A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos)

Canena, Jorge; Liberato, Manuel; Meireles, Liliane; Marques, Inês; Romão, Carlos; Coutinho, António Pereira; Neves, Beatriz; Veiga, Pedro Mota

doi:10.1016/j.gie.2014.11.038

Cited by 26 publications

(24 citation statements)

References 23 publications

(58 reference statements)

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“…Time to leak closure was described in five studies including two randomized trials [23,24,28,29,32]. A mean value of the duration of hospital stay was reported in only one study [24].…”

Section: Discussionmentioning

confidence: 99%

“…The severity of leak was described in four studies [16,24,27,28]. A leak was considered low grade (leak identified only after intrahepatic opacification) or high grade (leak observed before intrahepatic opacification) in 48.5 % and 51.5 %, respectively.…”

Section: Patientsmentioning

confidence: 99%

“…Sandha et al [27] investigated a systematic approach in which low grade leaks were treated with sphincterotomy, whereas stenting after sphincterotomy was used in high grade leaks. Canena et al [28] compared the use of an FCSEMS with the placement of MPS for the treatment of refractory biliary leaks. Refractory biliary leaks are those that fail to respond (persistent high output from percutaneous drain or persistent leak at cholangiography) to a plastic stent and biliary sphincterotomy for more than 2 weeks [28,33].…”

Section: Prospective Cohort Studiesmentioning

confidence: 99%

“…Canena et al [28] compared the use of an FCSEMS with the placement of MPS for the treatment of refractory biliary leaks. Refractory biliary leaks are those that fail to respond (persistent high output from percutaneous drain or persistent leak at cholangiography) to a plastic stent and biliary sphincterotomy for more than 2 weeks [28,33]. Chandra et al [24] examined all kinds of biliary leaks (68 patients) and compared sphincterotomy alone vs. sphincterotomy with stenting.…”

Section: Prospective Cohort Studiesmentioning

confidence: 99%

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Endoscopic management of biliary leaks: a systematic review with meta-analysis

et al. 2019

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Background The first-line approach to the treatment of biliary leaks is endoscopic retrograde cholangiopancreatography. A variety of techniques can be used, including sphincterotomy, stenting, a combination of both techniques, or nasobiliary drainage. We performed a systematic review with meta-analysis to define the optimal strategy. Methods We searched MEDLINE/PubMed, EMBASE, CENTRAL, Scopus, Google Scholar, and Web of Science until January 2018 for randomized clinical trials, case-control studies, and prospective cohort studies. Data on procedure, success, and complication rate were extracted. Risk of bias was assessed. A network meta-analysis was performed to compare sphincterotomy alone vs. stenting alone vs. combination treatment. Stenting was further stratified into leak-bridging and short stenting. Results 11 studies out of 5085 references were included. Compared with sphincterotomy alone, the combination of sphincterotomy with leak-bridging stenting had the highest success rate (risk ratio [RR] 1.15, 95 % confidence interval [CI] 0.97 – 1.50), followed by leak-bridging stenting alone (RR 1.10, 95 %CI 0.84 – 1.44). For nonbridgeable leaks, stenting alone had a higher success rate than sphincterotomy alone (RR 1.07, 95 %CI 0.72 – 1.40). The combination of short stents with sphincterotomy had no added benefit (RR 0.94, 95 %CI 0.49 – 1.29). Overall quality of the included studies was considered to be moderate. Conclusions We recommend sphincterotomy with stenting if the biliary leak can be bridged. If not, stenting alone with a short stent may be preferred in order to avoid sphincterotomy-related complications. More and larger studies are needed to confirm these findings.

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“…Time to leak closure was described in five studies including two randomized trials [23,24,28,29,32]. A mean value of the duration of hospital stay was reported in only one study [24].…”

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Prospective Cohort Studiesmentioning

confidence: 99%

Section: Prospective Cohort Studiesmentioning

confidence: 99%

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Endoscopic management of biliary leaks: a systematic review with meta-analysis

et al. 2019

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“…Given the perceived high-grade nature of the leak, the premise is that a FCSEMS is necessary to "seal off" the cystic duct and prevent leakage from the residual gallbladder. While FCSEMS have expanded indications for treatment of benign biliary disease including benign bile duct strictures [7], and while use of FCSEMS has been reported for successful management of refractory bile duct leaks [8,9], to our knowledge controlled or comparative data have not been reported to either question the utility of plastic stents or support the use of FCSEMS as firstline management for bile duct leaks following subtotal cholecystectomy.…”

Section: Patients and Methods A Retrospective Cohort Of Patientsmentioning

confidence: 99%

Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

2020

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Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy. Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP). Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87 % of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13 % (8/61). Leak resolution was evident at first follow-up ERCP in 96 % of subjects (26/27) who had undergone total cholecystectomy and 91 % of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96 % (23/24) of those who had undergone total cholecystectomy and 90 % (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62). Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.

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