BACKGROUND AND AIMS: Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events (AEs). Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, AEs, and long-term results of endoscopic therapy. METHODS: We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014. Data were assembled on patient demographics, etiology of BDL, and procedural details. Endotherapy for BDLs were classified a priori into 3 groups based on timing of ERCP from time of biliary injury: within 1 day of BDL, on day 2 or 3 after BDL, and greater than 3 days after BDL. The relationship among timing of ERCP after BDL injury and outcomes, procedure-related AEs, and patient AEs and mortality were evaluated. RESULTS: From February 2006 to June 2014, 518 patients (50% male; mean age, 51.7 years) underwent ERCP for therapy of BDLs. The etiology of the BDL was laparoscopic cholecystectomy (70.7%), post-liver transplantation (11.2%), liver resection (14.1%), trauma (2.5%), and other causes (1.5%). Endotherapy was performed by placing a transpapillary stent alone (73.5%) or with a sphincterotomy (26.5%). The timing of ERCPs was as follows: ≤1 day = 57 patients, day 2 or 3 = 140 patients, and >3 days = 321 patients. There was no statistical difference in patient demographics, etiology/site of BDL, or type of endotherapy performed among the 3 groups. On multivariate analysis there was no statistically significant difference in BDL success rate for ERCPs performed within 1 day compared with those performed on day 2 or 3 or after 3 days of bile duct injury (91.2%, 90%, and 88.5%, respectively; P = .77). Similarly, there was no significant difference in the overall patient AE rate among the 3 groups (21.1%, 22.9%, and 24.6%, respectively; P = .81). AEs in men occurred significantly more frequently when compared with women, even after adjusting for age, BDL etiology, and location of leak (27.6% vs 19.9%; OR, 1.53; P = .04). Patients whose BDL was due to a cholecystectomy had a lower AE and mortality rate compared with those who had biliary injury from other etiologies (OR, .42; P < .001). CONCLUSIONS: The overall success rates and AEs after ERCP were not dependent on the timing of the procedure relative to the discovery of the bile leak. This suggests that ERCP in these patients can usually be performed in an elective, rather than an urgent, manner.
BACKGROUND AND AIMS: Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events (AEs). Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, AEs, and long-term results of endoscopic therapy. METHODS: We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014. Data were assembled on patient demographics, etiology of BDL, and procedural details. Endotherapy for BDLs were classified a priori into 3 groups based on timing of ERCP from time of biliary injury: within 1 day of BDL, on day 2 or 3 after BDL, and greater than 3 days after BDL. The relationship among timing of ERCP after BDL injury and outcomes, procedure-related AEs, and patientAEs and mortality were evaluated. RESULTS: From February 2006 to June 2014, 518 patients (50% male; mean age, 51.7 years) underwent ERCP for therapy of BDLs. The etiology of the BDL was laparoscopic cholecystectomy (70.7%), post-liver transplantation (11.2%), liver resection (14.1%), trauma (2.5%), and other causes (1.5%). Endotherapy was performed by placing a transpapillary stent alone (73.5%) or with a sphincterotomy (26.5%). The timing of ERCPs was as follows: ≤1 day = 57 patients, day 2 or 3 = 140 patients, and >3 days = 321 patients. There was no statistical difference in patient demographics, etiology/site of BDL, or type of endotherapy performed among the 3 groups. On multivariate analysis there was no statistically significant difference in BDL success rate for ERCPs performed within 1 day compared with those performed on day 2 or 3 or after 3 days of bile duct injury (91.2%, 90%, and 88.5%, respectively; P = .77). Similarly, there was no significant difference in the overall patient AE rate among the 3 groups (21.1%, 22.9%, and 24.6%, respectively; P = .81). AEs in men occurred significantly more frequently when compared with women, even after adjusting for age, BDL etiology, and location of leak (27.6% vs 19.9%; OR, 1.53; P = .04). Patients whose BDL was due to a cholecystectomy had a lower AE and mortality rate compared with those who had biliary injury from other etiologies (OR, .42; P < .001). CONCLUSIONS: The overall success rates and AEs after ERCP were not dependent on the timing of the procedure relative to the discovery of the bile leak. This suggests that ERCP in these patients can usually be performed in an elective, rather than an urgent, manner.
Authors: Zhi Ven Fong; Henry A Pitt; Steven M Strasberg; Andrew P Loehrer; Jason K Sicklick; Mark A Talamini; Keith D Lillemoe; David C Chang Journal: J Am Coll Surg Date: 2018-01-04 Impact factor: 6.113
Authors: Anne Marthe Schreuder; Olivier R Busch; Marc G Besselink; Povilas Ignatavicius; Antanas Gulbinas; Giedrius Barauskas; Dirk J Gouma; Thomas M van Gulik Journal: Dig Surg Date: 2019-01-17 Impact factor: 2.588
Authors: Massimiliano Mutignani; Edoardo Forti; Alberto Larghi; Stefanos Dokas; Francesco Pugliese; Marcello Cintolo; Giulia Bonato; Alberto Tringali; Lorenzo Dioscoridi Journal: Endosc Int Open Date: 2019-01-30
Authors: Nicola de'Angelis; Fausto Catena; Riccardo Memeo; Federico Coccolini; Aleix Martínez-Pérez; Oreste M Romeo; Belinda De Simone; Salomone Di Saverio; Raffaele Brustia; Rami Rhaiem; Tullio Piardi; Maria Conticchio; Francesco Marchegiani; Nassiba Beghdadi; Fikri M Abu-Zidan; Ruslan Alikhanov; Marc-Antoine Allard; Niccolò Allievi; Giuliana Amaddeo; Luca Ansaloni; Roland Andersson; Enrico Andolfi; Mohammad Azfar; Miklosh Bala; Amine Benkabbou; Offir Ben-Ishay; Giorgio Bianchi; Walter L Biffl; Francesco Brunetti; Maria Clotilde Carra; Daniel Casanova; Valerio Celentano; Marco Ceresoli; Osvaldo Chiara; Stefania Cimbanassi; Roberto Bini; Raul Coimbra; Gian Luigi de'Angelis; Francesco Decembrino; Andrea De Palma; Philip R de Reuver; Carlos Domingo; Christian Cotsoglou; Alessandro Ferrero; Gustavo P Fraga; Federica Gaiani; Federico Gheza; Angela Gurrado; Ewen Harrison; Angel Henriquez; Stefan Hofmeyr; Roberta Iadarola; Jeffry L Kashuk; Reza Kianmanesh; Andrew W Kirkpatrick; Yoram Kluger; Filippo Landi; Serena Langella; Real Lapointe; Bertrand Le Roy; Alain Luciani; Fernando Machado; Umberto Maggi; Ronald V Maier; Alain Chichom Mefire; Kazuhiro Hiramatsu; Carlos Ordoñez; Franca Patrizi; Manuel Planells; Andrew B Peitzman; Juan Pekolj; Fabiano Perdigao; Bruno M Pereira; Patrick Pessaux; Michele Pisano; Juan Carlos Puyana; Sandro Rizoli; Luca Portigliotti; Raffaele Romito; Boris Sakakushev; Behnam Sanei; Olivier Scatton; Mario Serradilla-Martin; Anne-Sophie Schneck; Mohammed Lamine Sissoko; Iradj Sobhani; Richard P Ten Broek; Mario Testini; Roberto Valinas; Giorgos Veloudis; Giulio Cesare Vitali; Dieter Weber; Luigi Zorcolo; Felice Giuliante; Paschalis Gavriilidis; David Fuks; Daniele Sommacale Journal: World J Emerg Surg Date: 2021-06-10 Impact factor: 5.469