Cholangitis is associated with liver fibrosis in choledochal cyst patients [Oral presentation]

Abstract

<div><p><strong>Purpose: </strong>Most choledochal cyst patients carry favourable prognosis post-surgery, a minority may experience liver fibrosis. This study explores the use of liver transient elastography to monitor for any progression of liver fibrosis and evaluate potential risk factors.</p><p><strong>Method: </strong>Seventy patients with choledochal cyst received surgery between 2000-2022. Operative details, biochemical profiles, episodes of cholangitis, and contrast studies for biliary reflux were evaluated. A single experienced operator performed liver stiffness measurements using FibroScan for all patients, with 6.7 kilopascal (kPa) taken as the upper limit of normal.</p><p><strong>Results: </strong>At least one set of liver fibrosis score by FibroScan was obtained from 42 patients, with initial measurement at median 71 months post-operatively. Median fibrosis score was 4.26 kPa (IQR 3.5-5.3 kPa). Four patients (9.5%) had measurements compatible with fibrosis (6.9-10.8 kPa) and post-operative episodes of cholangitis (50% vs 7.9%, p<0.001) were found to be associated. </p><p>The liver was found to be more stiff in patients with reflux into biliary tree upon contrast studies (3.87 vs 4.89, p=0.049) and those with post-operative episodes of cholangitis (4.38 vs 7.47, p<0.01). Comparable liver stiffness scores were achieved in hepaticoduodenostomy and hepaticojejunostomy groups (3.94 vs 4.93, p=0.129). No significant correlation was found with the age of operation (p=0.278). </p><p>Twelve patients who demonstrated fibrotic features in intraoperative liver biopsy showed subsequent recovery with comparable fibrosis scores as those with no previous histological fibrosis (4.26 vs 4.99, p=0.143). Serial liver stiffness measurements were performed for seventeen patients at a mean of 45 months, none has shown progression to liver fibrosis. </p><p><strong>Conclusion: </strong>Cholangitis imposes higher risk of fibrosis in choledochal cyst patients as evidenced by the detrimental effect on liver stiffness. Effort should be made to prevent cholangitis. Serial testing of transient liver elastography can acts as a non-invasive tool to closely monitor for any progression to liver fibrosis. </p></div>