Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak

Kaffes, Arthur John; Hourigan, Luke; De Luca, Nicolas; Byth, Karen; Williams, Stephen John; Bourke, Michael John

doi:10.1016/s0016-5107(04)02468-x

Cited by 172 publications

(153 citation statements)

References 19 publications

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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%

“…Clinically significant biliary leaks can occur after hepatobiliary surgery and are the main cause of postoperative bile leaks following laparoscopic cholecystectomy procedures [4,5]. Despite the widespread use and efficacy of ERCP in the diagnosis and treatment of biliary leaks [4-6, 11, 12], a variety of percutaneous and surgical treatments have been proposed [13,14].…”

mentioning

confidence: 99%

“…Despite the widespread use and efficacy of ERCP in the diagnosis and treatment of biliary leaks [4-6, 11, 12], a variety of percutaneous and surgical treatments have been proposed [13,14]. Biliary sphincterotomy alone [5], use of large-bore transpapillary biliary stents [5], or a combination of both therapies have become the first-line interventions for the treatment of bile leaks [4,5]. Although there is no consensus as to the optimal endoscopic intervention, recent data suggest that a combination of biliary sphincterotomy and placement of a transpapillary biliary stent has a better outcome for the treatment of high-grade biliary leaks [4,14].…”

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confidence: 99%

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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%

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confidence: 99%

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confidence: 99%

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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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“…In a series of three patients with persistent biliary leaks despite sphincterotomy, Libby et al [4] reported successful closure in all with placement of a biliary stent. In a study by Kaffes et al [5], 76 out of 80 (95%) of patients with a biliary leak were successfully treated with ERCP, 18 with sphincterotomy alone, 40 with stent alone, and 32 with sphincterotomy or balloon sphincteroplasty plus stent. 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.…”

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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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Cystic Duct Stump Leaks

Eisenstein

Greenstein²,

Kim³

et al. 2008

Arch Surg

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To describe a series of patients who have had cystic duct stump leaks (CDSLs) after laparoscopic cholecystectomy and to compare the current presentation and management with that in previous studies. Design: Two-institution retrospective case series and review of the previously published literature. Setting: Two teaching hospitals. Patients: Twelve patients who had CDSLs of 5751 patients who underwent total laparoscopic cholecystectomy. Main Outcome Measures: Symptoms at presentation, laboratory values, imaging modalities, treatment modalities, and operative indications and techniques.

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Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak

Cited by 172 publications

References 19 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

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

Cystic Duct Stump Leaks

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