Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center

Abstract

The International Study Group of Liver Surgery has defined bile duct leak (BDL) as "fluid with an increased bilirubin concentration in the abdominal drain or in the intra-abdominal fluid or as the need for radiologic intervention because of bil-iary fluid collection or re-laparotomy resulting from bile peritonitis". 1 Bile leak is commonly associated with surgeries (such as cholecystectomy, liver transplantation, partial hepatectomy, and hydatid cyst excision). However, it may also occur secondary to various necro-inflammatory conditions involving the liver. The most frequent cause of bile leak is iatrogenic, and cholecystectomy is the most common procedure associated with this condition. Bile leak occurs in 0.1%-0.5% of patients who underwent open cholecystectomy. 2,3 Approximately 0.5%-2% of patients who underwent laparoscopic cholecystectomy can develop bile leak, with the majority arising from the cystic duct stump. 4-6 The clinical presentation of bile leak varies from asymptomatic drainage of bile to life-threatening conditions including biliary peritonitis. Thus, bile leak can be associated with significant morbidity and can lead to death if left untreated. The communication between the biliary tree and amoebic liver abscess is observed in up to 27% of cases, and it commonly presents with jaundice and has a longer duration. 7 In

Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy

“…Most of the bile leakage after hepatectomy or cholecystectomy was known to be improved by non-surgical treatment, such as percutaneous drainage, ERCP, and biliary stent insertion. [12,13] However, it is questionable whether non-surgical treatment, such as maintenance of drainage tubes, can improve bile leakage in the present cases, with an amount of >150 mL/day. Furthermore, in our cases, the probability of anastomotic leakage had to be considered first, making it difficult to perform conservative treatment without surgical exploration.…”

Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study

“…Bile leak was most commonly diagnosed on hospital day 6 [4][5][6][7][8][9][10] based on surgical drain output (n = 37 [39%]) or computed tomography scan (n = 34 [36%]) (Table 2). On the day of bile leak diagnosis, drain output among patients with a surgical drain in situ was 270 mL/24 hours [125-555 mL].…”

“…Part of the challenge in the evidence-based management of traumatic bile leaks is the paucity of data to guide treatment, with the vast majority of bile leaks occurring following cholecystectomy. 5,6 Therefore, the need for and timing of interventions for traumatic bile leak management and the utility of various investigations used to confirm the diagnosis of bile leak are not yet established by existing literature. Internal biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and/or biliary stenting is the mainstay of bile leak management, with success rates that approach 100% and relatively low rates of complications.…”

The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak

“…Bile leak occurs commonly after surgery, particularly following cholecystectomy, liver transplantation, partial liver resection, or hydatid cyst excision [ 1 , 2 ]. Non-surgical bile leak can occur in association with liver abscess or trauma [ 3 ]. Early recognition and diagnosis of bile leak are important because untreated ductal disruptions can result in significant morbidity and mortality.…”

“…In a study published in this issue of Clinical Endoscopy , Giri et al [ 3 ] retrospectively evaluated the efficacy and outcomes of endoscopic treatment for bile leak of various etiologies including cholecystectomy ( n =34), liver abscess ( n =20), hydatid cyst surgery ( n =11), other surgeries ( n =5), and trauma ( n =1).…”