CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1895-E1899
DOI: 10.1055/a-1300-1319
Original article

Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

Patrick Yachimski
Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville Tennessee, United States
,
Jordan K. Orr
Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville Tennessee, United States
,
Anthony Gamboa
Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville Tennessee, United States
› Author Affiliations

Abstract

Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy.

Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP).

Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87 % of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13 % (8/61). Leak resolution was evident at first follow-up ERCP in 96 % of subjects (26/27) who had undergone total cholecystectomy and 91 % of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96 % (23/24) of those who had undergone total cholecystectomy and 90 % (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62).

Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.



Publication History

Received: 30 June 2020

Accepted: 05 October 2020

Article published online:
27 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

© Georg Thieme Verlag KG
Stuttgart · New York

 
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