Endoscopic Sphincterotomy Alone in the Management of Low‐grade Biliary Leaks Due to Cholecystectomy

Aksöz, Kadir; Ünsal, Belkıs; Yörük, Gazi; Buyraç, Zafer; Hacıyanlı, Mehmet; Akpınar, Zehra; Alper, Emrah

doi:10.1111/j.1443-1661.2009.00878.x

Cited by 33 publications

(23 citation statements)

References 27 publications

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“…demonstrated no additional benefit from sphincterotomy in terms of leak resolution; however, they and other authors suggest there may be a higher incidence of pancreatitis without sphincterotomy 12,24,31–33 . Earlier publications have reported sphincterotomy alone as a means of overcoming ampullary pressure, but have quoted a biliary leak resolution rate of only 87.1% 34 . This is inadequate when compared with the findings of other reports using stents (Table 3) and both Aksoz et al .…”

Section: Discussionmentioning

confidence: 78%

“…12,24,[31][32][33] Earlier publications have reported sphincterotomy alone as a means of overcoming ampullary pressure, but have quoted a biliary leak resolution rate of only 87.1%. 34 This is inadequate when compared with the findings of other reports using stents (Table 3) and both Aksoz et al and Familiari et al report that up to 12% of patients require subsequent stent insertion after sphincterotomy alone. 34,35 The current policy in this unit is to use large-bore (10-Fr) stent insertion alone and to use sphincterotomy only for access or if an additional diagnosis such as choledocholithiasis is made and requires treatment.…”

Section: Discussionmentioning

confidence: 81%

“…and Familiari et al . report that up to 12% of patients require subsequent stent insertion after sphincterotomy alone 34,35 …”

Section: Discussionmentioning

confidence: 99%

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Endoscopic management of post-cholecystectomy biliary fistula

Hii

Gyorki

Sakata

et al. 2011

HPB

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 81%

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Endoscopic management of post-cholecystectomy biliary fistula

Hii

Gyorki

Sakata

et al. 2011

HPB

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“…This contradicts the earlier perception that unsuspected CBD stone is the commonest predisposing factor for cystic duct 'blow out' [12]. Retained CBD stone has been reported in about 20 % of patients with cystic duct leak [13][14][15][16]. Management of type A injury includes ERC, EPT alone for low-grade leaks or with bile duct stenting.…”

Section: Discussionmentioning

confidence: 90%

“…Management of type A injury includes ERC, EPT alone for low-grade leaks or with bile duct stenting. Additionally, drainage of intraabdominal collection, when present is achieved by US or CT guided percutaneously placed catheter or relaparoscopy [13][14][15][16]. Percutaneous placement of catheter precedes ERC whereas relaparoscopy follows ERC during the same anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

et al. 2012

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The clinical presentation, management and outcome of all patients with bile duct injury who presented to our tertiary care centre at various stages after cholecystectomy were analyzed. The patients were categorized into three groups: group A-patients in whom the injury was detected during cholecystectomy, group B-patients who presented within 2 weeks of cholecystectomy and group C-patients who presented after 2 weeks of cholecystectomy. Our team acted as rescue surgeons and performed 'on-table' repair for injuries occurring in another unit or in another hospital. Strasberg classification of bile duct injury was followed. In group A, partial and complete transections were managed by repair over T-tube and high hepaticojejunostomy, respectively. Patients in group B underwent endoscopic retrograde cholangiogram and/ or magnetic resonance cholangiogram to evaluate the biliary tree. Those with intact common bile duct underwent endoscopic papillotomy and stenting in addition to drainage of intraabdominal collection when present. For those with complete transection, early repair was considered if there was no sepsis. In presence of intra-abdominal sepsis an attempt was made to create controlled external biliary fistula. This was followed by hepatico jejunostomy at least after 3 months. Group C patients underwent hepaticojejunostomy at least 6 weeks after the injury. The outcome was graded into three categories: grade A-no clinical symptoms, normal LFT; grade B-no clinical symptoms, mild derangement of LFT or occasional episodes of pain or fever; grade C-pain, cholangitis and abnormal LFT; grade D-surgical revision or dilatation required. Fifty nine patients were included in the study and the distribution was group A-six patients, group B-33 patients and group C-20 patients. In group A, one patient with complete transection of the right hepatic duct (type C) and partial injury to left hepatic duct (LHD) underwent right hepaticojejunostomy and repair of the LHD over stent. Two patients with type D and three patients with type E 2 injury underwent repair over T-tube and hepaticojejunostomy, respectively. In group B, all except one of the 18 patients with type A injury underwent endoscopic papillotomy and stenting. The bile leak subsided at a mean interval of 8 days in all, except one patient who died of fulminant sepsis. Of the 15 patients with type E injury, five underwent hepaticojejunostomy after a minimum gap of 3 months. Early repair was considered in 10 patients. Twenty patients in group C underwent hepaticojejunostomy. In a mean follow-up of 40 months, the outcome was grade A in 54 patients, grade B in three patients (one from each of the three groups) and grade D in one patient (group C). The latter patient with a type E3 injury developed recurrent stricture and cholangitis necessitating percutaneous transhepatic dilatation. The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.Keywords Cholecystect...

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

Murata,

Shigekawa,

Ishii

et al. 2023

DEN Open

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ObjectiveAdequate biliary decompression is important in treating bile leaks, and endoscopic transpapillary drainage is widely used for this purpose. As an indicator to evaluate the usefulness of endoscopic drainage for postoperative biliary leakage, we focused on external drain removability, which affects quality of life, after endoscopic treatment. Our aim was to clarify the success rate of external tube removal after endoscopic drainage for postoperative biliary leakage and to examine associated factors.MethodsThis was a multicenter retrospective study; 99 patients with biliary leakage at 13 institutions were enrolled between April 2014 and March 2019. Among these patients, 66 who were initially treated with endoscopic interventions for biliary leakage after cholecystectomy (n = 17) or hepatectomy (n = 49) were reviewed.ResultsIn post‐cholecystectomy biliary leakage, the external‐drain‐free rate at first endoscopic intervention was 100%, and the drains, including transpapillary stents, were successfully removed in almost all cases (16/17). In contrast, in post‐hepatectomy biliary leakage, the external‐drain‐free rate was 44.9% (22/49), with all 22 of those patients eventually becoming entirely drain‐free. A lower body mass index was the only significant factor associated with freedom from external drainage in post‐hepatectomy biliary leakage (odds ratio 0.18, 95% confidence interval 0.05–0.65).ConclusionsInitial endoscopic treatment was effective for post‐cholecystectomy biliary leakage, while approximately half of the patients with post‐hepatectomy biliary leakage required multidisciplinary management. Achieving freedom from external drainage contributes to patients’ quality of life and may be a predictor of treatment response after endoscopic therapy for postoperative biliary leakage.

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Endoscopic Sphincterotomy Alone in the Management of Low‐grade Biliary Leaks Due to Cholecystectomy

Abstract: Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.

Cited by 33 publications

References 27 publications

Endoscopic management of post-cholecystectomy biliary fistula

Endoscopic management of post-cholecystectomy biliary fistula

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

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

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