EFFICACY OF ENDOSCOPIC DIAGNOSIS AND TREATMENT FOR POSTOPERATIVE BILIARY LEAK

BACKGROUND/AIMS: The purpose of this study was to evaluate the efficac y of endoscopic approaches for the diagnosis and treatment of postoper ative biliary leak. METHODOLOGY: Endoscopic retrograde cholangiopancre atography (ERCP) was performed in eight patients with postoperative bi liary leak. Of 8 cases, 6 had biliary leak alone (4 cases with a cysti c duct leak and 2 cases with a bile duct leak) and 2 cases with a bile duct leak were associated with a bile duct stricture. Endoscopic sphi ncterotomy (ES) and endoscopic biliary stenting (EBS) were employed in 5 patients and nasobiliary tube drainage (NBD) without ES was perform ed in 3 patients. RESULTS: In all the patients, ERCP was successfully performed and could demonstrate exact nature and site of postoperative bile duct injuries. In 2 patients with a concomitant bile duct strict ure, repetive endoprosthesis placements were required. The remaining s ix patients with biliary leak alone were successfully treated by tempo rary stenting, i.e., ES and EBS (n=3), and NBD (n=3). CONCLUSIONS: The patients with postoperative biliary leaks can be successfully diagnos ed by ERCP and treated by temporary endoscopic methods. Among various endoscopic treatments, NBD alone appears to be preferable in treating patients with small bile leaks. However, cases with a concomitant bile duct stricture were intractable and required longer period of stentin g.