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News

Endoscopic treatment of post-surgical bile leakage is safe

November's issue of Gut evaluates long term outcomes and predictors of success for endoscopic treatment of post-surgical bile duct injuries.

News image

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Dr Marco Bruno and colleagues from the Netherlands analyzed the short and long term outcomes of endoscopic stent treatment after bile duct injury.

The research team determined the effect of multiple stent treatment.

The team performed the study in a tertiary referral center to analyze the outcome of endoscopic stenting in 67 patients with cystic duct leakage, 26 patients with common bile duct leakage and 110 patients with a bile duct stricture.

The team assessed long term outcomes and independent predictors for successful stent treatment.

In patients with a bile duct stricture, the overall success rate was 74%
Gut

The researchers found that overall success in patients with cystic duct leakage was 97%.

The team observed that in patients with common bile duct leakage, stent related complications occurred in 4%.

The overall success rate was 89%.

The team found in patients with a bile duct stricture, stent related complications occurred in 33%, and the overall success rate was 74%.

After a mean follow up of 5 years, liver function tests did not identify ‘occult' bile duct strictures.

Independent predictors for outcome were the number of stents inserted during the first procedure.

The team found that injuries classified as Bismuth 3 and 4, and endoscopic stenting before referral was a predictor for outcomes.

Introduction of sequential insertion of multiple stents did not improve outcome.

However, the team observed that more patients reported stent related pain.

Dr Bruno's team concluded, "In patients with a postoperative bile duct leakage and/or strictures, endoscopic stent treatment should be regarded as the choice of primary treatment because of safety and favourable long term outcome."

"Apart from the early insertion of more than one stent, the benefit from sequential insertion of multiple stents did not become readily apparent from this series."

Gut 2007: 56(11): 1599-1605
25 October 2007

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