Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study

Adler, Douglas G.; Papachristou, Georgios I.; Taylor, Linda J.; McVay, Tyler; Birch, Madeleine; Francis, Gloria; Zabolotsky, Andrew; Laique, Sobia N.; Hayat, Umar; Zhan, Tingting; Das, Rohit; Slivka, Adam; Rabinovitz, Mordechai; Munigala, Satish; Siddiqui, Ali A.

doi:10.1016/j.gie.2016.08.018

Cited by 44 publications

(39 citation statements)

References 18 publications

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“…Review of institutional databases have reported bile leak rates ranging widely from 0.2% to 4.2%, mainly due to their limited sample sizes. 14–17 The current study reports a bile leak rate of 0.50%, which is 2.3 times more common than the incidence of BDIs.…”

Section: Discussionmentioning

confidence: 64%

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Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Fong

Pitt

Strasberg

et al. 2018

Journal of the American College of Surgeons

101

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BACKGROUND The increased incidence of bile duct injuries (BDIs) after the adoption of laparoscopic cholecystectomy has been well documented. However, the longitudinal impact of bile leaks and BDIs on survival and healthcare use have not been studied adequately. The aims of this analysis were to determine the incidence, long-term outcomes, and costs of bile leaks and ductal injuries in a large population. STUDY DESIGN The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014. Bile leaks, BDIs, and their management strategy were defined. Survival was calculated by Kaplan-Meier failure estimates with multivariable regression and propensity analyses. Cost analyses used inflation adjustments and institution-specific cost-to-charge ratios. RESULTS Of 711,454 cholecystecomies, bile leaks occurred in 3,551 patients (0.50%) and were managed almost exclusively by endoscopists. Bile duct injuries occurred in 1,584 patients (0.22%) with 84% managed surgically. Patients with a bile leak were more likely to die at 1 year (2.4% vs 1.4%; odds ratio 1.85; p < 0.001). Similarly, BDI patients had an increased 1-year mortality (7.2% vs 1.3%; odds ratio 2.04; p < 0.0001). Survival of BDI patients was better with an operative approach (odds ratio 0.19; p < 0.001) when compared with endoscopic management. Operatively managed BDIs were also associated with fewer emergency department visits and readmissions, as well as lower cumulative costs at 1 year ($60,539 vs $118,245; p < 0.001). CONCLUSIONS The 0.22% incidence of BDIs observed in California is lower than reported in the first decade after the introduction of laparoscopic cholecystectomy. Bile leaks are 2.3 times more common than BDIs. Patients with a bile leak or BDI have diminished survival. Surgical repair of a BDI leads to enhanced survival and reduced cumulative cost compared with endoscopic management.

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Section: Discussionmentioning

confidence: 64%

“…Most studies assessing bile leaks after cholecystectomy report on its incidence, 14 risk factors, 15,16 and short-term success rates, 17 but not on long-term survival. In an analysis of 57 patients with bile leaks after cholecystectomy, Buanes and colleagues 15 reported a mortality rate of 8.8% (5 patients).…”

Section: Discussionmentioning

confidence: 99%

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Fong

Pitt

Strasberg

et al. 2018

Journal of the American College of Surgeons

101

View full text Add to dashboard Cite

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“…The main aim of surgical treatment is the reconstruction of proper flow of bile to the alimentary tract. The following operations are performed in biliary injuries surgical treatment: Roux-Y hepaticojejunostomy, end-to-end ductal biliary anastomosis with tube drainage choledochoduodenostomy, hepaticojejunostomy, jejunal interposition hepticoduodenostomy [6] .…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study

Fayek¹,

Ezzat

2020

The Medical Journal of Cairo University

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Background: Preventive strategies and safe surgery are of utmost importance to minimize BDI during cholecystectomy. The importance of frank communication with the patient and accurate documentation cannot be overemphasized. Diagnosis requires a high index of suspicion with focused clinical, biochemical, and radiological examination. Aim of Study: Is to evaluate the best protocol in management of iatrogenic biliary injuries sustained during either laparoscopic or open cholecystectomy. Patients and Methods: 40 patients with iatrogenic bile duct injuries following cholecystectomy (open and Laparoscopic) referred to the

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“…10 If the bile duct fistula persists, ERCP with sphincterotomy and/or endoprosthesis insertion is commonly first-choice therapy. 11 If the bile duct fistula is not controlled by endoscopic drainage, endoscopic embolization with cyanoacrylate can be performed. 12 When endoscopic therapy has failed, or the bile duct system (BDS) cannot be accessed by standard ERCP, PBI is necessary.…”

mentioning

confidence: 99%

Percutaneous Embolization of Biliary Leaks: A Systematic Interdisciplinary Review and Proposal for a New Classification

Schmitz

Mutignani

Neumann

et al. 2020

Digestive Disease Interventions

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Objectives Biliary leak can be treated by percutaneous biliary embolization. The aim of this systematic interdisciplinary review was to analyze available reports on percutaneous embolization of biliary leak. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach to perform literature database search. The following terms were systematically analyzed: type of embolic agent, success rates, embolization-related adverse events, cause of biliary leak, fistula connection type, anatomic bile duct variants, and access routes. Results Of 713 publications identified, 45 reports with 101 patients were included. Six temporary and 4 permanent embolic agents were used in 55/101 (54.5%) and 46/101 (45.5%) patients; combined in 18/101 patients (17.8%). Bile leak was successfully embolized in 97/101 (96.0%) patients, in 48/101 (47.5%) patients after repeated procedures with the same agent, and in 4/101 (3.9%) patients after a failed embolization with other agents: isolated bile duct fistula (n = 2), intrahepatic fistula after liver resection, and biliary-bronchial fistula. Five types of biliary leak were associated with the following success rates: (A) common bile duct (CBD) or cystic duct: 4/4 (100%); (B) intrahepatic bile duct (IHBD), communicating with CBD: 16/18 (88.9%); (C) isolated IHBD: 49/51 (96%); (D) CBD or cystic duct, bile duct system (BDS) not accessible by endoscopic retrograde cholangiopancreatography (ERCP): 7/7 (100%); and (E) IHBD, communicating with CBD, BDS not accessible by ERCP: 9/9 (100%). Conclusions Embolization was highly successful without clear preference for one embolic agent. A new classification of biliary leak is proposed to direct nonsurgical treatments.

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Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study

Cited by 44 publications

References 18 publications

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study

Percutaneous Embolization of Biliary Leaks: A Systematic Interdisciplinary Review and Proposal for a New Classification

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