Mia Rainio1, Outi Lindström2, Marianne Udd2, Carola Haapamäki2, Arno Nordin3, Leena Kylänpää2. 1. Department of Gastroenterological Surgery, Helsinki University Hospital, Helsinki University, Haartmaninkatu 4, 00290, Helsinki, Finland. mia.rainio@hus.fi. 2. Department of Gastroenterological Surgery, Helsinki University Hospital, Helsinki University, Haartmaninkatu 4, 00290, Helsinki, Finland. 3. Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
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.
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.
Entities:
Keywords:
Amsterdam criteria; Bile leak; Biliary stent; Endoscopic retrograde cholangiopancreatography; Iatrogenic bile duct injury; Sphincterotomy
Authors: Arthur John Kaffes; Luke Hourigan; Nicolas De Luca; Karen Byth; Stephen John Williams; Michael John Bourke Journal: Gastrointest Endosc Date: 2005-02 Impact factor: 9.427
Authors: Gary C Vitale; Tin C Tran; Brian R Davis; Michael Vitale; David Vitale; Gerald Larson Journal: J Am Coll Surg Date: 2008-05 Impact factor: 6.113
Authors: Wong Hoi She; Tan To Cheung; Miu Yee Chan; Ka Wan Chu; Ka Wing Ma; Simon H Y Tsang; Wing Chiu Dai; Albert C Y Chan; Chung Mau Lo Journal: Surg Endosc Date: 2022-02-22 Impact factor: 3.453