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Safety and efficacy of therapeutic endoscopic interventions in the management of biliary leak

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Abstract

Endoscopic procedures which reduce the trans-papillary pressure gradient are the treatment of choice for management of biliary leaks. We analyzed the data of 102 patients with biliary leak managed by various endoscopic procedures like endoscopic sphincterotomy (ES), ES with stenting, stenting alone or nasobiliary drainage (NBD) alone; 90 of these patients had developed a leak after cholecystectomy. In the post-cholecystectomy group, cannulation was successful in 79 patients; therapeutic intervention was not possible in 14 of them due to complete transection of common bile duct in 6, and leak proximal to ligature in 8. In the remaining 65 patients, ES with stenting was done in 52, stent alone in 6, ES alone in 5 and NBD alone in 2. All 12 patients in other etiology group were treated with ES plus stenting. The leak closed in a mean of 3 (1–10) days in all patients. Stents were removed after 6–8 weeks. Endoscopic procedures are effective in managing biliary leaks.

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References

  1. Schlumpf R, Klotz HP, Wehrli H, Herzog U. A nation’s experience in laparoscopic cholecystectomy. Prospective multicenter analysis of 3722 cases. Surg Endosc. 1994;8:35–41.

    Article  PubMed  CAS  Google Scholar 

  2. Khan MH, Howard TJ, Fogel EL, et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc. 2007;65:247–52.

    Article  PubMed  Google Scholar 

  3. Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12,397 patients. Surg Laparosc Endosc. 1992;2:191–8.

    PubMed  CAS  Google Scholar 

  4. Qin YS, Li ZS, Sun ZX, Wu RP, Wang N, Yao YZ. Endoscopic management of biliary complications after orthotopic liver transplantation. Hepatobiliary Pancreat Dis Int. 2006;5:39–42.

    PubMed  Google Scholar 

  5. Morgenstern L, McGrath MF, Carroll BJ, Paz-Partlow M, Berci G. Continuing hazards of the learning curve in laparoscopic cholecystectomy. Am Surg. 1995;61:914–8.

    PubMed  CAS  Google Scholar 

  6. Ryan ME, Geenen JE, Lehman GA, et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review. Gastrointest Endosc. 1998;47:261–6.

    Article  PubMed  CAS  Google Scholar 

  7. Al Karawi MA, Sanai FM, Mohamed Ael S, Mohamed SA. Endoscopic management of postcholecystectomy bile duct injuries: review. Saudi J Gastroenterol. 2000;6:67–78.

    PubMed  Google Scholar 

  8. Browder IW, Dowling JB, Koontz KK, Litwin MS. Early management of operative injuries of the extrahepatic biliary tract. Ann Surg. 1987;205:649–58.

    Article  PubMed  CAS  Google Scholar 

  9. Lillemoe KD. Benign post-operative bile duct strictures. Baillieres Clin Gastroenterol. 1997;11:749–79.

    Article  PubMed  CAS  Google Scholar 

  10. Bridges A, Wilcox CM, Varadarajulu S. Endoscopic management of traumatic bile leaks. Gastrointest Endosc. 2007;65:1081–5.

    Article  PubMed  Google Scholar 

  11. Shah JN. Endoscopic treatment of bile leaks: current standards and recent innovations. Gastrointest Endosc. 2007;65:1069–72.

    Article  PubMed  Google Scholar 

  12. Pawa S, Al-Kawas FH. ERCP in the management of biliary complications after cholecystectomy. Curr Gastroenterol Rep. 2009;11:160–6.

    Article  PubMed  Google Scholar 

  13. Donnellan F, Zeb F, Courtney G, Aftab AR. Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks. Hepatobiliary Pancreat Dis Int. 2009;8:309–11.

    PubMed  Google Scholar 

  14. Katsinelos P, Kountouras J, Paroutoglou G, et al. A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc. 2008;22:101–6.

    Article  PubMed  Google Scholar 

  15. Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc. 2005;61:269–75.

    Article  PubMed  Google Scholar 

  16. Mavrogiannis C, Liatsos C, Papanikolaou IS, Karagiannis S, Galanis P, Romanos A. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study. Eur J Gastroenterol Hepatol. 2006;18:405–9.

    Article  PubMed  CAS  Google Scholar 

  17. Agarwal N, Sharma BC, Garg S, Kumar R, Sarin SK. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int. 2006;5:273–7.

    PubMed  Google Scholar 

  18. Pinkas H, Brady PG. Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int. 2008;7:628–32.

    PubMed  Google Scholar 

  19. Cote GA, Ansstas M, Shah S, et al. Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks. Surg Endosc. 2010;24:1752–6.

    Article  PubMed  Google Scholar 

  20. Salih M, Hamid S, Shah HA, Abbas Z, Jafri W. Endoscopic management of biliary leaks after open and laparoscopic cholecystectomy. J Pak Med Assoc. 2007;57:117–9.

    PubMed  Google Scholar 

  21. Sandha GS, Bourke MJ, Haber GB, Kortan PP. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc. 2004;4:567–74.

    Article  Google Scholar 

  22. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18.

    Article  PubMed  CAS  Google Scholar 

  23. Freeman ML. Complications of endoscopic sphincterotomy. Endoscopy. 1998;30:A216–20.

    Google Scholar 

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Authors and Affiliations

  1. Department of General Medicine, Government Medical College, Sector 32 A, Chandigarh, 160 030, India

    Atul Sachdev, Jeet Ram Kashyap, Sanjay D’Cruz, Divyanshoo R. Kohli, Ram Singh & Kamal Singh

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  1. Atul Sachdev
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  2. Jeet Ram Kashyap
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  3. Sanjay D’Cruz
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  4. Divyanshoo R. Kohli
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  5. Ram Singh
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  6. Kamal Singh
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Correspondence to Atul Sachdev.

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Sachdev, A., Kashyap, J.R., D’Cruz, S. et al. Safety and efficacy of therapeutic endoscopic interventions in the management of biliary leak. Indian J Gastroenterol 31, 253–257 (2012). https://doi.org/10.1007/s12664-012-0209-x

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  • DOI: https://doi.org/10.1007/s12664-012-0209-x

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