Endoscopic retrograde cholangiopancreatography in managements of postoperative biliary leakage

Abstract

Objective To evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography （ERCP） for postoperative biliary leakage. Methods Data of 120 patients who developed biliary leakage after hepatobiliary operations and underwent ERCP from January 2003 to December 2008 were retrospectively reviewed. Results There were 71 cases of extra-hepatic biliary leakage （type Ⅰ ）, 39 intra-hepatic biliary leakage （ type Ⅱ） and 10 cystic duct leakage （ type Ⅲ ）, among which endoscopic nasobiliary drainage （ENBD） was performed in 76 cases, endoscopic retrograde biliary stent drainage （ERBD） in 35, ERBD plus ENBD in 3, endoscopic sphincterotomy （EST） in 2, endoscopic metal biliary endoprothesis （EMBE） in 1 and ERCP/elated procedures failed in 3 patients. A total of 98 （81.7%） patients were successfully followed up. Bile leakage was completely controlled in 85 patients （ 86. 7% ） at a mean time of 18.2 ±7.0 d. Leakage of type Ⅲhad the highest cure rate of 100% and the shortest cure time of 8.2 ±3.5 d. For leakage of type Ⅰ and Ⅱ developed after non-liver transplantation operations, the success rate and cure time were significantly better than those after liver transplantation （ P 〈 0.01 ）. Conclusion ERCP is safe and effective for the diagnosis and treatment of biliary leakage after hepatobiliary operations, and can be the first choice of managements, especially in biliary leakage of type Ⅲ. Key words: Cholangiopancreatography, endoscopic retrograde; Postoperative complications ; Biliary leakage