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Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success.
  1. Philip de Reuver (p.r.dereuver{at}amc.uva.nl)
  1. Amsterdam Medical Centre, Netherlands
    1. Erik Rauws (e.a.rauws{at}amc.uva.nl)
    1. Amsterdam Medical Centre, Netherlands
      1. Mattijs Vermeulen (mattijs{at}hotmail.com)
      1. Amsterdam Medical Centre, Netherlands
        1. Marcel Dijkgraaf (m.g.dijkgraaf{at}amc.uva.nl)
        1. Amsterdam Medical Centre, Netherlands
          1. Dirk Gouma (d.j.gouma{at}amc.uva.nl)
          1. Amsterdam Medical Centre, Netherlands
            1. Marco Bruno (m.j.bruno{at}amc.uva.nl)
            1. Amsterdam Medical Centre, Netherlands

              Abstract

              Objective: To analyze the short and long term outcome of endoscopic stent therapy after bile duct injury (BDI), and to determine the effect of multiple stent therapy.

              Design, setting and patients: A retrospective cohort study was performed in a tertiary referral centre to analyse 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.

              Main outcome measures: Long term outcome and independent predictors for successful stent therapy

              Results: Overall success in patients with cystic duct leakage was 97%. In patients with common bile duct leakage, stent related complications occurred in 3.8% (n=1). The overall success rate was 89% (n=23). In patients with a bile duct stricture, stent related complications occurred in 33% (n=36) and the overall success rate was 74% (n=81). After a mean follow-up of 4.5 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 (Odds ratio [OR]=3.2 per stent, 95% confidence interval [CI] =1.3-8.4), injuries classified as Bismuth III (OR=0.12, CI=0.02-0.91) and IV (OR=0.04 CI=0.003-0.52), and endoscopic stenting before referral (OR=0.24, CI=0.06-0.88). Introduction of sequential insertion of multiple stents did not improve outcome (before 77% vs. after 66%, p=0.25), but more patients reported stent related pain (before 11% vs. after 28%, p=0.02).

              Conclusions: In patients with a postoperative bile duct leakage and/or strictures endoscopic stent therapy 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 of sequential insertion of multiple stents did not become readily apparent from this series.

              • bile duct injury
              • endoscopic therapy
              • laparoscopic cholecystectomy
              • multiple stents

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