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Endoscopic management of postcholecystectomy biliary leaks
  1. Hemant Sharma1,
  2. George Bird1
  1. 1Department of Medicine, Maidstone Hospital, Maidstone, UK
  1. Correspondence to Dr George Bird, Department of Medicine, Division of Gastroenterology, Maidstone Hospital, Hermitage Lane, Maidstone ME16 9QQ, UK; gbird{at}nhs.net

Abstract

Objective To evaluate the nature of bile duct injuries following cholecystectomy and the success of endoscopic retrograde cholangiopancreatography (ERCP) in their identification and management.

Design All patients referred for ERCP with a diagnosis of a postcholecystectomy bile leak were identified prospectively from October 1994 to August 2008.

Setting The study was carried out in a district general hospital with the endoscopies performed by a single operator.

Patients All patients had undergone imaging with at least two of abdominal ultrasound scanning, CT scanning or MR cholangiopancreatography.

Interventions ERCP with treatment of a biliary leak by sphincterotomy and insertion of a temporary 7 Fr plastic biliary stent.

Main outcome measurements Clinical healing of the injury was assessed as resolution of symptoms with normalisation of liver function tests, cessation of external drain output and a repeat ERCP with removal of the indwelling stent within 2–8 weeks and no further complications.

Results 46 patients were identified, of whom 42 responded well to endoscopic treatment. Four patients ultimately needed surgery, of whom three had recurrent strictures. One patient had complete transection of the biliary duct and endoscopic treatment was not attempted.

Conclusion ERCP, with sphincterotomy and temporary plastic stent placement, is successful in the early management of patients with postcholecystectomy biliary leaks, which most commonly involve the cystic duct stump. ERCP carried out in a district general hospital identifies those patients requiring further specialised hepatobiliary care in a tertiary centre.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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