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  • Title: What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy?
    Author: Prat F, Pelletier G, Ponchon T, Fritsch J, Meduri B, Boyer J, Person B, Bretagne JF.
    Journal: Endoscopy; 1997 Jun; 29(5):341-8. PubMed ID: 9270913.
    Abstract:
    BACKGROUND AND STUDY AIMS: This study was carried out to establish the indications for biliary endoscopy due to biliary complications after laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: One hundred nineteen patients (36 men, 86 women; median age 59, range 16-93) were referred for endoscopic retrograde cholangiopancreatography (ERCP) to five centers between 1990 and 1994, and included in the study. The delay between LC and ERCP was 105 +/- 21 days. RESULTS: Four types of complications were observed. a) Fifty-seven patients had residual stones or clip migration into the common bile duct (CBD); all were successfully treated with endoscopic sphincterotomy (ES). b) Twelve major injuries to the CBD were diagnosed by ERCP; successful surgical repair was carried out in most of these cases. c) Twenty patients had a partial biliary stricture; endoscopic stenting was attempted as a primary procedure in eight patients, with a satisfactory outcome in five (63%). d) Thirty patients had a bile leak; endoscopic therapy (26 patients) led to recovery in 18 (69%). The benefit of endoscopic treatment was less clear in five (19%); ES failed to bring about improvement in three patients (12%). CONCLUSIONS: ERCP is indicated when a biliary complication is suspected after laparoscopic cholecystectomy. Endoscopic sphincterotomy is effective for the treatment of retained stones, clip migration, and bile leakage. Endoscopic stenting may be offered as a primary option in partial CBD strictures.
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