Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center
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Background/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions suchas ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-linemanagement for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies otherthan post-cholecystectomy injury are extremely limited. Methods: We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care centerand who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution withoutextravasation of the contrast medium during the second ERCP conducted after 6 weeks. Results: In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP,sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65(91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis ofbile leak and ERCP. Conclusions: Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.
Abstract
Background/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions suchas ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-linemanagement for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies otherthan post-cholecystectomy injury are extremely limited. Methods: We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care centerand who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution withoutextravasation of the contrast medium during the second ERCP conducted after 6 weeks. Results: In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP,sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65(91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis ofbile leak and ERCP. Conclusions: Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.
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