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Biliary Leaks: Role of ERCP in Post-operative Biliary Complications

  • Jörg G. AlbertEmail author
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Abstract

Iatrogenic bile duct injury (BDI) might be sequel of surgical interventions and requires ERCP to establish a diagnosis and—in many cases—to offer an effective treatment. Patients’ presentation in post-operative biliary complications is often non-specific and symptoms may range from pruritus, fatigue, jaundice, and abdominal pain to frank cholangitis and sepsis. The treatment plan should be based on an interdisciplinary discussion amongst interventionalists and hepato-biliary surgeons. This survey highlights several classification systems of BDI to illustrate differential indication of interventional vs. surgical repair. Thereby, a high overall success rate can be achieved by tailoring percutaneous, endoscopic, and surgical approaches to the types of lesions. Transpapillary plastic stent insertion together with sphincterotomy is usually preferred, bridging the leakage if feasible and—most important—decreasing the intraductal pressure by opening the sphincter. The role of covered metal stents is promising for sealing a leak (e.g., from the cystic stump) or to treat concurrent CBD stricture and leak, but still experimental. For plastic stents, 6–8 weeks stenting is usually sufficient. Initial percutaneous drainage can usually be removed shortly after successful ERCP. For large defects and refractory leakage, hepato-jejunal anastomosis or other reconstructive surgery might be necessary.

Keywords

Bile duct injury Biliary leak Bile leakage ERCP PTCD Percutaneous transhepatic cholangiodrainage Endoscopic retrograde cholangiopancreatography 

Abbreviations

BDI

Bile duct injury

CT

Computed tomography

CBD

common bile duct

CHD

common hepatic duct

ERC

Endoscopic-retrograde cholangiography

ERCP

Endoscopic retrograde cholangiopancreatography

EUS

Endoscopic ultrasound

HIDA

Hepatobiliary iminodiacetic acid

LHD

left hepatic duct

MRCP

Magnetic resonance cholangiopancreatography

MRI

Magnetic resonance imaging

PTCD

Percutaneous transhepatic cholangiodrainage

RHD

right hepatic duct

US

Percutaneous ultrasound

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hepatologie und EndokrinologieAbteilung für Gastroenterologie, Robert-Bosch-KrankenhausAuerbachstraßeGermany

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