摘要
Background: Bile leak is a recognized complication of cholecystectomy. Endosc opic intervention is widely ac cepted as a treatment for this complication, but the optimal form is not well defined. Methods: An ERCP database was reviewed retrospectively to identify all cases of bile leak related to cholecystectomy. Patient records and endoscopy re ports were reviewed, and structured telephone interviews were conducted to colle ct data. Results: A total of 100 patients (61 women, 39 men; mean age, 53 [17] y ears) with suspected postcholecystectomy bile leak were referred for ERCP. Chole cystectomy was commenced laparoscopically in 83 patients (with an open conversio n rate of 30% ). The most common symptoms were pain (n=62) and fever (n = 37). Cholangiography was obtained in 96 patients. A leak was identified in 80/96 pati ents, the most common site being the cystic- duct stump (48), followed by ducts of Luschka (15), the T- tube site (7), and other sites (10). Treatment include d stent insertion alone (40), sphincterotomy alone (18), combination stent/sphin cterotomy (31), none (6), and other (1). Three patients with major bile- duct i njuries were excluded from the analysis. Endoscopic therapy was unsuccessful in 7 patients (6 in the sphincterotomy alone group; p=0.001). Four patients underwe nt surgery subsequent to ERCP to control the leak. All 4 were in the sphincterot omy alone group (p = 0.001). Post- ERCP pancreatitis developed in 4 patients (3 mild, 1 moderate). Conclusions: The optimal endoscopic intervention for postcho lecystectomy bile leak should include temporary insertion of a biliary stent.
Background: Bile leak is a recognized complication of cholecystectomy. Endosc opic intervention is widely ac cepted as a treatment for this complication, but the optimal form is not well defined. Methods: An ERCP database was reviewed retrospectively to identify all cases of bile leak related to cholecystectomy. Patient records and endoscopy re ports were reviewed, and structured telephone interviews were conducted to colle ct data. Results: A total of 100 patients (61 women, 39 men; mean age, 53 [17] y ears) with suspected postcholecystectomy bile leak were referred for ERCP. Chole cystectomy was commenced laparoscopically in 83 patients (with an open conversio n rate of 30% ). The most common symptoms were pain (n=62) and fever (n = 37). Cholangiography was obtained in 96 patients. A leak was identified in 80/96 pati ents, the most common site being the cystic- duct stump (48), followed by ducts of Luschka (15), the T- tube site (7), and other sites (10). Treatment include d stent insertion alone (40), sphincterotomy alone (18), combination stent/sphin cterotomy (31), none (6), and other (1). Three patients with major bile- duct i njuries were excluded from the analysis. Endoscopic therapy was unsuccessful in 7 patients (6 in the sphincterotomy alone group; p=0.001). Four patients underwe nt surgery subsequent to ERCP to control the leak. All 4 were in the sphincterot omy alone group (p = 0.001). Post- ERCP pancreatitis developed in 4 patients (3 mild, 1 moderate). Conclusions: The optimal endoscopic intervention for postcho lecystectomy bile leak should include temporary insertion of a biliary stent.
