Endoscopic biliary stenting for treatment of bile leakage after hepatic resection.
OBJECTIVE
Persistent bile leakage after hepatic resection may cause intraperitoneal sepsis and hepatic failure. Surgical treatment for bile leakage carries a high risk. Endoscopic treatment has only infrequently been documented.


METHODS
Ten patients underwent endoscopic biliary stenting without sphincterotomy for persistent (9-138 days; median, 19 days) bile leakage after hepatic resection. Bile leakage was complicated by intraperitoneal sepsis in seven patients.


RESULTS
ERCP showed bile leakage from the bile duct stump in nine patients. Stent placement was successful without complications in all 10 patients. Bile leakage disappeared within 1-17 days (mean, 5 days) in all patients. After 55-91 days, the stent was removed and ERCP confirmed disappearance of the leak. No patients have developed recurrent bile leakage for a mean of 4.1 years of follow-up after stent removal.


CONCLUSIONS
Endoscopic biliary stenting is a safe and effective treatment for persistent bile leakage after hepatic resection. Endoscopic treatment may eliminate the need for difficult operations in high risk postoperative cases.
Sugiyama
M
M
First Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
Izumisato
Y
Y
Abe
N
N
Yamaguchi
Y
Y
Yamato
T
T
Masaki
T
T
Mori
T
T
Atomi
Y
Y
D000328:Adult; D000818:Animals; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004724:Endoscopy; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents