ENDOSCOPIC TREATMENT OF POST-CHOLECYSTECTOMY BILE LEAKS: A TERTIARY CENTER EXPERIENCE OF 100 CASES

Postcholecystectomy leaks may occur in 0.3–2.7% of patients. Bile leaks associated with laparoscopy are often more complex and difficult to treat than those occurring after open cholecystectomy. Furthermore, their incidence has remained unchanged despite improvements in laparoscopic training and technological developments. The management of biliary leaks has evolved from surgery into a minimally invasive endoscopic procedural approach, namely, endoscopic retrograde cholangiopancreatography (ERCP), which decreases or eliminates the pressure gradient between the bile duct and the duodenum, thus creating a preferential transpapillary bile flow and allowing the leak to seal. For simple leaks, the success rate of endotherapy is remarkably high. However, there are more severe and complex leaks that require multiple endoscopic interventions, and clear strategies for endoscopic treatment have not emerged. Therefore, there is still some debate regarding the optimal time point at which to intervene, which technique to use (sphincterotomy alone or in association with the placement of stents, whether metallic or plastic stents should be used, and, if plastic stents are used, whether they should be single or multiple), how long the stents should remain in place, and when to consider treatment failure. Here, we review the types and classification of postoperative biliary injuries, particularly leaks, as well as the evidence for endoscopic treatment of the latter.

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PA.231 STENT PLACEMENT IN ENDOSCOPIC TREATMENT OF POSTSURGICAL BILE LEAKS: A PROSPECTIVE ANALYSIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(08)60426-0 ◽

2008 ◽

Vol 40 ◽

pp. S160

Author(s):

S. Ghersi ◽

P. Billi ◽

V. Cennamo ◽

C. Fabbri ◽

F. Ferrara ◽

...

Keyword(s):

Stent Placement ◽

Endoscopic Treatment ◽

Prospective Analysis ◽

Bile Leaks

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Sa1491 VAILDATION OF A CLINICAL PREDICTION RULE TO DETERMINE THE NEED FOR REPEAT ERCP AFTER ENDOSCOPIC TREATMENT OF POSTSURGICAL BILE LEAKS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.285 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB257-AB258

Author(s):

Hassaan Zia ◽

Jason G. Bill ◽

Michael S. Green ◽

Rabia Saleem ◽

Mohammad F. Madhoun ◽

...

Keyword(s):

Endoscopic Treatment ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Bile Leaks

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Clinical prediction rule to determine the need for repeat ERCP after endoscopic treatment of postsurgical bile leaks

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.10.027 ◽

2017 ◽

Vol 85 (5) ◽

pp. 1047-1056.e1

Author(s):

Apostolos V. Tsolakis ◽

Paul D. James ◽

Gilaad G. Kaplan ◽

Robert P. Myers ◽

James Hubbard ◽

...

Keyword(s):

Endoscopic Treatment ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Bile Leaks

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Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks

Surgical Endoscopy ◽

10.1007/s00464-009-0842-3 ◽

2009 ◽

Vol 24 (7) ◽

pp. 1752-1756 ◽

Cited By ~ 10

Author(s):

Gregory A. Coté ◽

Michael Ansstas ◽

Somal Shah ◽

Rajesh N. Keswani ◽

Saad Alkade ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Treatment ◽

Endoscopic Retrograde ◽

Bile Leaks

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P.06.15 ENDOSCOPIC TREATMENT OF LEAKS FOLLOWING BARIATRIC SURGERY: A TERTIARY CENTER EXPERIENCE

Digestive and Liver Disease ◽

10.1016/s1590-8658(19)30445-1 ◽

2019 ◽

Vol 51 ◽

pp. e219

Author(s):

A. D'Alessandro ◽

D. Napoletano ◽

F.P. Zito ◽

E. Sessa ◽

G. Ciccarelli ◽

...

Keyword(s):

Bariatric Surgery ◽

Endoscopic Treatment ◽

Tertiary Center

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DOZ047.73: Endoscopic treatment of esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.73 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

T Vogiatzoglou ◽

S Arrigo ◽

P Gandullia

Keyword(s):

Esophageal Atresia ◽

Endoscopic Treatment ◽

Anastomotic Stricture ◽

Symptom Relief ◽

Balloon Catheter ◽

Therapeutic Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Anastomotic Strictures ◽

Tertiary Center ◽

Therapeutic Alternatives

Abstract Aim of the Study The aim of this study was to provide an overview of endoscopic treatment in children after reconstruction of esophageal atresia. Methods This study, conducted at a single tertiary center, reviewed patients requiring endoscopic treatment during a 15-year period, from 2004 to 2018. Collected data include number, frequency, complications, and effectiveness of esophageal anastomotic dilations. Results A total of 55 children with esophageal atresia (EA) underwent upper gastrointestinal endoscopy. Of those, 37 required therapeutic endoscopy with dilation procedures for anastomotic strictures. Thirty-five patients underwent dilations using only through-the-scope (TTS) balloon (BD),1 patient using only a Savary bougie (SB), and 1 using both. A total of 126 dilations were performed using BD in 36 patients and 6 dilations using SB in 2 patients. Specifically, in children treated only with BD were performed 1 dilation in 6 children (17.1%), 2 in 6 children (17.1%), 3 in 7 children (20%), 4 in 6 children (17.1%), 5 in 6 children (17.1%), 7 in 2 children (5.7%), and 8 in 2 children (5.7%). Balloon catheter sizes ranged from 6 mm to 15 mm. In 2 patients (5.4%) stents were placed, 1 and 6 stents, respectively. Intralesional triamcinolone was injected in 8 patients (21.6%) as additional therapy. Major complications included perforation in 4 patients (10,8%), resolved with conservative treatment. All patients had clinical improvement in the follow-up. Conclusion Currently, endoscopic treatment for esophageal anastomotic stricture is the first procedure adopted in clinical practice after the surgical approach, since it is regarded safe and effective. Balloon dilations are preferred in our overview as a treatment option for esophageal anastomotic strictures. Symptom relief is reported in all cases, while the rate of complications is very low. Sometimes, refractory strictures influence the patient's quality of life and therapeutic alternatives such as stent placement should be considered.

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