Endoscopic management of bile duct injuries in 107 patients: experience of a Saudi referral center.
OBJECTIVE
Management of postcholecystectomy complications has been variably discussed. Various options exist but the recent trend has been towards the endoscopic retrograde approach favoring a simultaneous diagnostic and therapeutic potential. We studied the various endoscopic modalities to evaluate the efficacy of this approach.


METHODS
A retrospective analysis was conducted of 318 patients referred to the endoscopy department for suspected postcholecystectomy complications. A total of 107 patients were identified to have biliary injury. The study period extended from May 1982 to April 2000. All cases of bile duct injury were evaluated by endoscopic retrograde cholangiopancreatography for the feasibility of offering therapy.


RESULTS
From a total of 107 cases, 123 sites of biliary injury were identified. There were 66 patients with benign strictures and 57 patients with leaks and another 16 patients had a combination of leaks and strictures. Endoscopic diagnosis was feasible in 98% of patients. Subsequently, 81 patients accounting for 76% of the cases were considered for endotherapy and successful healing was shown in 90%. Seventy-seven percent of the leaks underwent trial of endoscopic management with successful response seen in 93.2% cases. Similar results occurring for strictures where 87.2% maintained sustained dilatation from a total of 45 case that had attempted endotherapy. There were no complications encountered in any of the patients.


CONCLUSIONS
Endoscopic retrograde cholangiopancreatography is a safe and feasible mode of therapy for patients presenting with suspected bile duct injuries. This form of intervention should be considered as the initial step in the diagnosis and treatment of postcholecystectomy complications.
al-Karawi
Mohamed A
MA
Department of Gastroenterology, P. O. Box 7897 (A41), Riyadh Armed Forces Hospital, Riyadh 11159, Saudi Arabia.
Sanai
Faisal M
FM
D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D003251:Constriction, Pathologic; D012189:Retrospective Studies; D012529:Saudi Arabia; D015607:Stents