title: A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage.
abstract: OBJECTIVE
  Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage.
  
  
  METHODS
  Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed.
  
  
  RESULTS
  Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases.
  
  
  CONCLUSIONS
  ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula.
authors.affiliation: Department of Gastroenterology, Umraniye Trianing and Research Hospital, Istanbul, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Sayar
authors.affiliation: Department of Gastroenterology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Sehmus
authors.initials: S
authors.lastname: Olmez
authors.affiliation: Department of Gastroenterology, Koru Hospital, Ankara, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Avcioglu
authors.affiliation: Department of Gastroenterology, Turkish Advanced Specialty Training and Research Hospital, Ankara, Turkey.
authors.forename: Ilyas
authors.initials: I
authors.lastname: Tenlik
authors.affiliation: Department of Gastroenterology, Medicalpark Hospital, Elazig, Turkey.
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Saritas
authors.affiliation: Department of Gastroenterology, Umraniye Trianing and Research Hospital, Istanbul, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Ozdil
authors.affiliation: Department of Gastroenterology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Altiparmak
authors.affiliation: Department of Gastroenterology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Ersan
authors.initials: E
authors.lastname: Ozaslan
keywords: Biliary fistula; ERCP; postoperative bile leakage