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