CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E247-E252
DOI: 10.1055/a-1322-2425
Original article

Clinical efficacy, timing, and outcomes of ERCP for management of bile duct leaks: a nationwide cohort study

Aakash Desai
1   Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States
,
Patrick Twohig
1   Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States
,
Sophie Trujillo
1   Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States
,
Shaman Dalal
1   Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States
,
Gursimran S. Kochhar
2   Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
,
Dalbir S. Sandhu
1   Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States
3   Division of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery
Institute, Cleveland Clinic, Cleveland, Ohio, United States
› Author Affiliations

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) can safely and effectively manage postsurgical or traumatic bile duct leaks (BDLs). Standardized guidelines are lacking regarding effective management of BDLs. Our aim was to evaluate the efficacy, clinical outcomes, and complications of different ERCP techniques and intervention timing using a nationwide database.

Patients and methods We performed a retrospective analysis of the IBM Explorys database (1999–2019), a pooled, national, de-identified clinical database of over 64 million unique patients across the United States. ERCP timing after BDL was classified as emergent (< 1 day), urgent (1–3 days) or expectant (> 3 days). ERCP technique was classified into sphincterotomy, stent or combination therapy. ERCP complications were defined as pancreatitis, duodenal perforation, duodenal hemorrhage, and ascending cholangitis within 7 days of the procedure.

Results Expectant ERCP had a decreased risk of adverse events (AEs) compared to emergent and urgent ERCP (P = 0.004). Rehospitalization rates also were lower in expectant ERCP (P < 0.001). Patients with COPD were more likely to have an AE if the ERCP was performed emergently compared to expectantly (P = 0.002). Combination therapy had a lower rate of ERCP failure compared to placement of a biliary stent (P = 0.02). There was no statistically significant difference in rates of ERCP failure between biliary stent and sphincterotomy (P = 0.06) or sphincterotomy and combination therapy (P = 0.74).

Conclusion Our study suggests that ERCP does not need to be performed emergently or urgently for management of BDLs. Combination therapy is superior to stenting but not sphincterotomy; however, future prospective studies are needed to validate these findings.



Publication History

Received: 02 August 2020

Accepted: 22 October 2020

Article published online:
03 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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