Endoscopy 2019; 51(04): S122
DOI: 10.1055/s-0039-1681529
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 14:30 – 16:00: ERCP cannulation 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

PREDICTIVE FACTORS OF LACK OF RESPONSE TO ENDOSCOPIC TREATMENT FOR POST-OPERATIVE BILIARY LEAKS: A PROSPECTIVE STUDY

R Ballester-Clau
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
M Albuquerque Miranda
2   Clinica Girona, Girona, Spain
3   Hospital de Palamós, Palamós, Spain
,
G Torres Vicente
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
A Luz Vargas
2   Clinica Girona, Girona, Spain
3   Hospital de Palamós, Palamós, Spain
,
I Miguel Salas
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
N Zaragoza Velasco
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
M Figa Francesch
4   Hospital Dr. Josep Trueta, Girona, Spain
,
JM Miñana Calafat
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
JM Reñé Espinet
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
,
F Gonzalez-Huix Lladó
1   Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
2   Clinica Girona, Girona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    To determine the predictive factors of lack of resolution of post-operative biliary leaks after endoscopic treatment.

    Methods:

    Consecutive patients with post-operative biliary leaks (POL) were prospectively enrolled at two centers. All of them underwent ERCP and sphincterotomy with or without plastic stent placement. Variables: Demographic, clinical and endoscopic data, type of surgery, leak location and output, related to POL complications, endoscopic treatment, leak resolution and resolution time (days).

    Results:

    113 patients (women 36.3%; age X = 63.2 ± 16.1y). 89 (78.8%) with post-cholecystectomy leak and 24 (21.2%) with post-hepatic surgery (PHL). The majority of them were extrahepatic (66.4%) and originated in cystic stump (41.6%) or in the common bile or hepatic duct (24.8%). We performed only sphincterotomy in 14 cases (12.4%) and sphincterotomy + stent insertion in 96 (85%). Biliary stricture was detected in 28 cases (24.8%), biloma in 36 (31.9%) and residual biliary stones in 38 (33.6%). In 76.1% the leak was solved and the resolution time was 5.7 ± 6.4 days. The leaks after hepatic resection surgery (62% vs. 13.5%; p = 0.000), located in intra-hepatic ducts (40% vs. 13.3%; p = 0.003), associated with stricture (39.3% vs. 1.9%; p = 0.016) and biloma (47.2% vs. 9.5%, p = 0.000) were most often not resolved. The predictors of lack of POL resolution in the multivariate analysis were PHL (OR = 6.9; 95% CI 2.1 – 22.6), presence of biloma (OR = 4.2, 95% CI 1.3 – 13.3) and to perform only sphincterotomy without stent placement (OR = 4.1, 95% IC 1.0 – 17.3).

    Conclusions:

    Post hepatic resection biliary leaks have a resolution rate significantly lower than the post-cholecystectomy ones, especially when they are associated to biloma and it is not possible the biliary stenting.


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