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

Kostas Fasoulas, Christos Zavos, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Jannis Kountouras, Panagiotis Katsinelos, Kostas Fasoulas, Christos Zavos, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Jannis Kountouras, Panagiotis Katsinelos

Abstract

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

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

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

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

Keywords: ERCP; bile leak; cholecystectomy; complications; endoscopic sphincterotomy; endoscopic stenting.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Endoscopic retrograde cholangiogram showing a leak from the cystic duct stump (arrow).
Figure 2
Figure 2
Radiograph showing a Tannenbaum stent (Wilson-Cook, Athens) inserted proximally to the site of the bile leak.
Figure 3
Figure 3
Endoscopic treatment of 71 patients for suspected post-cholecystectomy bile leak CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; ES, endoscopic sphincterotomy

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