title: Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks.
abstract: BACKGROUND
  Although the endoscopic management of bile leaks after cholecystectomy (CCY) is well established, the yield of a routine endoscopic retrograde cholangiogram (ERC) with a bile duct sweep at the time of stent removal is unclear. This study aimed to describe the prevalence of abnormal findings at follow-up ERC to determine whether upper endoscopy with stent removal and without cholangiography would suffice.
  
  
  METHODS
  A retrospective cohort analysis of all patients referred for initial and follow-up ERC with post-CCY bile leak was performed. The rate of abnormal findings was measured including choledocholithiasis, biliary strictures, and persistent bile leaks at follow-up ERC. Secondarily, the study sought to define the clinical characteristics of patients who demonstrated stones or sludge at follow-up assessment.
  
  
  RESULTS
  Between January, 2003 and April, 2008, 105 patients underwent initial and follow-up ERC. After a mean interval of 6.9 +/- 2.7 weeks between endoscopies, 29 (27.6%) of the 105 patients demonstrated one or more abnormalities including persistent bile leak (n = 8), common bile duct (CBD) stones (n = 12), and CBD sludge alone (n = 9). In the subgroup analysis of the patients who underwent a balloon sweep at initial and follow-up ERC, the prevalence of CBD stones or sludge at the follow-up ERC was 17.6%. Besides stones during the initial ERC, no significant clinical predictors of CBD stones were found at follow-up ERC including surgical approach, interval between endoscopies, and location of bile leak.
  
  
  CONCLUSIONS
  After endoscopic treatment of a bile leak, the prevalence of abnormalities at follow-up ERC is significant. A repeat cholangiogram with a balloon sweep is preferred at the time of stent removal.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Coté
authors.forename: Michael
authors.initials: M
authors.lastname: Ansstas
authors.forename: Somal
authors.initials: S
authors.lastname: Shah
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.forename: Saad
authors.initials: S
authors.lastname: Alkade
authors.forename: Sreenivasa S
authors.initials: SS
authors.lastname: Jonnalagadda
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D015607:Stents