Impact Of Endoscopic Intervention In 100 Patients With Suspected Postcholecystectomy Bile Leak.
A. Kaffes, L. Hourigan, N. de Luca, K. Byth, S. J. Williams, M. Bourke
Published 2005 · Medicine
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BACKGROUND Bile leak is a recognized complication of cholecystectomy. Endoscopic intervention is widely accepted as a treatment for this complication, but the optimal form is not well defined. METHODS An ERCP database was reviewed retrospectively to identify all cases of bile leak related to cholecystectomy. Patient records and endoscopy reports were reviewed, and structured telephone interviews were conducted to collect data. RESULTS A total of 100 patients (61 women, 39 men; mean age, 53  years) with suspected postcholecystectomy bile leak were referred for ERCP. Cholecystectomy was commenced laparoscopically in 83 patients (with an open conversion rate of 30%). The most common symptoms were pain (n = 62) and fever (n = 37). Cholangiography was obtained in 96 patients. A leak was identified in 80/96 patients, the most common site being the cystic-duct stump (48), followed by ducts of Luschka (15), the T-tube site (7), and other sites (10). Treatment included stent insertion alone (40), sphincterotomy alone (18), combination stent/sphincterotomy (31), none (6), and other (1). Three patients with major bile-duct injuries were excluded from the analysis. Endoscopic therapy was unsuccessful in 7 patients (6 in the sphincterotomy alone group; p = 0.001). Four patients underwent surgery subsequent to ERCP to control the leak. All 4 were in the sphincterotomy alone group ( p = 0.001). Post-ERCP pancreatitis developed in 4 patients (3 mild, 1 moderate). CONCLUSIONS The optimal endoscopic intervention for postcholecystectomy bile leak should include temporary insertion of a biliary stent.
This paper references
Endoscopic therapy for patients with a post-operative biliary leak.
P. Foutch (1993)
Abstract presentation at Australian Gastroenterology Week
Complications of laparoscopic cholecystectomy.
D. Jones (1996)
Endoscopic treatment of postoperative biliary fistulae.
C. Liguory (1991)
Bile duct injury and bile leakage in laparoscopic cholecystectomy
S. Huang (1993)
3400 Endoscopic management of post-operative bile leak (embl) in 53 patients.
L. Hourigan (1995)
Postoperative bile leakage: endoscopic management.
P. Davids (1992)
The learning curve for laparoscopic cholecystectomy . The Southern Surgeon ’ s Club
E Trondsen (1995)
Suspected postcholecystectomy bile leak: impact of endoscopic intervention Kaffes et al
Fistole biliari post-colecistectomia laparoscopica: Risultati del trattamento endoscopico
G. D. Palma (2002)
[Topical nitroglycerin: an alternative in the conservative treatment of biliary fistula].
X. FeliuPalá (1996)
Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals.
E. Trondsen (1994)
The learning curve for laparoscopic cholecystectomy
M. Moore (1995)
Endoscopic management of post-operative bile leak (EMBL) in 85 patients [abstract]
Mj Bourke (1995)
Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough.
D. Bjorkman (1995)
Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management. McGill Gallstone Treatment Group.
A. Barkun (1997)
Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review.
M. E. Ryan (1998)
Cystic duct leaks in laparoscopic cholecystectomy.
M. Woods (1994)
[Topical nitroglycerin: an alternative in the conservative treatment of biliary fistula].
X. Feliu Palá (1996)
Bile leak after cholecystectomy significance and treatment: results from the National Norwegian Cholecystectomy Registry.
T. Buanes (1996)
Biliary leaks after laparoscopic cholecystectomy. Results of the endoscopic treatment.
G. D. De Palma (2002)
Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent in resolving cystic duct leaks in a canine model.
J. Brodsky (2002)
Suspected postcholecystectomy bile leak: impact of endoscopic intervention www.mosby.com/gie
Iatrogenic bile duct injury: The scourge of laparoscopic cholecystectomy
K. Slater (2002)
The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy.
