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.
