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Ratone JP, Caillol F, Marx M, Hoibian S, Dahel Y, Giovannini M, Devière J. A novel case of biliary common bile duct reconstruction by the rendezvous technique using endoscopic cholangioscopy and percutaneous cholangioscopy. Endoscopy 2022; 54:E950-E951. [PMID: 35863339 PMCID: PMC9736840 DOI: 10.1055/a-1883-9446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Mariola Marx
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Solene Hoibian
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Jacques Devière
- Department of Gastroenterology, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
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Lorenzo D, Bromberg L, Arvanitakis M, Delhaye M, Fernandez Y Viesca M, Blero D, Pezzullo M, Racapé J, Lucidi V, Le Moine O, Devière J, Lemmers A. Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access. Gastrointest Endosc 2022; 95:131-139.e6. [PMID: 34310921 DOI: 10.1016/j.gie.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Bilomas most frequently result from postoperative bile leaks. The endoscopic conventional treatment is sphincterotomy ± stent placement. In complex cases, such as altered anatomy or failure of conventional treatment, transpapillary/transfistulary (TP/TF) drainage or EUS-guided transmural drainage (EUS-TD) may obviate additional biliary surgery. This study reports our experience with treating biloma secondary to refractory biliary leak with TP/TF drainage or EUS-TD and evaluates the safety and outcomes associated with this approach. METHODS This observational study focused on consecutive patients managed for biliary leakage (diagnosis based on imaging and/or bile outflow from a surgical drain) at a tertiary care hospital (2007-2017). TP/TF drainage was performed by double-pigtail stent(s) placement to drain the biloma through the leak during ERCP. For EUS-TD, plastic stent(s) were placed under EUS control. Primary outcomes were a composite of clinical success (patient free of sepsis after percutaneous drain removal and, in patients with benign disease, removal of all endoscopically placed stents, without need for reintervention) and biloma regression (<3 cm) at last follow-up. RESULTS Thirty patients (men, 57%; median age, 55 years) were included. Most biliary leaks resulted from cholecystectomy (27%) and hepatectomy (50%). Initial EUS-TD and TP/TF drainage were performed in 14 (47%) and 16 (53%) patients, respectively. At last follow-up (median, 33.2 months), clinical success and primary outcome were achieved in 70.4% of patients (EUS-TD, 75%; TP/TF, 67%). Additional surgery was necessary in 1 patient. Rate of serious adverse events was 23% (7/30), of which 13% (4/30) were procedure related. There were 4 deaths during the course of treatment, 2 of which were related to endoscopic interventions (hemorrhage and fibrillation). CONCLUSIONS TP/TF drainage or EUS-TD is technically feasible with high clinical success and may avoid the need for additional surgery in complex cases or in patients with altered anatomy.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Laura Bromberg
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Myriam Delhaye
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michael Fernandez Y Viesca
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Martina Pezzullo
- Department of Radiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Judith Racapé
- CUB Erasme Hospital, Statistic Department, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valerio Lucidi
- Department of Abdominal Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Olivier Le Moine
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Abstract
The major causes of benign biliary strictures include surgery, chronic pancreatitis, primary sclerosing cholangitis, and autoimmune cholangitis. Biliary leaks mainly occur after surgery and, rarely, abdominal trauma. These conditions may benefit from a nonsurgical approach in which endoscopic retrograde cholangiopancreatography (ERCP) plays a pivotal role in association with other minimally invasive approaches. This approach should be evaluated for any injury before deciding about the method for repair. ERCP, associated with peroral cholangioscopy, plays a growing role in characterizing undeterminate strictures, avoiding both unuseful major surgeries and palliative options that might compromise any further management.
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Donatelli G, Vergeau BM, Derhy S, Dumont JL, Tuszynski T, Dhumane P, Meduri B. Combined endoscopic and radiologic approach for complex bile duct injuries (with video). Gastrointest Endosc 2014; 79:855-64. [PMID: 24556053 DOI: 10.1016/j.gie.2013.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/23/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Gianfranco Donatelli
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Bertrand Marie Vergeau
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Serge Derhy
- Service de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Jean Loup Dumont
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Thierry Tuszynski
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
| | - Parag Dhumane
- Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India
| | - Bruno Meduri
- Service d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France
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