Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2014; 05(01): 002-012
DOI: 10.4103/0976-5042.141926
Review Article
Society of Gastrointestinal Endoscopy of India

Endoscopic treatment for complex biliary and pancreatic duct injuries

Simon Bouchard
Department of Gastroenterology, Hepato-pancreatology and Digestive Oncology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
,
Jacques Devière
Department of Gastroenterology, Hepato-pancreatology and Digestive Oncology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

Also available at
  PDF Download Permissions and Reprints

Abstract

Severe injuries of biliary or pancreatic ducts are associated with significant morbidity and mortality. Severe bile duct injuries such as major biliary leaks, complete transection, or complete occlusion of bile ducts can be grouped under the term complex bile duct injuries (CBDI). In the spectrum of pancreatic duct injuries, disconnected pancreatic duct syndrome (DPDS) represents the most severe form and most often occurs after a severe episode of acute pancreatitis. Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. However, in the past few years, some studies have reported the successful management of CBDI or DPDS using endoscopic procedures alone or in combination with a percutaneous approach. In this review, we detail the endoscopic or combined endoscopic/percutaneous treatment possibilities for CBDI and DPDS.

Key words

Bile duct injuries - disconnected pancreatic duct syndrome - pancreatic duct rupture
 

  • References

  • 1 Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290:2168-73.
  • 2 Weber A, Feussner H, Winkelmann F, Siewert JR, Schmid RM, Prinz C. Long-term outcome of endoscopic therapy in patients with bile duct injury aft er cholecystectomy. J Gastroenterol Hepatol 2009;24:762-9.
  • 3 Donatelli G, Vergeau BM, Derhy S, Dumont JL, Tuszynski T, Dhumane P, et al. Combined endoscopic and radiologic approach for complex bile duct injuries (with video). Gastrointest Endosc 2014;79:855-64.
  • 4 Fiocca F, Salvatori FM, Fanelli F, Bruni A, Ceci V, Corona M, et al. Complete transection of the main bile duct: Minimally invasive treatment with an endoscopic-radiologic rendezvous. Gastrointest Endosc 2011;74:1393-8.
  • 5 Miller T, Singhal S, Neese P, Duddempudi S. Non-operative repair of a transected bile duct using an endoscopic-radiological rendezvous procedure. J Dig Dis 2013;14:509-11.
  • 6 Aytekin C, Boyvat F, Yimaz U, Harman A, Haberal M. Use of the rendezvous technique in the treatment of biliary anastomotic disruption in a liver transplant recipient. Liver Transpl 2006;12:1423-6.
  • 7 Nasr JY, Hashash JG, Orons P, Marsh W, Slivka A. Rendezvous procedure for the treatment of bile leaks and injury following segmental hepatectomy. Dig Liver Dis 2013;45:433-6.
  • 8 Dumonceau JM, Baize M, Devière J. Endoscopic transhepatic repair of the common hepatic duct aft er excision during cholecystectomy. Gastrointest Endosc 2000;52:540-3.
  • 9 Kozarek RA. Endoscopic therapy of complete and partial pancreatic duct disruptions. Gastrointest Endosc Clin N Am 1998;8:39-53.
  • 10 Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW. Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 1991;100:1362-70.
  • 11 Pelaez-Luna M, Vege SS, Petersen BT, Chari ST, Clain JE, Levy MJ, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: Clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc 2008;68:91-7.
  • 12 Devière J, Antaki F. Disconnected pancreatic tail syndrome: A plea for multidisciplinarity. Gastrointest Endosc 2008;67:680-2.
  • 13 Devière J, Bueso H, Baize M, Azar C, Love J, Moreno E, et al. Complete disruption of the main pancreatic duct: Endoscopic management. Gastrointest Endosc 1995;42:445-51.
  • 14 Varadarajulu S, Wilcox CM. Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: Does benefit outweigh the risks? Gastrointest Endosc 2011;74:1408-12.
  • 15 Lawrence C, Howell DA, Stefan AM, Conklin DE, Lukens FJ, Martin RF, et al. Disconnected pancreatic tail syndrome: Potential for endoscopic therapy and results of long-term follow-up. Gastrointest Endosc 2008;67:673-9.
  • 16 Shrode CW, Macdonough P, Gaidhane M, Northup PG, Sauer B, Ku J, et al. Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: How efficacious is it? Dig Liver Dis 2013;45:129-33.
