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Endoscopic Therapy of Biliary Injury After Cholecystectomy

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Abstract

Background

Iatrogenic bile duct injury (BDI) is a common complication after cholecystectomy. Patients are mainly treated endoscopically, but the optimal treatment method has remained unclear.

Aims

The aim was to analyze endoscopic treatment in BDI after cholecystectomy and to explore endoscopic sphincterotomy (ES), with or without stenting, as the primary treatment for an Amsterdam type A bile leak.

Methods

All patients referred to Helsinki University Hospital endoscopy unit due to a suspected BDI between the years 2004 and 2014 were included in this retrospective study. To collect the data, all ERC reports were reviewed.

Results

Of the 99 BDI patients, 94 (95%) had bile leak of whom 11 had concomitant stricture. Ninety-three percent of all patients were treated endoscopically. Seventy-one patients had native papillae and a leak in the cystic duct or peripheral radicals. They were treated with ES (ES group, n = 50) or with sphincterotomy and stenting (EST group, n = 21). There was no difference between the closure time of the fistula (p = 0.179), in the time of discharge from hospital (p = 0.298), or in the primary healing rate between the ES group and the EST group (45/50 vs 19/21 patients, p = 0.951).

Conclusion

After the right patient selection, the success rate of endoscopic treatment can approach 100% for Amsterdam type A bile leak. ES is an effective and cost-effective single procedure with success rate similar to EST. It may be considered as a first-line therapy for the management of Amsterdam type A leaks.

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Funding

This study was supported by the Helsinki University Hospital Research Funds, Helsinki, Finland.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Helsinki University Hospital, Helsinki University, Haartmaninkatu 4, 00290, Helsinki, Finland

    Mia Rainio, Outi Lindström, Marianne Udd, Carola Haapamäki & Leena Kylänpää

  2. Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland

    Arno Nordin

Authors
  1. Mia Rainio
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  2. Outi Lindström
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  3. Marianne Udd
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  4. Carola Haapamäki
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  6. Leena Kylänpää
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Contributions

MR collected clinical data and performed the data analysis and drafted the manuscript. OL and LK participated in designing and coordinating the study and provided supervision. CH collected clinical data. MU and AN provided supervision. All authors critically revised the manuscript and read and approved the final version.

Corresponding author

Correspondence to Mia Rainio.

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Conflict of interest

Mia Rainio, Outi Lindström, Marianne Udd, Carola Haapamäki, Arno Nordin, and Leena Kylänpää have no conflict of interest or financial ties to disclose.

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Rainio, M., Lindström, O., Udd, M. et al. Endoscopic Therapy of Biliary Injury After Cholecystectomy. Dig Dis Sci 63, 474–480 (2018). https://doi.org/10.1007/s10620-017-4768-7

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  • DOI: https://doi.org/10.1007/s10620-017-4768-7

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