Eleven-year experience on the endoscopic treatment of post-cholecystectomy bile leaks

Abstract

Background Bile leak is a common and serious complication of cholecystectomy with endotherapybeing an established method of treatment. This retrospective study presents the 11-yearexperience of a referral center in endoscopic management of post-cholecystectomy bile leaks.

Methods During the period between January 2000 and December 2010, records of patientswho had undergone endoscopic retrograde cholangiopancreatography (ERCP) for suspectedpost-cholecystectomy bile leaks were reviewed for evidence of clinical presentation of bileleaks, cholangiographic findings, type of endoscopic intervention, procedural complicationsand post-procedure follow-up.

Results Seventy-one patients with suspected post-cholecystectomy bile leak were referred forERCP. Common bile duct (CBD) cannulation was successful in 70 patients (98.59%). Completetransection of CBD was diagnosed in 4 patients; they were treated with surgery. A leak fromthe cystic duct stump was demonstrated in 49 patients (74.24%), from the ducts of Luschkain 4 (6.06%), from the gallbladder bed in 2 (3.03%), from the CBD in 7 (10.61%) and fromthe common hepatic duct (CHD) in 4 patients (6.06%). Endoscopic sphincterotomy (ES) plusendoprosthesis was performed in 64 patients (96.97%). A 12-year-old girl with a leak fromcystic duct stump was successfully treated with stenting without ES and one patient with leakfrom gallbladder bed underwent only ES. Endoscopic intervention failed to treat a leak fromCHD in one patient. During the follow-up, three patients developed bile duct stricture. Twowere treated endoscopically and one with hepaticojejunostomy.

Conclusions ES plus large-bore straight plastic biliary stent placement is a safe and effectiveintervention in post-cholecystectomy bile leaks.

Keywords ERCP, cholecystectomy, endoscopic sphincterotomy, complications, bile leak,endoscopic stenting

Ann Gastroenterol 2011; 24 (3): 200-205