  • 17 Varadarajulu S, Rana SS, Bhasin DK. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am 2013;23:863-92.
  • 18 Waage A, Nilsson M. Iatrogenic bile duct injury: A population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 2006;141:1207-13.
  • 19 Gentileschi P, Di Paola M, Catarci M, Santoro E, Montemurro L, Carlini M, et al. Bile duct injuries during laparoscopic cholecystectomy: A 1994-2001 audit on 13,718 operations in the area of Rome. Surg Endosc 2004;18:232-6.
  • 20 Lau WY, Lai EC, Lau SH. Management of bile duct injury after laparoscopic cholecystectomy: A review. ANZ J Surg 2010;80:75-81.
  • 21 Bismuth H. Postoperative strictures of the bile ducts. In: Blumgart LH, editor. The Biliary Tract V. New York, NY: Churchill-Livingstone; 1982. p. 209-18.
  • 22 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101-25.
  • 23 Bergman JJ, van den Brink GR, Rauws EA, de Wit L, Obertop H, Huibregtse K, et al. Treatment of bile duct lesions aft er laparoscopic cholecystectomy. Gut 1996;38:141-7.
  • 24 Neuhaus P, Schmidt SC, Hintze RE, Adler A, Veltzke W, Raakow R, et al. Classification and treatment of bile duct injuries aft er laparoscopic cholecystectomy. Chirurg 2000;71:166-73.
  • 25 Tann M, Maglinte D, Howard TJ, Sherman S, Fogel E, Madura JA, et al. Disconnected pancreatic duct syndrome: Imaging findings and therapeutic implications in 26 surgically corrected patients. J Comput Assist Tomogr 2003;27:577-82.
  • 26 Lau WY, Lai EC. Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 2007;6:459-63.
  • 27 Truant S, Boleslawski E, Lebuffe G, Sergent G, Pruvot FR. Hepatic resection for post-cholecystectomy bile duct injuries: A literature review. HPB (Oxford) 2010;12:334-41.
  • 28 Nordin A, Halme L, Mäkisalo H, Isoniemi H, Höckerstedt K. Management and outcome of major bile duct injuries aft er laparoscopic cholecystectomy: From therapeutic endoscopy to liver transplantation. Liver Transpl 2002;8:1036-43.
  • 29 Vitale GC, Tran TC, Davis BR, Vitale M, Vitale D, Larson G. Endoscopic management of postcholecystectomy bile duct strictures. J Am Coll Surg 2008;206:918-23.
  • 30 Misra S, Melton GB, Geschwind JF, Venbrux AC, Cameron JL, Lillemoe KD. Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: A decade of experience. J Am Coll Surg 2004;198:218-26.
  • 31 Itoi T, Yamao K, EUS 2008 Working Group. EUS 2008 Working Group document: Evaluation of EUS-guided choledochoduodenostomy (with video). Gastrointest Endosc 2009;69:S8-12.
  • 32 Savides TJ, Varadarajulu S, Palazzo L, EUS 2008 Working Group. EUS 2008 Working Group document: Evaluation of EUS-guided hepaticogastrostomy. Gastrointest Endosc 2009;69:S3-7.
  • 33 Park SJ, Choi JH, Park do H, Choi JH, Lee SS, Seo DW, et al. Expanding indication: EUS-guided hepaticoduodenostomy for isolated right intrahepatic duct obstruction (with video). Gastrointest Endosc 2013;78:374-80.
  • 34 Shami VM, Talreja JP, Mahajan A, Phillips MS, Yeaton P, Kahaleh M. EUS-guided drainage of bilomas: A new alternative? Gastrointest Endosc 2008;67:136-40.
  • 35 Perez-Miranda M, Aleman N, de la Serna Higuera C, Gil-Simon P, Perez-Saborido B, Sanchez-Antolin G. Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation. Gastrointest Endosc 2014;80:520-1.
  • 36 Uomo G, Molino D, Visconti M, Ragozzino A, Manes G, Rabitti PG. The incidence of main pancreatic duct disruption in severe biliary pancreatitis. Am J Surg 1998;176:49-52.
  • 37 Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg 1993;80:94-9.
  • 38 Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174:331-6.
  • 39 Matos C, Cappeliez O, Winant C, Coppens E, Devière J, Metens T. MR imaging of the pancreas: A pictorial tour. Radiographics 2002;22:e2.
  • 40 Gillams AR, Kurzawinski T, Lees WR. Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol 2006;186:499-506.
  • 41 Drake LM, Anis M, Lawrence C. Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 2012;46:696-9.
  • 42 Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, et al. Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 2004;126:715-23.
  • 43 Pearson EG, Scaife CL, Mulvihill SJ, Glasgow RE. Roux-en-Y drainage of a pancreatic fistula for disconnected pancreatic duct syndrome aft er acute necrotizing pancreatitis. HPB (Oxford) 2012;14:26-31.
