Endoscopic Therapy of Biliary Injury After Cholecystectomy

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Rainio , M , Lindström , O , Udd , M , Haapamäki , C , Nordin , A & Kylänpää , L 2018 , ' Endoscopic Therapy of Biliary Injury After Cholecystectomy ' , Digestive Diseases and Sciences , vol. 63 , no. 2 , pp. 474-480 . https://doi.org/10.1007/s10620-017-4768-7

Title: Endoscopic Therapy of Biliary Injury After Cholecystectomy
Author: Rainio, Mia; Lindström, Outi; Udd, Marianne; Haapamäki, Carola; Nordin, Arno; Kylänpää, Leena
Contributor: University of Helsinki, II kirurgian klinikka
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, IV kirurgian klinikka
University of Helsinki, Department of Surgery
Date: 2018-02
Language: eng
Number of pages: 7
Belongs to series: Digestive Diseases and Sciences
ISSN: 0163-2116
URI: http://hdl.handle.net/10138/308084
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.
Subject: Iatrogenic bile duct injury
Endoscopic retrograde cholangiopancreatography
Bile leak
Biliary stent
Sphincterotomy
Amsterdam criteria
BILE-DUCT INJURIES
LAPAROSCOPIC CHOLECYSTECTOMY
RISK-FACTORS
SPHINCTEROTOMY
MANAGEMENT
LEAKS
CLASSIFICATION
COMPLICATIONS
PANCREATITIS
ERCP
3126 Surgery, anesthesiology, intensive care, radiology
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