Endoscopic Therapy of Biliary Injury After Cholecystectomy

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2017 Sep 27

PMID 28948425

Citations 16

Authors

Mia Rainio

Outi Lindstrom

Marianne Udd

Carola Haapamaki

Arno Nordin

Leena Kylanpaa

Affiliations

Soon will be listed here.

Abstract

Background: Iatrogenic bile duct injury (BDI) is a common complication after cholecystectomy. Patients are mainly treated endoscopically, but the optimal treatment method has remained unclear.

Aims: The aim was to analyze endoscopic treatment in BDI after cholecystectomy and to explore endoscopic sphincterotomy (ES), with or without stenting, as the primary treatment for an Amsterdam type A bile leak.

Methods: All patients referred to Helsinki University Hospital endoscopy unit due to a suspected BDI between the years 2004 and 2014 were included in this retrospective study. To collect the data, all ERC reports were reviewed.

Results: Of the 99 BDI patients, 94 (95%) had bile leak of whom 11 had concomitant stricture. Ninety-three percent of all patients were treated endoscopically. Seventy-one patients had native papillae and a leak in the cystic duct or peripheral radicals. They were treated with ES (ES group, n = 50) or with sphincterotomy and stenting (EST group, n = 21). There was no difference between the closure time of the fistula (p = 0.179), in the time of discharge from hospital (p = 0.298), or in the primary healing rate between the ES group and the EST group (45/50 vs 19/21 patients, p = 0.951).

Conclusion: After the right patient selection, the success rate of endoscopic treatment can approach 100% for Amsterdam type A bile leak. ES is an effective and cost-effective single procedure with success rate similar to EST. It may be considered as a first-line therapy for the management of Amsterdam type A leaks.

Citing Articles

Is there a place for endoscopic management in post-cholecystectomy iatrogenic bile duct injuries?.

Cai H, Pan G, Luan S, Wang J, Jiao Y World J Gastrointest Surg. 2024; 16(5):1218-1222.

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Usefulness of Intraductal Placement of a Dumbbell-Shaped Fully Covered Self-Expandable Metal Stent for Post-Cholecystectomy Bile Leaks.

Nakagawa K, Matsubara S, Suda K, Otsuka T, Oka M, Nagoshi S J Clin Med. 2023; 12(20).

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Efficacy and associated factors of endoscopic transpapillary drainage for postoperative biliary leakage.

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Losurdo P, Giunta C, Modica A, de Manzini N, Bortul M Eur J Trauma Emerg Surg. 2023; 50(1):275-281.

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Initial management of suspected biliary injury after laparoscopic cholecystectomy.

Siiki A, Ahola R, Vaalavuo Y, Antila A, Laukkarinen J World J Gastrointest Surg. 2023; 15(4):592-599.

PMID: 37206082 PMC: 10190719. DOI: 10.4240/wjgs.v15.i4.592.

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