title: Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury.
abstract: BACKGROUND
  Surgical treatment for persistent biliary fistula after blunt hepatic injury is often technically difficult. Endoscopic treatment for such fistulas has been described only infrequently.
  
  
  METHODS
  We reviewed 6 patients who underwent endoscopic biliary stent placement with (n = 1) or without (n = 5) sphincterotomy for persistent (12 to 138 days; mean 48 days) biliary fistula after blunt hepatic injury.
  
  
  RESULTS
  ERCP showed bile leakage from a second-order or more peripheral branch of the intrahepatic bile ducts in 5 patients but failed to reveal the fistula in 1. Stent placement was successful without complications in all patients. Bile leakage resolved within 1 to 3 days in 5 patients. After 36 to 86 days, the stent was removed and ERCP confirmed disappearance of the fistula. These patients have remained asymptomatic for a mean of 2.6 years since stent removal. In the patient in whom ERCP had not shown a fistula, bile leakage continued despite successful stent placement.
  
  
  CONCLUSIONS
  Endoscopic biliary stent placement is a rapid, safe and effective treatment for persistent post-traumatic biliary fistula demonstrated by ERCP.
authors.affiliation: First Department of Surgery and Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Atomi
authors.forename: T
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D015607:Stents; D014949:Wounds, Nonpenetrating / Q000150:complications*