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Endoscopy 2019; 51(11): 1074-1081
DOI: 10.1055/a-0835-5940
Review
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic management of biliary leaks: a systematic review with meta-analysis

Kenny Vlaemynck
1   Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
,
Lies Lahousse
2   Department of Bioanalysis, Ghent University, Ghent, Belgium
,
Aude Vanlander
3   Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
,
Hubert Piessevaux
4   Department of Gastroenterology, University Hospital Saint-Luc, Brussels, Belgium
,
Pieter Hindryckx
1   Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
› Author Affiliations
Further Information

Publication History

submitted 26 August 2018

accepted after revision 22 December 2018

Publication Date:
13 February 2019 (online)

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See also:

Reply to Chandra et al.Endoscopy 2019; 51(12): 1188-1188
DOI: 10.1055/a-1008-9325

See also:

Sphincterotomy alone appears sufficient for the treatment of bile leaksEndoscopy 2019; 51(12): 1187-1187
DOI: 10.1055/a-1008-9257

Abstract

Background The first-line approach to the treatment of biliary leaks is endoscopic retrograde cholangiopancreatography. A variety of techniques can be used, including sphincterotomy, stenting, a combination of both techniques, or nasobiliary drainage. We performed a systematic review with meta-analysis to define the optimal strategy.

Methods We searched MEDLINE/PubMed, EMBASE, CENTRAL, Scopus, Google Scholar, and Web of Science until January 2018 for randomized clinical trials, case-control studies, and prospective cohort studies. Data on procedure, success, and complication rate were extracted. Risk of bias was assessed. A network meta-analysis was performed to compare sphincterotomy alone vs. stenting alone vs. combination treatment. Stenting was further stratified into leak-bridging and short stenting.

Results 11 studies out of 5085 references were included. Compared with sphincterotomy alone, the combination of sphincterotomy with leak-bridging stenting had the highest success rate (risk ratio [RR] 1.15, 95 % confidence interval [CI] 0.97 – 1.50), followed by leak-bridging stenting alone (RR 1.10, 95 %CI 0.84 – 1.44). For nonbridgeable leaks, stenting alone had a higher success rate than sphincterotomy alone (RR 1.07, 95 %CI 0.72 – 1.40). The combination of short stents with sphincterotomy had no added benefit (RR 0.94, 95 %CI 0.49 – 1.29). Overall quality of the included studies was considered to be moderate.

Conclusions We recommend sphincterotomy with stenting if the biliary leak can be bridged. If not, stenting alone with a short stent may be preferred in order to avoid sphincterotomy-related complications. More and larger studies are needed to confirm these findings.

Appendix 1s – 3s, Table 1s – 3s

Refers to:

Video Comment on Kenny Vlaemynck et al.Endoscopy 2019; 51(11): v31-v31
DOI: 10.1055/a-0872-7600

 

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