Postoperative bile leakage: endoscopic management.

Davids, P. H. P.; Rauws, E. A. J.; Tytgat, G. N. J.; Huibregtse, K.

doi:10.1136/gut.33.8.1118

Cited by 120 publications

(71 citation statements)

References 19 publications

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“…The pancreas poses an added barrier due to the increasing utilization of metal biliary stents. Metal stents are preferred over plastic stents due to lower occlusion and complication rates [25]. Recently, multiple companies have developed MRI compatible metal stents using a nickel titanium alloy (nitinol).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Cuneo¹,

Chenevert²,

Feng³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Cuneo¹,

Chenevert²,

Feng³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…Several endoscopic approaches for the management of symptomatic postoperative bile leaks are now well established, including biliary sphincterotomy alone, plastic stent placement with or without sphincterotomy, and sphincterotomy followed by nasobiliary tube placement. 2,3 However, large or complex bile leaks require the placement of multiple large stents that cover the bile leak, and surgery may still required. 4 In this report, we present our experience using a newly designed, fully covered, self-expandable metal stent (FC-SEMS) for the treatment of bile leaks from the subvesical duct in a patient whose general condition worsened and ongoing leakage persisted despite conventional endoscopic treatment.…”

Section: Introductionmentioning

confidence: 99%

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Hwang¹,

Kim²,

Yoo³

et al. 2011

Gut Liver

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Bile leaks remain a signifi cant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration with laparoscopy and ligation of the injured subvesical duct should be considered. We present herein the case of a 31-year-old woman with refractory bile leakage from a disrupted subvesical duct after cholecystectomy that could not be managed with endoscopic sphincterotomy and plastic-stent placement. A newly designed, fully covered, self-expandable metal stent (FC-SEMS) was successfully placed for the treatment of refractory bile leaks in this patient. It appears that temporary placement of an FC-SEMS is technically feasible and provides an effective alternative to surgical therapy for refractory bile leaks after cholecystectomy. (Gut Liver 2011;5:96-99)

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“…Some authors propose the use of biliary sphincterotomy alone as it is easy to perform and patients do not require a subsequent ERCP for stent removal; however, most of the available data supporting this practice stem from patients with bile leaks following cholecystectomy. 14,16,34,35 In the case of bile leaks after LT, available data regarding the use of biliary sphincterotomy alone for bile leaks are scant and limited to large series of patients treated for an array of biliary adverse events after LT. [14][15][16][17] The success rate of this approach in LT is poorly understood as no randomized controlled trials have directly compared this strategy to sphincterotomy plus biliary plastic stent placement. We believe plastic stent placement for bile leaks after LT has the advantage of preferentially diverting bile flow to the duodenum through the elimination of the transpapillary pressure gradient, and perhaps could be the reason why stent placement was responsible for better outcomes when compared to sphincterotomy alone.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers

Sendino

Fernandez-Simon

Law

et al. 2017

United European Gastroenterology Journal

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Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results: Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively (p ¼ 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion: ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.

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Postoperative bile leakage: endoscopic management.

Cited by 120 publications

References 19 publications

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers

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