Subscribe to RSS
DOI: 10.1055/a-2261-3137
Evaluation of exclusive internal endoscopic drainage for complex biloma with transluminal and transpapillary stenting
Abstract
Background and study aims Biloma is treated endoscopically with endoscopic retrograde cholangiography (ERCP) or endoscopi ultrasound-guided transluminal biloma drainage (EUS-TBD). However, almost all previous studies have used both internal and external drainage. External drainage has the disadvantages of poor cosmetic appearance and self-tube removal. The aim of the present study was to evaluate the internal endoscopic drainage for complex biloma after hepatobiliary surgery with an ERCP- or EUS-guided approach, without external drainage.
Patients and methods This retrospective study included consecutive patients who had bilomas. A 7F plastic stent was deployed from the biloma to the duodenum in the ERCP group and the metal stent was deployed from the biloma to the stomach in the EUS-TBD group.
Results Forty-seven patients were enrolled. The technical success rate was similar between the groups (ERCP 94% vs EUS-TBD 100%, P=0.371); however, mean procedure time was significantly shorter in the EUS-TBD group (16.9 minutes) than in the ERCP group (26.6 minutes) (P=0.009). The clinical success rate was 87% (25 of 32 patients) in the ERCP group and 84% (11 of 13 patients) in the EUS-TBD group (P=0.482). The duration of median hospital stay was significantly shorter in the EUS-TBD group (22 days) than in the ERCP group (46 days) (P=0.038). There was no significant difference in procedure-associated adverse events between the groups.
Conclusions In conclusion, ERCP and EUS-TBD are complementary techniques, each with its own merits in specific clinical scenarios. If both techniques can be performed, EUS-TBD should be considered because of the short times for the procedure, hospital stay. and biloma resolution.
Publication History
Received: 04 December 2023
Accepted after revision: 01 February 2024
Accepted Manuscript online:
05 February 2024
Article published online:
28 February 2024
© 2024. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Gopelan A, Bahoura L, Tardy F. et al. Etiology, diagnosis, and management of bilomas: a current update. Tech Interv Radiol 2015; 18: 236-243
- 2 Zhu Y, Hickey R. The Role of the interventional radiologist in bile leak diagnosis and management. Semin Intervent Radiol 2021; 38: 309-320 DOI: 10.1055/s-0041-1731369. (PMID: 34393341)
- 3 Würstle S, Göß A, Spinner CD. et al. A retrospective clinical and microbial analysis of 32 patients with bilomas. BMC Gastroenterol 2019; 19: 50
- 4 Bjorkman DJ, Carr-Locke DL, Lichtenstein DR. et al. Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough. Am J Gastroenterol 1995; 90: 2128-2133
- 5 de Reuver PR, Rauws EA, Vermeulen M. et al. Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success. Gut 2007; 56: 1599-1605 DOI: 10.1136/gut.2007.123596. (PMID: 17595232)
- 6 Barakat M, Kothari S, Sethi S. et al. Au Naturel: Transpapillary endoscopic drainage of an infected biloma. Dig Dis Sci 2018; 63: 597-600 DOI: 10.1007/s10620-017-4723-7. (PMID: 28856471)
- 7 Dell'Anna G, Ogura T, Vanella G. et al. Endoscopic ultrasound guided biliary interventions. Best Pract Res Clin Gastroenterol 2022; 60–61: 101810
- 8 Khizar H, Yufei H, Yanhua W. et al. Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis. Ann Med 2023; 55: 578-591 DOI: 10.1080/07853890.2022.2164048. (PMID: 36779694)
- 9 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091
- 10 Baron TH. Combined endoscopic transgastric and transpapillary drainage of an infected biloma. Endoscopy 2006; 38: 436 DOI: 10.1055/s-2006-925174. (PMID: 16680658)
- 11 Ponnudurai R, George A, Sachithanandan S. et al. Endoscopic ultrasound-guided drainage of a biloma: a novel approach. Endoscopy 2006; 38: 199 DOI: 10.1055/s-2006-925143. (PMID: 16479434)
- 12 Shami VM, Talreja JP, Mahajan A. et al. EUS-guided drainage of bilomas: a new alternative?. Gastrointest Endosc 2008; 67: 136-140 DOI: 10.1016/j.gie.2007.07.040. (PMID: 18155436)
- 13 Somani SK, Somani A, Singh V. Endoscopic drainage of a post-cholecystectomy biloma with biloma-gastric stenting. Endoscopy 2013; 45: E173-E174 DOI: 10.1055/s-0032-1326498. (PMID: 23801288)
- 14 Cassis P, Shah-Khan SM, Nasr J. EUS-guided drainage of a 20-cm biloma by use of a lumen-apposing metal stent. VideoGIE 2019; 31: 20-21 DOI: 10.1016/j.vgie.2019.09.009. (PMID: 31922075)
- 15 Ulla-Rocha JL, Lopez-Piñeiro S, Dominguez-Comesaña E. EUS-Guided transgastric drainage of perihepatic biloma after laparoscopic liver metastasectomy from colon cancer. J Gastrointest Cancer 2016; 47: 468-469 DOI: 10.1007/s12029-015-9772-6. (PMID: 26500100)
- 16 Tonozuka R, Itoi T, Tsuchiya T. et al. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos). Gastrointest Endosc 2015; 81: 1463-1469
- 17 Lorenzo D, Bromberg L, Arvanitakis M. et al. Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access. Gastrointest Endosc 2022; 95: 131-139 DOI: 10.1016/j.gie.2021.07.016. (PMID: 34310921)
- 18 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454 DOI: 10.1016/j.gie.2009.10.027. (PMID: 20189503)
- 19 Boerma D, Rauws EA, Keulemans YC. et al. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 2001; 234: 750-757
- 20 Cozzi G, Severini A, Civelli E. et al. Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 2006; 29: 380-388
- 21 Mergener K, Strobel JC, Suhocki P. et al. The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy. Gastrointest Endosc 1999; 50: 527-531 DOI: 10.1016/s0016-5107(99)70077-5. (PMID: 10502175)
- 22 Agarwal N, Sharma BC, Garg S. et al. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int 2006; 5: 273-277 (PMID: 16698590)
- 23 Chang JM, Lee JM, Suh KS. et al. Biliary complications in living donor liver transplantation: imaging findings and the roles of interventional procedures. Cardiovasc Intervent Radiol 2005; 28: 756-767 DOI: 10.1007/s00270-004-0262-7. (PMID: 16160754)