A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos)

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Abstract

Background: Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear. Objective: To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic stents (MPS) for the treatment of postcholecystectomy refractory biliary leaks. Design: Prospective study. Setting: Two tertiary-care referral academic centers and one general district hospital. Patients: Forty consecutive patients with refractory biliary leaks who underwent endoscopic management. Interventions: Temporary placement of MPS (n = 20) or FCSEMSs (n = 20). Main Outcome Measurements: Clinical outcomes of endotherapy as well as the technical success, adverse events, need for reinterventions, and prognostic factors for clinical success. Results: Endotherapy was possible in all patients. After endotherapy, closure of the leak was accomplished in 13 patients (65\%) who received MPS and in 20 patients (100\%) who received FCSEMSs (P = .004). The Kaplan-Meier (log-rank) leak-free survival analysis showed a statistically significant difference between the 2 patient populations (chi(2) {[}1] = 8.30; P < .01) in favor of the FCSEMS group. Use of <3 plastic stents (P = .024), a plastic stent diameter <20F (P = .006), and a high-grade biliary leak (P = .015) were shown to be significant predictors of treatment failure with MPS. The 7 patients in whom placement of MPS failed were retreated with FCSEMSs, resulting in closure of the leaks in all cases. Limitations: Non-randomized design. Conclusion: In our series, the results of the temporary placement of FCSEMSs for postcholecystectomy refractory biliary leaks were superior to those from the use of MPS. A randomized study is needed to confirm our results before further recommendations.}
Original languageEnglish
Pages (from-to)70-78
JournalGastrointestinal Endoscopy
Volume82
Issue number1
DOIs
Publication statusPublished - Jul 2015

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