title: Biliary leakage after urgent cholecystectomy: Optimization of endoscopic treatment.
abstract: OBJECTIVE
  To investigate the results of endoscopic treatment of postoperative biliary leakage occurring after urgent cholecystectomy with a long-term follow-up.
  
  
  METHODS
  This is an observational database study conducted in a tertiary care center. All consecutive patients who underwent endoscopic retrograde cholangiography (ERC) for presumed postoperative biliary leakage after urgent cholecystectomy in the period between April 2008 and April 2013 were considered for this study. Patients with bile duct transection and biliary strictures were excluded. Biliary leakage was suspected in the case of bile appearance from either percutaneous drainage of abdominal collection or abdominal drain placed at the time of cholecystectomy. Procedural and main clinical characteristics of all consecutive patients with postoperative biliary leakage after urgent cholecystectomy, such as indication for cholecystectomy, etiology and type of leakage, ERC findings and post-ERC complications, were collected from our electronic database. All patients in whom the leakage was successfully treated endoscopically were followed-up after they were discharged from the hospital and the main clinical characteristics, laboratory data and common bile duct diameter were electronically recorded.
  
  
  RESULTS
  During a five-year period, biliary leakage was recognized in 2.2% of patients who underwent urgent cholecystectomy. The median time from cholecystectomy to ERC was 6 d (interquartile range, 4-11 d). Endoscopic interventions to manage biliary leakage included biliary stent insertion with or without biliary sphincterotomy. In 23 (77%) patients after first endoscopic treatment bile flow through existing surgical drain ceased within 11 d following biliary therapeutic endoscopy (median, 4 d; interquartile range, 2-8 d). In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven (23%) patients repeat ERC was done within one to fourth week after their first ERC, depending on the extent of the biliary leakage. In two of those patients common bile duct stone was recognized and removed. Three of those seven patients had more complicated clinical course and they were referred to surgery and were excluded from long-term follow-up. The median interval from endoscopic placement of biliary stent to demonstration of resolution of bile leakage for ERC treated patients was 32 d (interquartile range, 28-43 d). Among the patients included in the follow-up (median 30.5 mo, range 7-59 mo), four patients (14.8%) died of severe underlying comorbid illnesses.
  
  
  CONCLUSIONS
  Our results demonstrate the great efficiency of the endoscopic therapy in the treatment of the patients with biliary leakage after urgent cholecystectomy.
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Neven
authors.initials: N
authors.lastname: Ljubičić
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Alen
authors.initials: A
authors.lastname: Bišćanin
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Tajana
authors.initials: T
authors.lastname: Pavić
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Nikolić
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Budimir
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: August
authors.initials: A
authors.lastname: Mijić
authors.affiliation: Neven Ljubičić, Alen Bišćanin, Tajana Pavić, Marko Nikolić, Ivan Budimir, Ana Đuzel, Division of Gastroenterology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital, Zagreb 10000, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Đuzel
keywords: Acute cholecystitis cholecystectomy complications; Biliary leakage; Endoscopic retrograde cholangiography; Endoscopic treatment; Urgent cholecystectomy