Endoscopic management of bile leaks after cholecystectomy: Is there a treatment of choice?

Ivano Biviano; Sinan Sadalla; Pietro Maria Barazzoni; Zhaohan Wang; Alessia D’Ignazio; Alessia Santini; Elena Gianni; Raffaele Macchiarelli

doi:10.15406/ghoa.2023.14.00559

eISSN: 2373-6372

Gastroenterology & Hepatology: Open Access

Research Article Volume 14 Issue 5

Endoscopic management of bile leaks after cholecystectomy: Is there a treatment of choice?

Ivano Biviano, Sinan Sadalla, Pietro Maria Barazzoni, Zhaohan Wang, Alessia D’Ignazio, Alessia Santini, Elena Gianni, Raffaele Macchiarelli

Received: August 07, 2023 | Published: October 6, 2023

Citation: Biviano I, Sadalla S, Barazzoni PM, et al. Endoscopic management of bile leaks after cholecystectomy: Is there a treatment of choice? Gastroenterol Hepatol Open Access. 2023;14(5):139-143. DOI: 10.15406/ghoa.2023.14.00559

Abstract

Background: Iatrogenic bile duct injuries (BDI) are common post-cholecystectomy complications. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment, but it is not clear what is the best endotherapy option.
Aim: To evaluate the efficacy of endoscopic treatment for biliary leaks (BLs) after cholecystectomy; to investigate the predictive factors to guide treatment; to evaluate the best option between plastic (PS) or fully covered self-expandable metallic stents (FCSEMS).
Methods: We retrospectively analyzed data of all patients with BLs after cholecystectomy who underwent ERCP between 2011 and 2022. The severity of the leak was classified according to Amsterdam Criteria. Endoscopic treatment consisted of endoscopic sphincterotomy alone (ES) or sphincterotomy and stenting (EST). The resolution of the leak was evaluated by the biliary drainage cessation. We performed a multivariate analysis
to investigate predictive factors for successful endoscopic treatment.
Results: Thirty-eight patients (13F, 66±18 years) underwent ERCP for BL. Fifteen (5F, 75±12y) were treated with EST, while 23 (8F, 61±19y) with ES, 9 (3F) of which required additional ERCP for failure. Comparing the two groups, a statistical difference was demonstrated for the presence of stenosis (p 0.015) and high-grade leak (p 0.05) in Fisher’s test. Multivariate analysis revealed no predictors between the two groups (OR 1.35; 0<95%CI<2). In the EST group 14 (4F) were treated with PSs and 8 (3F) with FCSEM with a mean time of maintenance of 54±31 and 44±31 respectively (p=0,525).
Conclusion: ES alone or EST are both effective in BLs post-cholecystectomy. No predictive factors to guide endotherapy were identified; however, biliary stenting should be primarily considered in high grade leaks and in the stricture of the biliary ducts. There was no advantage in placing FCSEMS rather than PS.

Keywords: bile duct leaks, endoscopic retrograde cholangiopancreatography, cholecystectomy, sphincterotomy, biliary stenting