ThTP2.9 Managing Choledochal Cysts in Adults at a DGH

Abstract

Abstract Aims Choledochal Cycts (ChDCs) in adults are rare and mostly benign, although 7-11% can be associated with malignancy. This study explored a DGH experience in managing ChDCs. Methods Retrospective study from April 2019-April 2022. All patients ≥18 years diagnosed with ChDCs on MRCP/MRI-pancreas (regardless of MR indication) were included in the final analysis. HPB-MDT records were checked for relevant cases/management plans. Results 2013 MRCP/MRI-pancreas scans were performed. 29 (1.4%) patients were found to have ChDCs with around half reported as Type I. The mean age was 48 years, with a female: male ratio of 2.6:1. 70% of patients were white. In 55% of cases the main symptom was upper abdominal pain, with 3.4% of ChDCs found incidentally. There were 33 hospital admissions in total (including readmissions), mainly for pain control, with an average duration of 72 hours. 9 patients with ChDC had symptomatic gallstones over the study period, with nearly all requiring laparoscopic cholecystectomy. No patients had objective evidence of malignancy warranting ChDC excision/hepatico-jejunostomy. The management and annual surveillance plans were decided at the regional HPB-MDT. Conclusions ChDCs management in adults is challenging, since it requires long-term clinical/radiological surveillance. This is the largest DGH study of ChDCs in our region. Our findings are close to other studies, although we found a higher prevalence of ChDCs in white patients (usually well reported in Asian populations). Due to the rarity of this condition and paucity in the literature regarding its management challenges, we propose the implementation of standardised national databases/guidelines.