Biliary leakage after urgent cholecystectomy： Optimizationof endoscopic treatment

• 作者: Alen Bi??anin Ana ?uzel. August Miji? Ivan Budimir Marko Nikoli? Neven Ljubi?i? Tajana Pavi?
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: URGENT CHOLECYSTECTOMY Acute cholecystitischolecystectomy complications BILIARY LEAKAGE Endoscopic RETROGRADE CHOLANGIOGRAPHY Endoscopictreatment
• 年，卷（期）: 2015,（5）
• 页码范围: 547-554
• 页数: 8页
• 分类号: R

摘要

AIM To investigate the results of endoscopic treatmentof postoperative biliary leakage occurring after urgentcholecystectomy with a long-term follow-up.METHODS： This is an observational database studyconducted in a tertiary care center. All consecutivepatientswho underwent endoscopic retrograde cholangiography（ERC） for presumed postoperative biliaryleakage after urgent cholecystectomy in the periodbetween April 2008 and April 2013 were consideredfor this study. Patients with bile duct transection andbiliary strictures were excluded. Biliary leakage wassuspected in the case of bile appearance from eitherpercutaneous drainage of abdominal collection orabdominal drain placed at the time of cholecystectomy.Procedural and main clinical characteristics of allconsecutive patients with postoperative biliary leakageafter urgent cholecystectomy, such as indication forcholecystectomy, etiology and type of leakage, ERCfindings and post-ERC complications, were collectedfrom our electronic database. All patients in whomthe leakage was successfully treated endoscopicallywere followed-up after they were discharged from thehospital and the main clinical characteristics, laboratorydata and common bile duct diameter were electronicallyrecorded.RESULTS： During a five-year period, biliary leakagewas recognized in 2.2% of patients who underwenturgent cholecystectomy. The median time fromcholecystectomy to ERC was 6 d （interquartile range,4-11 d）. Endoscopic interventions to manage biliaryleakage included biliary stent insertion with or withoutbiliary sphincterotomy. In 23 （77%） patients after firstendoscopic treatment bile flow through existing surgicaldrain ceased within 11 d following biliary therapeuticendoscopy （median, 4 d; interquartile range, 2-8 d）.In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven（23%） patients repeat ERC was done within one tofourth week after their first ERC, depending on theextent of the biliary leakage. In two of those patients