Choledochal Cyst or Benign Biliary Dilation: Is Resection Always Necessary?

Background Choledochal cysts (CC) are often diagnosed during the first few decades of life, when, due to the risk of malignancy, resection is advised. With an increasing number of patients undergoing abdominal imaging, many older patients have recently been radiographically diagnosed with biliary du...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2021-09, Vol.25 (9), p.2353-2357
Main Authors: Gomes, Camilla, Tivnan, Patrick, McAneny, David, Tseng, Jennifer F., Tkacz, Jaroslaw, Sachs, Teviah E.
Format: Article
Language:English
Subjects:
Abdomen
Aged
Asymptomatic
Bile ducts
Cholangitis
Choledochal Cyst - diagnostic imaging
Choledochal Cyst - surgery
Cysts
Demographics
Dilatation
Enzymes
Ethnicity
Gallbladder
Gastroenterology
Hispanic Americans
Humans
Medicine
Medicine & Public Health
Older people
Original Article
Patients
Quality of life
Retrospective Studies
Surgery
Surveillance
Vomiting
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Summary:Background Choledochal cysts (CC) are often diagnosed during the first few decades of life, when, due to the risk of malignancy, resection is advised. With an increasing number of patients undergoing abdominal imaging, many older patients have recently been radiographically diagnosed with biliary duct enlargement that meets the criteria of choledochal cysts. The management in these patients is less well defined, but resection is often recommended as it is for younger patients. We sought to better understand the significance of these biliary duct anomalies in adults. Methods We retrospectively reviewed all patients 18 years and older at our institution, who were given a radiographic diagnosis of choledochal cyst during the interval 2006–2019. Demographics, comorbidities, complications, readmissions, and follow-up imaging were evaluated. Results We identified 22 patients, of whom 40.9% ( n  = 9) underwent an operation. The remainder was observed. Median duct size was 15 mm (range 2–25 mm). There were no significant differences in demographics between the two cohorts. Of those who underwent resection, none had evidence of high-grade dysplasia or invasive carcinoma upon final pathology. However, 33.3% ( n  = 3) had subsequent readmissions for complications, including post-operative nausea and vomiting, cholangitis, and anastomotic stenoses that required stenting. In the observation group, there was no obvious growth of the cysts or development of worrisome features to suggest malignant degeneration (median follow-up = 68 months). Conclusion A radiographic diagnosis of choledochal cyst in older adults is likely a different entity than those diagnosed in childhood. Close surveillance of these biliary duct anomalies in older adults may be a better option than resection and reconstruction with the associated risks of long-term morbidity.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-020-04896-w