title: Safety and efficacy of therapeutic endoscopic interventions in the management of biliary leak.
abstract: Endoscopic procedures which reduce the trans-papillary pressure gradient are the treatment of choice for management of biliary leaks. We analyzed the data of 102 patients with biliary leak managed by various endoscopic procedures like endoscopic sphincterotomy (ES), ES with stenting, stenting alone or nasobiliary drainage (NBD) alone; 90 of these patients had developed a leak after cholecystectomy. In the post-cholecystectomy group, cannulation was successful in 79 patients; therapeutic intervention was not possible in 14 of them due to complete transection of common bile duct in 6, and leak proximal to ligature in 8. In the remaining 65 patients, ES with stenting was done in 52, stent alone in 6, ES alone in 5 and NBD alone in 2. All 12 patients in other etiology group were treated with ES plus stenting. The leak closed in a mean of 3 (1-10) days in all patients. Stents were removed after 6-8 weeks. Endoscopic procedures are effective in managing biliary leaks.
authors.affiliation: Department of General Medicine, Government Medical College, Sector 32 A, Chandigarh, 160 030, India. atulsachedev@hotmail.com
authors.forename: Atul
authors.initials: A
authors.lastname: Sachdev
authors.forename: Jeet Ram
authors.initials: JR
authors.lastname: Kashyap
authors.forename: Sanjay
authors.initials: S
authors.lastname: D'Cruz
authors.forename: Divyanshoo R
authors.initials: DR
authors.lastname: Kohli
authors.forename: Ram
authors.initials: R
authors.lastname: Singh
authors.forename: Kamal
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome