7160 Usefulness of endoscopic treatment for persistent biliary leak due to hepatectomy.

Abstract

[Aim] Biliary leak is one of the major causes of morbidity after hepatectomy. To resolve this problem, we evaluated the efficacy of endoscopic treatment for biliary leak after hepatectomy using technique of endoscopic retrograde cholangiopancreatography (ERCP). [Subjects and Methods] From 1996 to 1999, eight patients (6 men and 2 women, mean age 48 years old) were diagnosed as having biliary leak after hepatectomy in Kyoto University Hospital. Original disease were hepatocellular carcinoma in 6 cases, traumatic liver injury in one case, donor for living related liver transplantation in one case. Five patients received right lobectomy, 2 left lobectomy and one segmentectomy. [Results] The biliary tract was clearly visualized on ERCP images in all patients. The leaking point was well defined with accuracy at the level of the hepatic duct in 7 patients and common bile duct in one. Seven of 8 patients had strictures of the biliary tract.We performed endoscopic treatment in all 8 patients [a combination of endoscopic sphincterotomy (EST) and placement of nasobiliary drainage (NBD) in 6 patients, and NBD placement alone in 2]. Successful drainage was achieved in all the patients without any complications. The biliary leak ceased after drainage in all the patients (mean duration of drainage, 18 days). However, one patient resulted in the recurrence of a bile leak after the removal of NBD, and subsequently received percutaneous transhepatic biliary drainage. This patient was discharged after 90 days. [Conclusion] Endoscopic management is very useful in not only accurate diagnosis but also treatment for biliary leak. Therefore, this procedure should be attempted as a first line of therapy for bile leak occurred after hepatectomy.