Endoscopic treatment of post-cholecystectomy bile leaks: a tertiary center experience.
Adolescent
Bile
/ chemistry
Cholangiopancreatography, Endoscopic Retrograde
/ adverse effects
Cholecystectomy
/ adverse effects
Endoscopy
Female
Humans
Laparoscopy
/ adverse effects
Male
Postoperative Complications
/ etiology
Retrospective Studies
Stents
/ adverse effects
Tertiary Care Centers
Treatment Outcome
Bile leak
Cholecystectomy
ERCP
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
08
08
2019
accepted:
19
02
2020
pubmed:
29
2
2020
medline:
3
7
2021
entrez:
29
2
2020
Statut:
ppublish
Résumé
Post-cholecystectomy bile leak is relatively a well-known surgical complication. Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data. However, there is no consensus as to the optimal endoscopic intervention. A retrospective review of ERCP database was done to identify all cases of bile leak related to cholecystectomy. Patient records including surgical and endoscopic reports were reviewed, and telephone interviews were conducted to collect data. During the period 2004-2016, 100 patients (53 men, 47 women; mean age, 55 years) with post-cholecystectomy bile leak were referred for ERCP. Cholecystectomy was done laparoscopically in 82 patients (with an open conversion rate of 13%). In the majority of cases (77%), the leak was diagnosed by ongoing bile flow from the drains. The most common symptoms were pain (17%) and fever (4%). The most common site of the leak was the cystic duct stump (79%) followed by subvesical ducts (7%). Low grade leaks were seen in 84% of cases. Treatment included stent insertion alone (9%), sphincterotomy alone (11%), combination stent/sphincterotomy (76%) and others (1%). Failed ERCP was encountered in 3%. Endoscopic therapy was successful in 90 patients (90%). In subgroup analysis, success rate of procedures with stent insertion (with or without sphincterotomy) is significantly higher compared to procedures without stent insertion (95.3% vs 72.7%, p < 0.05). The failure rate of sphincterotomy alone procedures (3/11, 27%) is much higher compared to procedures with stent insertion (4/85, 5%) with p < 0.05. Four patients (4%) developed post-ERCP pancreatitis (mild to moderate) and one patient (1%) suffered from retroperitoneal perforation. The optimal endoscopic intervention for post-cholecystectomy bile leak should include temporary insertion of a biliary stent.
Sections du résumé
BACKGROUND
Post-cholecystectomy bile leak is relatively a well-known surgical complication. Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data. However, there is no consensus as to the optimal endoscopic intervention.
METHODS
A retrospective review of ERCP database was done to identify all cases of bile leak related to cholecystectomy. Patient records including surgical and endoscopic reports were reviewed, and telephone interviews were conducted to collect data.
RESULTS
During the period 2004-2016, 100 patients (53 men, 47 women; mean age, 55 years) with post-cholecystectomy bile leak were referred for ERCP. Cholecystectomy was done laparoscopically in 82 patients (with an open conversion rate of 13%). In the majority of cases (77%), the leak was diagnosed by ongoing bile flow from the drains. The most common symptoms were pain (17%) and fever (4%). The most common site of the leak was the cystic duct stump (79%) followed by subvesical ducts (7%). Low grade leaks were seen in 84% of cases. Treatment included stent insertion alone (9%), sphincterotomy alone (11%), combination stent/sphincterotomy (76%) and others (1%). Failed ERCP was encountered in 3%. Endoscopic therapy was successful in 90 patients (90%). In subgroup analysis, success rate of procedures with stent insertion (with or without sphincterotomy) is significantly higher compared to procedures without stent insertion (95.3% vs 72.7%, p < 0.05). The failure rate of sphincterotomy alone procedures (3/11, 27%) is much higher compared to procedures with stent insertion (4/85, 5%) with p < 0.05. Four patients (4%) developed post-ERCP pancreatitis (mild to moderate) and one patient (1%) suffered from retroperitoneal perforation.
CONCLUSION
The optimal endoscopic intervention for post-cholecystectomy bile leak should include temporary insertion of a biliary stent.
Identifiants
pubmed: 32107631
doi: 10.1007/s00464-020-07472-0
pii: 10.1007/s00464-020-07472-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1088-1092Références
Rustagi T, Aslanian HR (2014) Endoscopic management of biliary leaks after laparoscopic cholecystectomy. J Clin Gastroenterol 48(8):674–678
doi: 10.1097/MCG.0000000000000044
Barkun AN, Rezieg M, Mehta SN et al (1997) Postcholesytectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management McGill Gallstone Treatment Group. Gastrointest Endosc 45:277–282
doi: 10.1016/S0016-5107(97)70270-0
MacFadyen BV, Vecchio R, Ricardo AE et al (1998) Bile duct injury after laparoscopic cholecystectomy: the United States experience. Surg Endosc 12:315–321
doi: 10.1007/s004649900661
Rerknimitr R, Sherman S, Fogel EL et al (2002) Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc 55:224–231
doi: 10.1067/mge.2002.120813
Bjorkman DJ, Carr-Locke DL, Lichtenstein DR et al (1995) Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough. Am J Gastroenterol 90:2128–2336
pubmed: 8540501
Sandha GS, Bourke MJ, Haber GB et al (2004) Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc. 60:567–574
doi: 10.1016/S0016-5107(04)01892-9
Schnelldorfer T, Sarr MG, Adams DB (2012) What is the duct of Luschka? A systematic review. J Gastrointest Surg 16(3):656–662
doi: 10.1007/s11605-011-1802-5
Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ (2005) Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc 61(2):269–275
doi: 10.1016/S0016-5107(04)02468-X
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC et al (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393
doi: 10.1016/S0016-5107(91)70740-2
Feliu Palá X, Encinas Méndez X, Poveda Gómez S, Martí SG (1996) Topical nitroglycerin: an alternative in the conservative treatment of biliary fistula. Rev Esp Enferm Dig 88(12):877–879
pubmed: 9072059
Brodsky JA, Marks JM, Malm JA, Bower A, Ponsky JL (2002) Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent in resolving cystic duct leaks in a canine model. Gastrointest Endosc 56(6):849–851
doi: 10.1016/S0016-5107(02)70358-1