The aim of this study was to describe the clinical and evolutionary features of patients presenting with biliary involvement of hydatid cysts.

We conducted a retrospective descriptive study in the Hepato-Gastroenterology and endoscopy department , from January 2019 to July 2025. Were incuded all patients admitted for biliary dilatation secondary to hepatic cystic echinococcosis and managed by endoscopic drainage.

Eleven patients were hospitalized for hydatid cysts complicated by biliary fistulization. The mean age was 44.6 years (range: 22–79), with a marked female predominance (female-to-male ratio: 4.5).Clinically, 7 patients (64%) presented with acute cholangitis, 2 cases were incidentally discovered, and 2 patients reported right upper quadrant pain.

Hydatid serology was positive in 7 patients (64%). Leukocytosis was observed in 9 patients (82%), associated with elevated CRP levels in 10 patients (90%).

Cyst localization was as follows: the left hepatic lobe in 6 patients (54%), the right lobe in 2 patients (18%), and bilobar involvement in 3 patients (28%).Two patients (19%) had cysts larger than 10 cm, six (54%) had cysts between 5 and 10 cm, and three (27%) had cysts smaller than 5 cm.WHO-IWGE staging was: CE2 in 5 patients (45%), CE1 in 1 patient (9%), CE4 in 1 patient (9%), and CE5 in 1 patient (9%). All patients (100%) presented with biliary dilatation and underwent endoscopic sphincterotomy with successful extraction of hydatid material. No post-procedural complications were noted, and no morbi-mortality was noted.

Biliary fistulization represents the most common complication of hepatic hydatid disease. Endoscopic treatment is effective and safe. In our series, left-lobe localization and cyst diameter greater than 5 cm were the most frequent characteristics of those patients.