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Endoscopic treatment of post-cholecystectomy bile leaks

What is bile leak?

  • Post-cholecystectomy bile leak is relatively a well-known surgical complication.
  • Bile leaks occur due to injury to the biliary tract wall, mostly as a complication of surgical procedures, particularly cholecystectomy and liver transplantation. The introduction of laparoscopic cholecystectomy was associated with an increased incidence of biliary injuries.


Management:

Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data.

A variety of endo-therapeutic (ERCP) procedures have been used to treat bile leaks, these include:

  • biliary sphincterotomy alone, biliary stenting with or without sphincterotomy, and nasobiliary drainage with or without sphincterotomy.
  • These methods decrease the pressure gradient between the bile duct and duodenum, allowing preferential antegrade shunting of bile from the duct into the duodenum.

The reduction of ongoing bile flow through the leak site allows the biliary tree wall defect to heal.

Endoscopic management of bile leaks is regarded safe and efficacious.

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