1. Endoscopic Therapy of Biliary Injury After Cholecystectomy
- Author
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Leena Kylänpää, Arno Nordin, Mia Rainio, Outi Lindström, Marianne Udd, Carola Haapamäki, II kirurgian klinikka, University of Helsinki, HUS Abdominal Center, Clinicum, Department of Surgery, and IV kirurgian klinikka
- Subjects
Male ,Physiology ,medicine.medical_treatment ,Fistula ,Biliary stent ,Amsterdam criteria ,Gastroenterology ,Endoscopy, Gastrointestinal ,0302 clinical medicine ,Endoscopic retrograde cholangiopancreatography ,BILE-DUCT INJURIES ,LAPAROSCOPIC CHOLECYSTECTOMY ,LEAKS ,Aged, 80 and over ,COMPLICATIONS ,medicine.diagnostic_test ,Bile duct ,PANCREATITIS ,Middle Aged ,3. Good health ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Iatrogenic bile duct injury ,030211 gastroenterology & hepatology ,Female ,Adult ,medicine.medical_specialty ,CLASSIFICATION ,Biliary injury ,ERCP ,03 medical and health sciences ,Internal medicine ,MANAGEMENT ,medicine ,Humans ,Bile leak ,Cholecystectomy ,Aged ,business.industry ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Endoscopy ,SPHINCTEROTOMY ,RISK-FACTORS ,Cystic duct ,Bile Ducts ,Complication ,business - Abstract
Iatrogenic bile duct injury (BDI) is a common complication after cholecystectomy. Patients are mainly treated endoscopically, but the optimal treatment method has remained unclear. The aim was to analyze endoscopic treatment in BDI after cholecystectomy and to explore endoscopic sphincterotomy (ES), with or without stenting, as the primary treatment for an Amsterdam type A bile leak. All patients referred to Helsinki University Hospital endoscopy unit due to a suspected BDI between the years 2004 and 2014 were included in this retrospective study. To collect the data, all ERC reports were reviewed. Of the 99 BDI patients, 94 (95%) had bile leak of whom 11 had concomitant stricture. Ninety-three percent of all patients were treated endoscopically. Seventy-one patients had native papillae and a leak in the cystic duct or peripheral radicals. They were treated with ES (ES group, n = 50) or with sphincterotomy and stenting (EST group, n = 21). There was no difference between the closure time of the fistula (p = 0.179), in the time of discharge from hospital (p = 0.298), or in the primary healing rate between the ES group and the EST group (45/50 vs 19/21 patients, p = 0.951). After the right patient selection, the success rate of endoscopic treatment can approach 100% for Amsterdam type A bile leak. ES is an effective and cost-effective single procedure with success rate similar to EST. It may be considered as a first-line therapy for the management of Amsterdam type A leaks.
- Published
- 2017