Purpose Biliary leak occurs most commonly as a complication of hepatobiliary surgery; another possible etiology for biliary and pancreatic duct leak is trauma. ERCP with cholangiogram allows not only diagnosis but also treatment in most cases. There is no consensus regarding the need for sphincterotomy during ERCP and stent placement. We are reporting our experience with different endoscopic techniques for the treatment of biliary and pancreatic duct leak.
Methods We retrospectively studied all ERCPs performed at the University of Tennesse-Bowld and MED hospitals between June 2002 and February 2004. We reviewed the Clinical Outcomes Research Initiative (CORI) database and identified ERCPs performed for treatment of biliary or pancreatic duct leak. We compiled demographic and procedural data and etiology of leak and treatment outcome from this database.
Results 20 ERCPs in 9 patients with bile leak and one with pancreatic duct leak out of a total of 170 ERCPs performed during this period were identified. Seven patients were s/p laparoscopic cholecystectomy, two patients with trauma-related leak (one biliary, one pancreatic), and one patient with biliary leak s/p Orthotopic liver transplantation (OLT) received ERCP as their initial treatment. Patients' ages ranged from 19 to 60 and 7/10 were female. 4/9 biliary leaks were treated with sphincterotomy and stent placement. 5/9 biliary leaks were treated with stent placement alone. There was no statistically significant difference in outcome. The sole pancreatic duct leak resolved with pancreatic stent placement alone. There were no procedure-related complications. All patients underwent another ERCP at the time of stent removal documenting resolution of leak. 2/10 patients, in addition to a leak, had retained stones in the common bile duct or cystic duct remnant.
Conclusions ERCP with stent placement is an effective treatment for biliary or pancreatic duct leak. Sphincterotomy does not appear to be necessary.
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