title: What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy?
abstract: OBJECTIVE
  This study was carried out to establish the indications for biliary endoscopy due to biliary complications after laparoscopic cholecystectomy (LC).
  
  
  METHODS
  One hundred nineteen patients (36 men, 86 women; median age 59, range 16-93) were referred for endoscopic retrograde cholangiopancreatography (ERCP) to five centers between 1990 and 1994, and included in the study. The delay between LC and ERCP was 105 +/- 21 days.
  
  
  RESULTS
  Four types of complications were observed. a) Fifty-seven patients had residual stones or clip migration into the common bile duct (CBD); all were successfully treated with endoscopic sphincterotomy (ES). b) Twelve major injuries to the CBD were diagnosed by ERCP; successful surgical repair was carried out in most of these cases. c) Twenty patients had a partial biliary stricture; endoscopic stenting was attempted as a primary procedure in eight patients, with a satisfactory outcome in five (63%). d) Thirty patients had a bile leak; endoscopic therapy (26 patients) led to recovery in 18 (69%). The benefit of endoscopic treatment was less clear in five (19%); ES failed to bring about improvement in three patients (12%).
  
  
  CONCLUSIONS
  ERCP is indicated when a biliary complication is suspected after laparoscopic cholecystectomy. Endoscopic sphincterotomy is effective for the treatment of retained stones, clip migration, and bile leakage. Endoscopic stenting may be offered as a primary option in partial CBD strictures.
authors.affiliation: Hepatology and Gastroenterology Service, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: F
authors.initials: F
authors.lastname: Prat
authors.forename: G
authors.initials: G
authors.lastname: Pelletier
authors.forename: T
authors.initials: T
authors.lastname: Ponchon
authors.forename: J
authors.initials: J
authors.lastname: Fritsch
authors.forename: B
authors.initials: B
authors.lastname: Meduri
authors.forename: J
authors.initials: J
authors.lastname: Boyer
authors.forename: B
authors.initials: B
authors.lastname: Person
authors.forename: J F
authors.initials: JF
authors.lastname: Bretagne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic