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Gastrointest Endosc. 2014 Oct;80(4):626-633.e1. doi: 10.1016/j.gie.2014.02.1028. Epub 2014 May 3.

Endoscopic management is the treatment of choice for bile leaks after liver resection.

Author information

1
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
2
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany; Department of General Surgery and Transplantation, University Hospital, University Duisburg-Essen, Essen, Germany.
3
Department of General Surgery and Transplantation, University Hospital, University Duisburg-Essen, Essen, Germany.
4
Department of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, Germany.
5
Regeneration and Repair Group, The Institute of Hepatology, London, United Kingdom.
6
Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany; Department of Internal Medicine and Gastroenterology, Diakonissen-Krankenhaus Rüppurr, Karlsruhe, Germany.

Abstract

BACKGROUND:

Despite improvements in surgical techniques and postoperative patient care, bile leaks still occur postoperatively in as many as 15% of liver resections (LRs) and are associated with high mortality. There is a paucity of outcome data on endoscopic treatment of complex bile leaks.

OBJECTIVE:

The aim of this retrospective study was to evaluate the efficacy of interventional endoscopy in the treatment of bile leaks after LR.

DESIGN:

Retrospective interventional study.

SETTING, PATIENTS, AND INTERVENTIONS:

Sixty patients with bile leaks after LR were treated endoscopically with or without implantation of endoprostheses by using ERCP. The characteristics of LR, effects of surgical and other nonendoscopic treatment measures, clinical and endoscopic presentation of bile leaks, and outcomes after stent placement were recorded.

MAIN OUTCOME MEASURE:

Main outcome measure was resolution of leakage or termination of unsuccessful endoscopic leakage therapy.

RESULTS:

The median age of the observed cohort was 58 years. Sixty-five percent of patients had central and 35% peripheral bile leaks; 55% had resection of an entire hepatic lobe, and 45% underwent segmental resection. The overall success rate of endoscopic therapy was 77%. Although endoscopic therapy was performed in all patients with a mean of 2.6 interventions, 28% underwent additional percutaneous drainage. Success of endoscopic treatment was related to stent implantation. Thirteen patients with unsuccessful endoscopic treatment underwent surgical reintervention, and 1 patient died before surgical intervention.

LIMITATIONS:

No standardized protocol for stent placement due to retrospective nature of the study. Small sample number with uneven distribution of outcome.

CONCLUSIONS:

Endoscopic therapy with sphincterotomy and insertion of endoprostheses is effective, even in large postoperative bile leaks and particularly for leaks proximal to the common hepatic duct. Complete resolution of the leakage often necessitates multiple treatment sessions.

PMID:
24796959
DOI:
10.1016/j.gie.2014.02.1028
[Indexed for MEDLINE]

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