Endoscopic therapy for bile leak based on a new classification: results in 207 patients

Sandha, Gurpal; Bourke, Michael J.; Haber, Gregory B.; Kortan, Paul P.

doi:10.1016/s0016-5107(04)01892-9

Cited by 206 publications

(211 citation statements)

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“…Ten-French stents are now the standard caliber, because use of 11.5-Fr plastic stents is more technically challenging and does not increase stent patency [3]. Plastic stents are routinely used to treat benign biliary conditions (BBCs) such as biliary leaks [4][5][6], strictures [7], postsphincterotomy bleeding (post-ES bleeding) [8], and perforations [9,10].…”

mentioning

confidence: 99%

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Canena

Liberato²,

Horta

et al. 2012

Surg Endosc

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Background Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. Methods This was a retrospective case series with longterm follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development. Results Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7-28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3-15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21-30 days). There were no complications related to stenting. Conclusions Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late complications.

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confidence: 99%

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Canena

Liberato²,

Horta

et al. 2012

Surg Endosc

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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: 92%

“…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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“…All of the six patients treated with sphincterotomy alone failed endoscopic therapy; two were subsequently treated successfully with stent placement, and four were treated surgically without any additional endoscopic therapy. In a study by Sandha et al [6] of 207 patients with biliary leaks, endoscopic therapy was selected based on the severity of the leaks. Seventy-five patients with low-grade leaks were treated with sphincterotomy alone with a 97% success rate; seven failures required additional therapy.…”

mentioning

confidence: 99%

“…Finally, there was no direct comparison between endoscopic sphincterotomy and biliary stent placement alone without sphincterotomy. The use of stent placement alone without sphincterotomy, with its inherent risks, is a central question that has been posed several times in the literature for which several studies have confirmed its effectiveness [5][6][7][8].…”

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confidence: 99%

Endoscopic Treatment of Biliary Leaks After Laparoscopic Cholecystectomy: Cut or Plug?

Brady

Taunk

2017

Dig Dis Sci

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Endoscopic therapy for bile leak based on a new classification: results in 207 patients

Cited by 206 publications

References 20 publications

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

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

Endoscopic Treatment of Biliary Leaks After Laparoscopic Cholecystectomy: Cut or Plug?

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