Resultados del tratamiento endoscópico en fugas biliares. Experiencia del Centro Médico Nacional Siglo XXI IMSS

Abstract

Injuries or bile leaks, among other causes, occur after open or laparoscopic cholecystectomy with an incidence of 0.1-1%. These bile leaks (Strasberg A-C) are treated by endoscopic retrograde cholangiopancreatography (ERCP). Sphincterotomy and placement of biliary stent decreases bile duct pressure to the duodenum, and promotes transpapillary bile flow, with a 70-90% response.

Objetives

To describe the characteristics of benign bile leaks treated by ERCP and their associated complications, as well as to evaluate the results of endoscopic treatment.

Material and methods

A descriptive, retrospective study was conducted by performing an analysis on ERCP reports from2011-2013, with a diagnosis of benign bile leakage.

Results

A total of 560 reports were reviewed, of which 82 (14.64%) underwent ERCP. The most common history was laparoscopic cholecystectomy in 62 (75.6%). A low biliary leakage (30.5%) and a high output (30.5%) was observed in 53 (64.6%) patients. The most common leakage site was cystic in 29.3%, and hepatobiliary stump in 20.7%. A sphincterotomy was performed on all of them, and a biliary stent was inserted in those with high output, with the leak being resolved in 95.1% of patients at 1 month, and in 100% at 6 months. Other complications related to biliary leakage were choledocholithiasis and benign biliary stenosis in 18 (22%) patients.

Conclusions

The endoscopic treatment using the sphincterotomy technique, or combined with biliary stent placement is effective in most patients with bile leaks.