An endoscopic approach to the management of surgical bile duct injuries: nine years’ experience

Familiari, L; Scaffidi, Mariagrazia; Familiari, Pietro; Consolo, Pierluigi; Ficano, Leonardo; Miceli, D.; Martorana, Guido; Tarantello, Marco

doi:10.1016/s1590-8658(03)00223-8

Cited by 20 publications

(13 citation statements)

References 20 publications

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“…A short (5‐cm) stent, which crosses the sphincter of Oddi, is all that is required. That it is not necessary to stent the leak point is supported by the current study and other published data 35 …”

Section: Discussionsupporting

confidence: 88%

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

Section: Discussionmentioning

confidence: 99%

“…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. A short (5-cm) stent, which crosses the sphincter of Oddi, is all that is required.…”

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: Discussionsupporting

confidence: 88%

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

Section: Discussionmentioning

confidence: 99%

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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“…The only probable explanation is the unwillingness of patients to proceed with endoscopic treatment because of pain. Although multiple stent treatment was associated with excellent outcome in previous series, the present results suggest that insertion of multiple stents is primarily beneficial in a patients in whom this was applied (or could be achieved) early in the course of treatment 18 20 34. Consequently, it may be worthwhile to adapt the procedure and timing of stent insertion in such a way that emphasis is put on early dilation rather than introducing many stents at any given time during treatment.…”

Section: Discussionmentioning

confidence: 57%

Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success

Reuver

Rauws

Vermeulen

et al. 2007

Gut

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Objective: To analyse the short and long term outcome of endoscopic stent treatment after bile duct injury (BDI), and to determine the effect of multiple stent treatment. Design, setting and patients: A retrospective cohort study was performed in a tertiary referral centre to analyse the outcome of endoscopic stenting in 67 patients with cystic duct leakage, 26 patients with common bile duct leakage and 110 patients with a bile duct stricture. Main outcome measures: Long term outcome and independent predictors for successful stent treatment. Results: Overall success in patients with cystic duct leakage was 97%. In patients with common bile duct leakage, stent related complications occurred in 3.8% (n = 1). The overall success rate was 89% (n = 23). In patients with a bile duct stricture, stent related complications occurred in 33% (n = 36) and the overall success rate was 74% (n = 81). After a mean follow up of 4.5 years, liver function tests did not identify ''occult'' bile duct strictures. Independent predictors for outcome were the number of stents inserted during the first procedure (OR 3.2 per stent; 95% CI 1.3 to 8.4), injuries classified as Bismuth III (OR 0.12; 95% CI 0.02 to 0.91) and IV (OR 0.04; CI 0.003 to 0.52) and endoscopic stenting before referral (OR 0.24; CI 0.06 to 0.88). Introduction of sequential insertion of multiple stents did not improve outcome (before 77% vs after 66%, p = 0.25), but more patients reported stent related pain (before 11% vs after 28%, p = 0.02). Conclusions: In patients with a postoperative bile duct leakage and/or strictures, endoscopic stent treatment should be regarded as the choice of primary treatment because of safety and favourable long term outcome. Apart from the early insertion of more than one stent, the benefit from sequential insertion of multiple stents did not become readily apparent from this series.

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“…Since, the role of MRCP in management of patients with suspected postoperative bile ductal injury is now well established, ERCP should no longer be used as a diagnostic tool[39–42] Any patient suspected to have postoperative biliary injury should have MRCP that helps confirm the type and extent of the lesion. Therefore, by adopting the policy of routine MRCP, a proper course of treatment may be chosen, i.e.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of postoperative bile duct injuries: A single center experience

Abdel-Raouf

Hamdy

Hanafy

et al. 2010

Saudi J Gastroenterol

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Background/Aim:Biliary endoscopic procedures may be less invasive than surgery for management of postoperative bile duct injuries (POBDI). This retrospective work presents the experience of a single referral center during a period of 14 years in endoscopic management of POBDI.Patients and Methods:Between 1994 (March) and 2008 (May), ERCP had been performed on 277 patients suspected to have POBDI. Patients shown to have complete transaction of bile duct were prepared for definitive surgery. For patients with simple biliary leak, sphincterotomy was performed with stenting. Pneumatic dilatation and stenting were done on patients with biliary stricture and preserved ductal continuity. ERCP was repeated every 3 months till the site of narrowing disappeared.Results: The mean age was 45.3 years, 162 (58.5%) were females. The most common previous surgery was cholecystectomy (open, [N=119] 44%, and laparoscopic, [N=77] 28%). ERCP failed in 17 patients (6.1%). For successfully cannulated cases (N=260, 93.9%), the type of bile duct injury diagnosed at ERCP was completely ligated CBD (N=31/260 , 11.9%). Bile leakage was detected in (N=167/260, 64.2%) all patients with endoscopic sphincterotomy and stent insertion, the leak stopped in all of them. Biliary stricture was diagnosed in 33/260 patients (12.7%) and 17 of them had repeated balloon dilatation with stenting while the remaining had surgical correction. The success rate of endoscopic therapy for biliary strictures was 82%. Cholangiogram was normal in 29 patients (11.2%).Conclusions:Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option.

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An endoscopic approach to the management of surgical bile duct injuries: nine years’ experience

Cited by 20 publications

References 20 publications

Endoscopic management of post-cholecystectomy biliary fistula

Endoscopic management of post-cholecystectomy biliary fistula

Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success

Endoscopic management of postoperative bile duct injuries: A single center experience

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