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Endoscopy III
PWE-191 The role of ERCP in the management of post cholecystectomy biliary leaks
  1. R Rameshshanker,
  2. A King,
  3. B Mcfarlane,
  4. A Leahy
  1. Department of Gastroenterology, Watford General Hospital, Watford, UK

Abstract

Introduction Bile duct injury causing a biliary leak after cholecystectomy is an important and well recognised surgical complication. It has a significant impact on the post operative recovery and is often managed endoscopically with the insertion of a biliary stent.

Objectives To assess the clinical course of patients who had a biliary stent placed for a post operative bile duct leak.

Methods All patients who underwent ERCP and biliary stent insertion for a biliary leak between 1 November 2009 and 30 November 2011 at our NHS trust were identified. Demographic data, endoscopic procedure details and outcomes were recorded.

Results 25 patients had endoscopic (Endoscopic Retrograde Cholangio Pancreatography-ERCP) management of a biliary leak by stent insertion. 72% of the cohort were females. Age range was between 19 and 80 years with a mean of 52.6 years. 16/25 (64%) of patients had two ERCPs for the insertion and subsequent removal of a plastic stent (size between 7 and 10 Fr). Nine patients (36%) had >2 ERCPs due to a persistent leak. 10/16 patients (62.5%) had the 2nd ERCP within 7 weeks and all had no persistent leak during that examination. The remaining 6 (37.5%) had the 2nd ERCP later than 7 weeks, and found to have no further biliary leak. The mean time between the two ERCPs was 9.3 weeks. Three Patients with a persistent biliary leak (33%) had an ERCP as early as 3 days. Others had between 1 and 4 weeks. None of the patients had any complications secondary to ERCP. The majority of the biliary leaks originated from the cystic duct stump (64%) or gall bladder bed (20%). Out of the total 25, four patients (16%) had retained stones within the common bile duct identified at the second ERCP and all were successfully extracted. 22 (88%) of the cohort did not have a persistent leak or stricture during their final ERCP. Three patients (12%) developed a stricture at the common bile duct or common hepatic duct.

Conclusion Within a district general hospital setting, the majority of patients with a post-cholecystectomy biliary leak can be managed effectively with the insertion of plastic biliary stents. A minority of patients will develop a subsequent biliary stricture.

Competing interests None declared.

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