Endoscopic retrograde cholangiopancreatography in the treatment of bile leaks and bile duct strictures after laparoscopic cholecystectomy.
We reviewed our experience over 3 years with 11 patients who had bile leaks (Group 1) and 8 patients who had bile duct strictures after laparoscopic cholecystectomy (LC) and were treated with endoscopic retrograde cholangiopancreatography (ERCP) (Group 2). In Group 1, bile leaks were at the level of the cystic duct in 10 patients and from a duct of Luschka in 1 patient; 10 patients had sphincterotomy and 11 patients received barbed stents. All patients had resolution of bile leak and stents were removed after an average of 5 weeks. In Group 2, stenoses were at the level of the common bile duct (CBD) in 7 patients and of the CBD-common hepatic duct in 1 patient. Six patients had a sphincterotomy and 7 patients were successfully treated with pneumatic polyethylene balloon dilatation and stent placement. One patient had unsatisfactory dilatation and was referred to surgery. Two patients had permanent resolution of stenosis at 3 and 4 years of follow-up, 5 patients had recurrence, and a total of 6 patients eventually needed surgery. We conclude that ERCP is effective in resolving isolated bile leaks, but iatrogenic strictures after LC more often require surgical treatment after ERCP.
Aru
G M
GM
Davis Memorial Gastrointestinal Diagnostic Laboratory, Crawford Long Hospital, Emory University, Atlanta, Ga, USA.
Davis
C R
CR
Elliott
N L
NL
Morris
S J
SJ
D001646:Bile; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D015641:Radiography, Interventional; D016717:Sphincterotomy, Endoscopic; D015607:Stents