Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) can safely and effectively
manage postsurgical or traumatic bile duct leaks (BDLs). Standardized guidelines are
lacking regarding effective management of BDLs. Our aim was to evaluate the efficacy,
clinical outcomes, and complications of different ERCP techniques and intervention
timing using a nationwide database.
Patients and methods We performed a retrospective analysis of the IBM Explorys database (1999–2019), a
pooled, national, de-identified clinical database of over 64 million unique patients
across the United States. ERCP timing after BDL was classified as emergent (< 1 day),
urgent (1–3 days) or expectant (> 3 days). ERCP technique was classified into sphincterotomy,
stent or combination therapy. ERCP complications were defined as pancreatitis, duodenal
perforation, duodenal hemorrhage, and ascending cholangitis within 7 days of the procedure.
Results Expectant ERCP had a decreased risk of adverse events (AEs) compared to emergent
and urgent ERCP (P = 0.004). Rehospitalization rates also were lower in expectant ERCP (P < 0.001). Patients with COPD were more likely to have an AE if the ERCP was performed
emergently compared to expectantly (P = 0.002). Combination therapy had a lower rate of ERCP failure compared to placement
of a biliary stent (P = 0.02). There was no statistically significant difference in rates of ERCP failure
between biliary stent and sphincterotomy (P = 0.06) or sphincterotomy and combination therapy (P = 0.74).
Conclusion Our study suggests that ERCP does not need to be performed emergently or urgently
for management of BDLs. Combination therapy is superior to stenting but not sphincterotomy;
however, future prospective studies are needed to validate these findings.
