Nasobiliary tube management of postcholecystectomy bile leaks.
BACKGROUND
Endobiliary stenting is the traditional form of endoprosthetic drainage for biliary leaks. Nasobiliary tubes offer the advantage of easy removal and interval tube cholangiograms to assess leak resolution.


OBJECTIVE
To determine the efficacy of nasobiliary tube drainage in patients with postcholecystectomy biliary leaks and provide our experience with management of biliary leak using nasobiliary drains.


METHODS
Retrospective study of 24 patients who were treated for postcholecystectomy biliary leaks in a tertiary referral center from 1998 to 2002. These patients were managed with either nasobiliary tube (NBT) alone or NBT + endoscopic sphincterotomy (ES).


RESULTS
Twenty-four patients (mean age, 57.5 years; 50% women) had postcholecystectomy leak noted on ERCP. Twenty patients were managed by NBT+ES and 4 patients had NBT placement alone. In the NBT+ES group, 2 patients pulled their NBT out, but 18 patients had complete leak resolution in 3 to 9 days. In the NBT group, all patients had complete leak resolution in 4 to 12 days. Using an intention-to-treat analysis, 22 of 24 (92%) patients were successfully treated with NBT treatment over 3 to 12 days.


CONCLUSIONS
ERCP with NBT placement is an effective and safe treatment modality in the management of postcholecystectomy biliary leaks.
Elmi
Farshad
F
Department of Internal Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Silverman
William B
WB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001652:Bile Ducts / Q000293:injuries*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome