Endoscopic Ultrasound-Guided Drainage of a Biloma: A Novel Approach

Ponnudurai, Ryan; George, Andrew J.T.; Sachithanandan, Sharmila; Abdullah, Ali Hashoosh; Ganesaligam, K.; Sanker, L.; Merican, I; Seewald, Stefan; Soehendra, Nib

doi:10.1055/s-2006-925143

Cited by 12 publications

(9 citation statements)

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“…EUS-TD is the standard treatment for pancreatic pseudocysts and collections and has been described in the drainage of postoperative abdominal collections. [16][17][18] In our series of refractory bile leak, EUS-TD had a similarly higher success rate after even fewer clinical sessions than TF/TP drainage. The population of our study was mostly composed of patients (60%) with advanced oncologic disease, and 10% of patients died before 3 months of follow-up.…”

Section: Discussionmentioning

confidence: 67%

Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access

Lorenzo

Bromberg

Arvanitakis

et al. 2022

Gastrointestinal Endoscopy

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Background and Aims: Bilomas most frequently result from postoperative bile leaks. The endoscopic conventional treatment is sphincterotomy AE stent placement. In complex cases, such as altered anatomy or failure of conventional treatment, transpapillary/transfistulary (TP/TF) drainage or EUS-guided transmural drainage (EUS-TD) may obviate additional biliary surgery. This study reports our experience with treating biloma secondary to refractory biliary leak with TP/TF drainage or EUS-TD and evaluates the safety and outcomes associated with this approach.Methods: This observational study focused on consecutive patients managed for biliary leakage (diagnosis based on imaging and/or bile outflow from a surgical drain) at a tertiary care hospital (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). TP/TF drainage was performed by double-pigtail stent(s) placement to drain the biloma through the leak during ERCP. For EUS-TD, plastic stent(s) were placed under EUS control. Primary outcomes were a composite of clinical success (patient free of sepsis after percutaneous drain removal and, in patients with benign disease, removal of all endoscopically placed stents, without need for reintervention) and biloma regression (<3 cm) at last follow-up.Results: Thirty patients (men, 57%; median age, 55 years) were included. Most biliary leaks resulted from cholecystectomy (27%) and hepatectomy (50%). Initial EUS-TD and TP/TF drainage were performed in 14 (47%) and 16 (53%) patients, respectively. At last follow-up (median, 33.2 months), clinical success and primary outcome were achieved in 70.4% of patients (EUS-TD, 75%; TP/TF, 67%). Additional surgery was necessary in 1 patient. Rate of serious adverse events was 23% (7/30), of which 13% (4/30) were procedure related. There were 4 deaths during the course of treatment, 2 of which were related to endoscopic interventions (hemorrhage and fibrillation).Conclusions: TP/TF drainage or EUS-TD is technically feasible with high clinical success and may avoid the need for additional surgery in complex cases or in patients with altered anatomy. (Gastrointest Endosc 2021;-:1-9.

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Section: Discussionmentioning

confidence: 67%

Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access

Lorenzo

Bromberg

Arvanitakis

et al. 2022

Gastrointestinal Endoscopy

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“…4,5 It was recently reported that EUS-FNA of an infected biloma, together with endoscopic biliary stent placement, resulted in complete resolution of a patient's biloma. 6 Thus cytologic diagnosis of biloma on EUS-FNA can help a great deal in managing this potentially complex problem.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Unusual Gross Appearance of Aspirated Material from Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic and Peripancreatic Cystic Lesions

Zhu¹,

Grieco²

2008

Acta Cytologica

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“…Alternatively symptomatic biloma may be treated successfully with interventional radiologic techniques instead of open surgery [54,55]. It was recently reported that endoscopic ultrasound-guided fine-needle aspiration of an infected biloma, together with endoscopic biliary stent placement, resulted in complete resolution of a patient's biloma [56]. Thus, cytological diagnosis of biloma upon EUS-FNA can help a great deal in managing this potentially complex problem.…”

Section: Endoscopymentioning

confidence: 99%

The Use of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in Cytopathology Diagnosis

Zhu¹,

Feng²,

Grieco³

2013

Endoscopy

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Endoscopic Ultrasound-Guided Drainage of a Biloma: A Novel Approach

Cited by 12 publications

References 0 publications

Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access

Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access

Diagnostic Value of Unusual Gross Appearance of Aspirated Material from Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic and Peripancreatic Cystic Lesions

The Use of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in Cytopathology Diagnosis

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