title: Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) is important in the diagnosis and management of postoperative bile leaks. Endoscopic sphincterotomy (ES) alone, ES with stent or nasobiliary drain (NBD) placement and stent or NBD without ES are the methods of choice. In the present study, we aimed to show the efficacy of ES alone in the management of low-grade (LGL) cystic duct stump (CDS) leaks due to cholecystectomy.
  
  
  METHODS
  Between September 2005 and January 2008, ES was carried out on 31 patients with LGL from the CDS due to cholecystectomy who were referred to the endoscopy unit of Izmir Ataturk Training and Research Hospital. Biliary leakage was detected by biliary discharge from a tube drain inserted during the operation. In cases of retaining common bile duct stones, balloon extraction was carried out. If bile discharge continued, a stent was introduced for cessation of the leak as a second procedure.
  
  
  RESULTS
  The success rate of ES alone was 87.1% (27 of 31 patients). In four patients (12.9%), ES alone was inadequate, therefore a stent was placed. The biliary leak ceased gradually and stopped in all patients at a mean of 11 (7-21) days. Balloon extraction of retained stones was carried out in six patients (19.6%). In two (6.5%) patients, mild hemorrhage and in two patients self-limited pancreatitis was seen (6.5%) as complications.
  
  
  CONCLUSIONS
  Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.
authors.affiliation: Izmir Ataturk Training and Research Hospital, Izmir, Turkey. kadiraksoz@hotmail.com
authors.forename: Kadir
authors.initials: K
authors.lastname: Aksoz
authors.forename: Belkis
authors.initials: B
authors.lastname: Unsal
authors.forename: Gazi
authors.initials: G
authors.lastname: Yoruk
authors.forename: Zafer
authors.initials: Z
authors.lastname: Buyrac
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haciyanli
authors.forename: Zehra
authors.initials: Z
authors.lastname: Akpinar
authors.forename: Emrah
authors.initials: E
authors.lastname: Alper
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D003549:Cystic Duct / Q000293:injuries*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D019919:Prosthesis Implantation; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome