Role of symptoms, trend of liver tests, and endotherapy in management of post-cholecystectomy biliary leak

P. Cantù, A. Tenca, C. Caparello, A. Grigolon, L. Piodi, I. Bravi, E. Contessini Avesani, D. Conte, R. Penagini

Research output: Contribution to journalArticle

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Abstract

Aim: Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak. Materials and Methods: Twenty-one patients (8 M, 26-77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients. Results: Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n = 10), accessory duct (n = 4), or cystic duct stump (n = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n = 8), stone (n = 2), or cholangiocarcinoma (n = 1) and underwent stenting (n = 4), naso-biliary drainage, NBD (n = 3), or surgery (n = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic. Conclusions: Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.

Original languageEnglish
Pages (from-to)1565-1571
Number of pages7
JournalDigestive Diseases and Sciences
Volume56
Issue number5
DOIs
Publication statusPublished - May 2011

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Cholecystectomy
Liver
Endoscopic Retrograde Cholangiopancreatography
Cholangiocarcinoma
Cystic Duct
Intraoperative Complications
Endoscopy
Drainage
Wounds and Injuries

Keywords

  • Biliary leak
  • ERCP
  • Naso-biliary drainage
  • Stenting

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Role of symptoms, trend of liver tests, and endotherapy in management of post-cholecystectomy biliary leak. / Cantù, P.; Tenca, A.; Caparello, C.; Grigolon, A.; Piodi, L.; Bravi, I.; Avesani, E. Contessini; Conte, D.; Penagini, R.

In: Digestive Diseases and Sciences, Vol. 56, No. 5, 05.2011, p. 1565-1571.

Research output: Contribution to journalArticle

Cantù, P. ; Tenca, A. ; Caparello, C. ; Grigolon, A. ; Piodi, L. ; Bravi, I. ; Avesani, E. Contessini ; Conte, D. ; Penagini, R. / Role of symptoms, trend of liver tests, and endotherapy in management of post-cholecystectomy biliary leak. In: Digestive Diseases and Sciences. 2011 ; Vol. 56, No. 5. pp. 1565-1571.
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AU - Cantù, P.

AU - Tenca, A.

AU - Caparello, C.

AU - Grigolon, A.

AU - Piodi, L.

AU - Bravi, I.

AU - Avesani, E. Contessini

AU - Conte, D.

AU - Penagini, R.

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N2 - Aim: Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak. Materials and Methods: Twenty-one patients (8 M, 26-77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients. Results: Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n = 10), accessory duct (n = 4), or cystic duct stump (n = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n = 8), stone (n = 2), or cholangiocarcinoma (n = 1) and underwent stenting (n = 4), naso-biliary drainage, NBD (n = 3), or surgery (n = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic. Conclusions: Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.

AB - Aim: Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak. Materials and Methods: Twenty-one patients (8 M, 26-77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients. Results: Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n = 10), accessory duct (n = 4), or cystic duct stump (n = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n = 8), stone (n = 2), or cholangiocarcinoma (n = 1) and underwent stenting (n = 4), naso-biliary drainage, NBD (n = 3), or surgery (n = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic. Conclusions: Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.

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KW - ERCP

KW - Naso-biliary drainage

KW - Stenting

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