In hepatic hydatid disease with biliary communication, ERCP traditionally aims to clear hydatid material from the bile ducts and close the cystobiliary fistula through stenting. In contrast to the conventional approach, this study aimed to investigate the efficacy and safety of complete endoscopic evacuation of the cyst content as a curative treatment in selected patients, with dilation of the fistulous tract when necessary.

This retrospective, single-center study included consecutive patients who underwent endoscopic cyst evacuation performed by a single endoscopist. The procedure was carried out in centrally located cysts that were completely surrounded by liver parenchyma, without exophytic extension, and whose cavities could be cannulated endoscopically. In patients whose fistulous tracts were not suitable for endoscopic evacuation, the tract was dilated with a 6–8 mm balloon. The cyst cavity was irrigated with saline and debrided in multiple sessions using endoscopic accessories such as stone extraction balloons and Dormia baskets. At the end of each session, a plastic stent, fully covered metal stent, or nasocystic drain was placed extending into the cyst cavity. Clinical success was defined as endoscopic clearance and reduction in the size of the cyst cavity.

Among 102 patients who underwent ERCP for biliary hydatid disease, 37 consecutive patients who received endoscopic cyst evacuation were included in the study. The mean age was 46.8 ± 19.1 years, and the mean cyst diameter was 82.9 ± 36.1 mm. A total of 184 ERCP procedures (median: 5) were performed. Sphincterotomy was performed in all cases. Balloon dilation of the cystobiliary opening orifice was carried out in 19 patients (51.4%). Nasocystic drainage was performed in 12 patients (32.4%). A fully covered metal stent was used in four patients (10.8%) due to dense cyst content. Clinical success was achieved in 36 patients (97.3%). One patient required surgery (right hepatectomy) due to multiple hepatic abscesses. No recurrence or procedure-related or disease-related mortality was observed during follow-up. Complications occurred in nine procedures (4.8%), all successfully managed with endoscopic and/or conservative treatment.

Endoscopic evacuation provides a safe and effective curative treatment option for hepatic hydatid disease with biliary communication, achieving high success rates with a low risk of complications.