Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury

Background: Surgical treatment for persistent biliary fistula after blunt h epatic injury is often technically difficult. Endoscopic treatment for such fistulas has been described only infrequently. Methods: We reviewed 6 patients who underwent endoscopic biliary stent plac ement with (n = 1) or without (n = 5) sphincterotomy for persistent (12 to 138 days; mean 48 days) biliary fistula after blunt hepatic injury. Results: ERCP showed bite leakage from a second-order or more peripheral br anch of the intrahepatic bite ducts in 5 patients but fatted to reveal the fistula in 1. Stent placement was successful without complications in all p atients. Bile leakage resolved within 1 to 3 days in 5 patients. After 36 t o 86 days, the stent was removed and ERCP confirmed disappearance of the fi stula. These patients have remained asymptomatic for a mean of 2.6 years si nce stent removal. In the patient in whom ERCP had not shown a fistula, bil e leakage continued despite successful stent placement. Conclusions: Endoscopic biliary stent placement is a rapid, safe and effect ive treatment for persistent post-traumatic biliary fistula demonstrated by ERCP.