cohort, 79.4% had Type I choledochal cysts. Intrahepatic dilation was more prevalent in pathology negative cases (66.7%) compared to pathology positive cases (15.4%), p= 0.0014. The presence of stricture in ERCP was also more common in pathology negative (44.4%) versus pathology positive (10.3%), p= 0.0131. Median CBD dilation was not significantly different between the two groups, (p=0.9916). Radiology reports prior to ERCP detected choledochal cyst presence in 10.3% of pathology proven cases.

Discussion: Better understanding features of choledochal cysts on ERCP is critical for improving diagnostics. Features such as intrahepatic dilation and strictures may indicate other underlying conditions. In these cases additional workup with brushings or stent placement may be aid in confirming the diagnosis.



Disclosures:


Angela Troia, MD¹, Ann Kopera, DO¹, Lynette Sequeira, MD², Srikar Reddy, MD¹, Carolyn Hofley, MS³, Emily Winslow, MD¹, Walid Chalhoub, MD¹, Nadim Haddad, MD¹, Stephanie M. Woo, MD¹, Mark Real, MD¹. P0012 - Exploring Factors for Improved Diagnosis of Choledochal Cysts Using ERCP, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.