K. Mergener (1999)
The learning curve for laparoscopic cholecystectomy . The Southern Surgeon's Club
Mj Moore (1995)
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
P. Cotton (1991)
Endoscopic biliary prosthesis: a comparison of materials
Jwc Leung (1985)
Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases.
D. Deziel (1993)
Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy
M. Saad (2000)
What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy?
F. Prat (1997)
Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks
J. Marks (1998)
Current affiliation: Department of Gastroenterology and Hepatology
Endoscopic biliary prostheses: a comparison of materials.
J. Leung (1985)
Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation.
K. Binmoeller (1991)
A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club.
This paper is referenced by
Effect of endoscopic transpapillary biliary drainage with/without endoscopic sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with biliary stricture (E-BEST): a protocol for a multicentre randomised controlled trial
S. Kato (2017)
Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks.
F. Donnellan (2009)
[Endoscopic management of postoperative biliary injuries].
Zoltán Völgyi (2009)
Plastic pancreatic and biliary stents: Concepts and insertion techniques
T. Baron (2008)
A Multimodal Approach in Coil Embolization of a Bile Leak Following Cholecystectomy
F. Schelhammer (2006)
Location of bile leak predicts the success of ERCP performed for postoperative bile leaks.
Sumeet K. Tewani (2013)
Resultados del tratamiento endoscópico en fugas biliares. Experiencia del Centro Médico Nacional Siglo XXI IMSS
M. L. Altamirano-Castañeda (2016)
Subvesical Bile Duct Injury: An Often Missed Cause of Postcholecystectomy Bile Leak
Shounak Majumder (2013)
Current management of biliary leaks.
N. Zyromski (2006)
A Case of Prolonged Bile Leakage after Laparoscopic Cholecystectomy
Shinji Takahashi (2015)
Identification and Management of Bile Leaks Post Cholecystectomy
George I. Kalogeropoulos (2018)
Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain.
H. Pinkas (2008)
Es la esfinterectomía con prótesis plástica por 8 semanas suficiente para tratar las fugas biliares
Miguel Soria (2015)
Necessity of a repeat cholangiogram during biliary stent removal after postcholecystectomy bile leak.
Vishal Jain (2012)
The Management of Gallstone Disease
Michael R Cox (2018)
Temporary placement of covered self-expandable metallic stents in patients with biliary leak: midterm evaluation of a pilot study.
M. Kahaleh (2007)
Original article Endoscopic therapy for biliary leak after laparoscopic cholecystectomy – diagnostic limitations and choice of therapy option
A. Jamry (2007)
Bile Leak After Laparoscopic Cholecystectomy
Hatef Massoumi (2007)
Bile leak detection by radionuclide scintigraphy.
V. Gupta (2006)
Endoscopic therapy for postoperative leaks and fistulae.
N. Kumar (2013)
The role of ERCP in the management of bile leakage: endoscopic sphincterotomy versus biliary stenting.
Kemal Dolay (2010)
Fully covered, self-expandable metal stents for first-step endoscopic treatment of biliary leaks secondary to hepato-biliary surgery: a retrospective study.
Benedetto Mangiavillano (2013)
Benign Biliary Diseases
John T. Cunningham (2013)
Assessment of Need for Repeat ERCP During Biliary Stent Removal After Clinical Resolution of Postcholecystectomy Bile Leak
N. Coelho-Prabhu (2010)
Endoscopic Retrograde Cholangiopancreatography
Hiromitsu Saisho (2013)
Successful Endoscopic Therapy of Traumatic Bile Leaks
Matthew P. Spinn (2013)
Endoscopic Treatment of Biliary Fistulas Developing After Liver Resections
Erkan Parlak (2013)
Bile Duct Injury after Cholecystectomy: Surgical Therapy
B. Renz (2017)
‘Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy bile leaks’
Abdul D L Carr-Locke (2006)
Endoscopic Treatment of Biliary Fistulas After Complex Liver Resection
Said Diez Farhat (2011)
Endoscopic Management of Bile Leakage after Cholecystectomy: A Single-Center Experience for 12 Years
Kook Hyun Kim (2014)
Endoscopic management of biliary leaks: a systematic review with meta-analysis.
Kenny Vlaemynck (2019)See more