Eleven-year experience on the endoscopic treatment of post-cholecystectomy bile leaks.
BACKGROUND
Bile leak is a common and serious complication of cholecystectomy with endotherapy being an established method of treatment. This retrospective study presents the 11-year experience of a referral center in endoscopic management of post-cholecystectomy bile leaks.


METHODS
During the period between January 2000 and December 2010, records of patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for suspected post-cholecystectomy bile leaks were reviewed for evidence of clinical presentation of bile leaks, cholangiographic findings, type of endoscopic intervention, procedural complications and post-procedure follow-up.


RESULTS
Seventy-one patients with suspected post-cholecystectomy bile leak were referred for ERCP. Common bile duct (CBD) cannulation was successful in 70 patients (98.59%). Complete transection of CBD was diagnosed in 4 patients; they were treated with surgery. A leak from the cystic duct stump was demonstrated in 49 patients (74.24%), from the ducts of Luschka in 4 (6.06%), from the gallbladder bed in 2 (3.03%), from the CBD in 7 (10.61%) and from the common hepatic duct (CHD) in 4 patients (6.06%). Endoscopic sphincterotomy (ES) plus endoprosthesis was performed in 64 patients (96.97%). A 12-year-old girl with a leak from cystic duct stump was successfully treated with stenting without ES and one patient with leak from gallbladder bed underwent only ES. Endoscopic intervention failed to treat a leak from CHD in one patient. During the follow-up, three patients developed bile duct stricture. Two were treated endoscopically and one with hepaticojejunostomy.


CONCLUSIONS
ES plus large-bore straight plastic biliary stent placement is a safe and effective intervention in post-cholecystectomy bile leaks.
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Kostas
K
Fasoulas
Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece (Christos Zavos, Jannis Kountouras).
Christos
C
Zavos
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Grigoris
G
Chatzimavroudis
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Christina
C
Trakateli
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Themistoklis
T
Vasiliadis
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Aristidis
A
Ioannidis
Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece (Christos Zavos, Jannis Kountouras).
Jannis
J
Kountouras
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos).
Panagiotis
P
Katsinelos
ERCP; bile leak; cholecystectomy; complications; endoscopic sphincterotomy; endoscopic stenting