Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury.
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.
Sugiyama
M
M
First Department of Surgery and Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Atomi
Y
Y
Matsuoka
T
T
Yamaguchi
Y
Y
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*