title: Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review.
abstract: BACKGROUND
  Endoscopic therapy of biliary tract leaks was uncommon before laparoscopic cholecystectomy. Studies have demonstrated the efficacy of endoscopic drainage by endoscopic sphincterotomy or stent placement. Various endoscopic therapeutic modalities and long-term follow-up of this problem were studied.
  
  
  METHODS
  Members of the Midwest Pancreaticobiliary Group reviewed all patients referred for endoscopic therapy of biliary leaks after laparoscopic cholecystectomy from 1990 to 1994. Long-term follow-up was by direct patient contact.
  
  
  RESULTS
  Fifty patients were referred for endoscopic therapy of biliary leaks. Abdominal pain was present in 94%. The mean time from laparoscopic cholecystectomy to referral was 6.9 days. Therapy consisted of sphincterotomy only in 6 patients, stent only in 13, and sphincterotomy with stent in 31. Biliary leaks were healed in 44 patients at a mean of 5.4 weeks. A second or third endoscopic procedure was necessary to achieve healing in five patients. Two stent-related complications were noted. Percutaneous or surgical drainage of biliary fluid collections was required in 16 patients. The mean hospital stay for treatment of the leak was 11.1 days after endoscopic therapy. On follow-up (mean 17.5 months), all patients were well except two with mild abdominal discomfort.
  
  
  CONCLUSIONS
  Endoscopic sphincterotomy, stent placement, or sphincterotomy with stent are effective in healing biliary leaks after laparoscopic cholecystectomy. Despite prolonged treatment for the leak, patients did well on long-term follow-up.
authors.affiliation: Department of Gastroenterology, Marshfield Clinic, Wis 54449, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Ryan
authors.forename: J E
authors.initials: JE
authors.lastname: Geenen
authors.forename: G A
authors.initials: GA
authors.lastname: Lehman
authors.forename: G
authors.initials: G
authors.lastname: Aliperti
authors.forename: M L
authors.initials: ML
authors.lastname: Freeman
authors.forename: W B
authors.initials: WB
authors.lastname: Silverman
authors.forename: G P
authors.initials: GP
authors.lastname: Mayeux
authors.forename: J T
authors.initials: JT
authors.lastname: Frakes
authors.forename: H W
authors.initials: HW
authors.lastname: Parker
authors.forename: P N
authors.initials: PN
authors.lastname: Yakshe
authors.forename: J S
authors.initials: JS
authors.lastname: Goff
mesh_terms: D001646:Bile; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D013997:Time Factors