Outcomes of ERCP for Post-operative Bile Leaks After Cholecystectomy, Hepatectomy, and Liver Transplantation: A High-Volume Tertiary Referral Center Experience.

Abstract

Background: Bile leak (BL) remains one of the major adverse events of hepatobiliary surgeries. We evaluated ERCP outcomes for postoperative BL (PBL) cholecystectomy (C-BL), hepatectomy (H-BL), and liver transplantation (LT-BL) and identified predictors of persistent leak after initial ERCP.

Methods: This study includes consecutive patients who underwent ERCP for PBL at a single high-volume center (2011-2021). Leaks were graded as low-grade BL (LG-BL) or high-grade BL (HG-BL). Initial success was defined as cholangiographic and clinical resolution of BL following a single therapeutic ERCP session at the first follow-up ERCP. Final success was defined as cholangiographic and clinical resolution of the BL at the last follow-up assessment, irrespective of the number of therapeutic ERCP sessions required.

Results: 417 patients with PBLs were included: 348 (83.5%) C-BL, 43 (10.3%) H-BL, and 26 (6.2%) LT-BL. Initial clinical success was 80.7% overall, with the highest in LT-BL (91.7%), followed by C-BL (83.5%), and then H-BL (50%) (p < 0.001). HG-BLs had lower initial success (54.7% vs. 87.8% for LG-BL; p < 0.001). Final success was 96% overall, but lower in H-BL (84.2%) than C-BL (97.3%) and LT-BL (95.8%) (p < 0.001). Overall, HG-BL (adjusted odds ratio [aOR] 5.79) and H-BL (aOR 3.52) were independent predictors of persistent leak.

Conclusion: ERCP is effective and safe for PBL. However, initial clinical success varied by surgical etiology and leak severity. HG-BL and H-BL were associated with lower initial success and more frequently required repeated ERCP interventions for leak resolution. Further studies are needed to validate optimal treatment strategies for higher-risk bile leak subgroups.