title: Endoscopic management of liver abscess with biliary communication.
abstract: OBJECTIVE
  The formation of a communication between liver abscesses and intrahepatic bile ducts is an uncommon cause of bile leak. The surgical management of biliary fistulas is associated with high morbidity and mortality. We performed a prospective study of the endoscopic management of liver abscess communicating with bile ducts.
  
  
  METHODS
  We studied 38 patients with liver abscesses that had ruptured into the intrahepatic bile ducts. The presence of a biliary fistula was suspected by jaundice and/or by the appearance of bile in percutaneous drainage effluent from a liver abscess and was confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Subsequently, patients underwent treatment by endoscopic sphincterotomy and either biliary stenting or nasobiliary drainage. Nasobiliary drains or biliary stents (both 7-Fr) were placed according to standard techniques. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after an interval of 4-6 weeks.
  
  
  RESULTS
  Of the total of 586 patients with liver abscesses, seen over a 10-year period, there were 38 (30 amebic, 8 pyogenic) patients who developed a biliary fistula between the liver abscess cavity and the intrahepatic bile ducts (right intrahepatic bile ducts in 30 patients, left intrahepatic bile ducts in 8 patients). We performed either endoscopic sphincterotomy with insertion of a nasobiliary drain (n = 18) or endoscopic sphincterotomy with biliary stenting (n = 20). The fistulas healed in all patients after a median time of 6 days (range 4-40 days) after endoscopic treatment. The nasobiliary drainage catheters and stents were removed after 8-40 days of their placement.
  
  
  CONCLUSIONS
  Endoscopic therapy is an effective mode of treatment for biliary fistulas complicating liver abscesses.
authors: Department of Gastroenterology, G B Pant Hospital, New Delhi, 110002, India. drbcsharma@hotmail.com
authors: Barjesh Chander
authors: BC
authors: Sharma
authors: Vishal
authors: V
authors: Garg
authors: Ravisankar
authors: R
authors: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D001653:Bile Ducts, Intrahepatic; D001658:Biliary Fistula / Q000150:complications* / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic; D055815:Young Adult