As far as percutaneous cholangiography, we all know that this test has a high morbidity rate and is not very well tolerated by patients. Given the difficulties involved in diagnosing Mirizzi syndrome, we believe that this disease should be ruled out first in every patient with abdominal pain due to cholelithiasis and related cholestasis. By doing so, iatrogenic bile duct complications in patients and increased morbidity and mortality rates could be reduced. Also, since endoscopic ultrasound EUS is less risky and less expensive than ERCP, we propose that it be used first, before other diagnostic methods, to confirm the whether or not this disease is present.
Consideramos entonces que dadas las dificultades en las ayudas diagnósticas que presenta el síndrome de Mirizzi, a todo paciente con dolor abdominal por colelitiasis y con una colestasis asociada debería descartársele esta enfermedad para disminuir las complicaciones asociadas a la iatrogenia de la vía biliar y aumento de la morbimortalidad que ocasiona en los pacientes; además, proponemos la ecoendoscopia como método diagnóstico de primera línea para confirmar este síndrome dados los menores riesgos y costos que representa con respecto a la CPRE.