Endoscopic management of traumatic bile leaks

BACKGROUND

Traumatic bile leaks often result in prolonged morbidity and an increased length of hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce.

OBJECTIVE

To evaluate the efficacy of endotherapy in the management of traumatic bile leaks.

DESIGN

Retrospective evaluation of prospectively collected data.

SETTING

Tertiary academic referral center.

PATIENTS

Consecutive patients referred for ERCP after traumatic abdominal injury for the management of bile leaks.

INTERVENTIONS

Biliary stent placement at ERCP.

MAIN OUTCOME MEASURES

Resolution of a bile leak on follow-up ERCP.

RESULTS

Ten patients underwent ERCP for the management of a traumatic bile leak over a 3-year period. The etiology included a penetrating injury from a gunshot wound in 5 patients, blunt injuries from a motor vehicle accident in 4 patients, and injury secondary to a fall in 1 patient. Liver injuries were grade II in 1 patient, grade IV in 7 patients, and grade V in 2 patients. A bile leak was treated by biliary stent placement in all patients, and the outcome was successful in 9 of 10 cases (90%). The mean duration of follow-up was 337 days (range, 101-821 days). Nine of 10 patients underwent surgery to control bleeding or other associated injuries. There were no ERCP-related complications.

LIMITATIONS

Small number of patients.

CONCLUSIONS

Consideration should be given to incorporate ERCP as first-line therapy in management of traumatic bile leaks, because endobiliary stent placement provides a successful outcome in a majority of cases, irrespective of the severity of injury.