  • 44 Howard TJ, Stonerock CE, Sarkar J, Lehman GA, Sherman S, Wiebke EA, et al. Contemporary treatment strategies for external pancreatic fistulas. Surgery 1998;124:627-32.
  • 45 Szentes MJ, Traverso LW, Kozarek RA, Freeny PC. Invasive treatment of pancreatic fluid collections with surgical and nonsurgical methods. Am J Surg 1991;161:600-5.
  • 46 Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: A comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 2006;63:635-43.
  • 47 Zhong N, Topazian M, Petersen BT, Baron TH, Chari ST, Gleeson FC, et al. Endoscopic drainage of pancreatic fluid collections into fourth portion of duodenum: A new approach to disconnected pancreatic duct syndrome. Endoscopy 2011;43 Suppl 2 UCTN: E45-6.
  • 48 Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: Long-term follow-up aft er 7 years of experience. Gastrointest Endosc 1989;35:1-9.
  • 49 Rana SS, Bhasin DK, Rao C, Sharma R, Gupta R. Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis and disconnected pancreatic duct syndrome. Pancreatology 2013;13:486-90.
  • 50 Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: Long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 2005;37:977-83.
  • 51 Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, et al. Pancreatic-fluid collections: A randomized controlled trial regarding stent removal aft er endoscopic transmural drainage. Gastrointest Endosc 2007;65:609-19.
  • 52 Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 2007;66:909-16.
  • 53 Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: A randomized trial. JAMA 2012;307:1053-61.
  • 54 Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas aft er surgical management of severe necrotizing pancreatitis. Arch Surg 1995;130:48-52.
  • 55 Neff R. Pancreatic pseudocysts and fluid collections: Percutaneous approaches. Surg Clin North Am 2001;81:399-403, xii.
  • 56 Chand B, Walsh RM, Ponsky J, Brody F. Pancreatic complications following laparoscopic splenectomy. Surg Endosc 2001;15:1273-1276.
  • 57 Li-Ling J, Irving M. Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: A systematic review of randomized controlled trials. Br J Surg 2001;88:190-9.
  • 58 Ridgeway MG, Stabile BE. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am 1996;76:1159-73.
  • 59 Lau ST, Simchuk EJ, Kozarek RA, Traverso LW. A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg 2001;181:411-5.
  • 60 Saeed ZA, Ramirez FC, Hepps KS. Endoscopic stent placement for internal and external pancreatic fistulas. Gastroenterology 1993;105:1213-7.
  • 61 Kozarek RA, Ball TJ, Patterson DJ, Raltz SL, Traverso LW, Ryan JA, et al. Transpapillary stenting for pancreaticocutaneous fistulas. J Gastrointest Surg 1997;1:357-61.
  • 62 Boerma D, Rauws EA, van Gulik TM, Huibregtse K, Obertop H, Gouma DJ. Endoscopic stent placement for pancreaticocutaneous fistula aft er surgical drainage of the pancreas. Br J Surg 2000;87:1506-9.
  • 63 Costamagna G, Mutignani M, Ingrosso M, Vamvakousis V, Alevras P, Manta R, et al. Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy 2001;33:317-22.
  • 64 Le Moine O, Matos C, Closset J, Devière J. Endoscopic management of pancreatic fistula aft er pancreatic and other abdominal surgery. Best Pract Res Clin Gastroenterol 2004;18:957-75.
  • 65 Arvanitakis M, Delhaye M, Bali MA, Matos C, Le Moine O, Devière J. Endoscopic treatment of external pancreatic fistulas: When draining the main pancreatic duct is not enough. Am J Gastroenterol 2007;102:516-24.
  • 66 Irani S, Gluck M, Ross A, Gan SI, Crane R, Brandabur JJ, et al. Resolving external pancreatic fistulas in patients with disconnected pancreatic duct syndrome: Using rendezvous techniques to avoid surgery (with video). Gastrointest Endosc 2012;76:586-93.e1.
  • 67 Will U, Fueldner F, Goldmann B, Mueller AK, Wanzar I, Meyer F. Successful transgastric pancreaticography and endoscopic ultrasound-guided drainage of a disconnected pancreatic tail syndrome. Therap Adv Gastroenterol 2011;4:213-8.
  • 68 Machado NO. Pancreaticopleural fistula: Revisited. Diagn Ther Endosc 2012;2012:815476.
  • 69 Tessier G, Bories E, Arvanitakis M, Hittelet A, Pesenti C, Le Moine O, et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007;65:233-41.
  • 70 François E, Kahaleh M, Giovannini M, Matos C, Devière J. EUS-guided pancreaticogastrostomy. Gastrointest Endosc 2002;56:128-33.