ERCP FOR THE TREATMENT OF BILIARY COMPLICATIONS FOLLOWING CHOLECYSTECTOMY

Aims The purpose of this study is to evaluate the usefulness and efficacy of endoscopic treatment of biliary complications in patients undergoing cholecystectomy, as illustrated by decades of data.

Methods During the 01/2009 - 12/2018 period, 4,360 ERCPs were performed in our department. We selected and studied retrospectively cases with complications after cholecystectomy. We evaluated mainly patients with postoperative biliary leak and biliary stenosis. Patients with choledocholithiasis found after cholecystectomy were not included in the study unless coexisting with the above conditions. All data were retrieved from patients´ files and electronic records.

Results A total of 78 ERCPs (1.8%) were performed in 54 unique patients for biliary complications following cholecystectomy. Patients range in age from 27 to 90, with relatively equal gender distribution (25 men, 29 women). The vast majority of patients (47 patients) presented with leakage. Of these 47 patients, 4 exhibited complete transection/discontinuation of the bile duct and in 4 biliary stenosis coexisted. Finally, there was 1 patient that ERCP (duct cannulation) failed. Thus, a total of 16 patients presented with biliary stenosis (4 postoperative stenosis and leak, 4 leakage and complete duct transection, 3 obstructive jaundice due to stenosis and 4 complete obstruction of duct). Patients with bile leakage: 30/47 (63%) presented with cystic duct leak, 6/47 (12%) had underlying choledocholithiasis (undetected at baseline evaluation) and 7/47 (15%) patients required more than one session. The success rate is > 85% (46/54).

Conclusions Endoscopic treatment of postoperative complications of cholecystectomy is possible and very effective and is accompanied by very high success rates. However, multiple sessions/hospitalizations are often required, and in cases such as the complete duct transection the solution remains surgical.