Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients

Jorge Canena, David Horta, João Coimbra, Liliane Meireles, Pedro Russo, Inês Marques, Leonel Ricardo, Catarina Rodrigues, Tiago Capela, Diana Carvalho, Rafaela Loureiro, António Mateus Dias, Gonçalo Ramos, António Pereira Coutinho, Carlos Romão, Pedro Mota Veiga

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Abstract

Background: Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. Methods: This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. Results: Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0%). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95% CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5% (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. Conclusions: Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90%). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.

Original languageEnglish
Article number105
Pages (from-to)Online
Number of pages9
JournalBMC Gastroenterology
Volume15
Issue number1
DOIs
Publication statusPublished - 19 Aug 2015

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Plastics
Stents
Treatment Failure
Bile
Multicenter Studies
Retrospective Studies
Logistic Models

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Canena, Jorge ; Horta, David ; Coimbra, João ; Meireles, Liliane ; Russo, Pedro ; Marques, Inês ; Ricardo, Leonel ; Rodrigues, Catarina ; Capela, Tiago ; Carvalho, Diana ; Loureiro, Rafaela ; Dias, António Mateus ; Ramos, Gonçalo ; Coutinho, António Pereira ; Romão, Carlos ; Veiga, Pedro Mota. / Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients. In: BMC Gastroenterology. 2015 ; Vol. 15, No. 1. pp. Online.
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title = "Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients",
abstract = "Background: Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. Methods: This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. Results: Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0{\%}). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95{\%} CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5{\%} (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. Conclusions: Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90{\%}). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.",
author = "Jorge Canena and David Horta and Jo{\~a}o Coimbra and Liliane Meireles and Pedro Russo and In{\^e}s Marques and Leonel Ricardo and Catarina Rodrigues and Tiago Capela and Diana Carvalho and Rafaela Loureiro and Dias, {Ant{\'o}nio Mateus} and Gon{\cc}alo Ramos and Coutinho, {Ant{\'o}nio Pereira} and Carlos Rom{\~a}o and Veiga, {Pedro Mota}",
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Canena, J, Horta, D, Coimbra, J, Meireles, L, Russo, P, Marques, I, Ricardo, L, Rodrigues, C, Capela, T, Carvalho, D, Loureiro, R, Dias, AM, Ramos, G, Coutinho, AP, Romão, C & Veiga, PM 2015, 'Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients', BMC Gastroenterology, vol. 15, no. 1, 105, pp. Online. https://doi.org/10.1186/s12876-015-0334-y

Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients. / Canena, Jorge; Horta, David; Coimbra, João; Meireles, Liliane; Russo, Pedro; Marques, Inês; Ricardo, Leonel; Rodrigues, Catarina; Capela, Tiago; Carvalho, Diana; Loureiro, Rafaela; Dias, António Mateus; Ramos, Gonçalo; Coutinho, António Pereira; Romão, Carlos; Veiga, Pedro Mota.

In: BMC Gastroenterology, Vol. 15, No. 1, 105, 19.08.2015, p. Online.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients

AU - Canena, Jorge

AU - Horta, David

AU - Coimbra, João

AU - Meireles, Liliane

AU - Russo, Pedro

AU - Marques, Inês

AU - Ricardo, Leonel

AU - Rodrigues, Catarina

AU - Capela, Tiago

AU - Carvalho, Diana

AU - Loureiro, Rafaela

AU - Dias, António Mateus

AU - Ramos, Gonçalo

AU - Coutinho, António Pereira

AU - Romão, Carlos

AU - Veiga, Pedro Mota

PY - 2015/8/19

Y1 - 2015/8/19

N2 - Background: Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. Methods: This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. Results: Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0%). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95% CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5% (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. Conclusions: Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90%). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.

AB - Background: Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. Methods: This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. Results: Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0%). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95% CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5% (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. Conclusions: Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90%). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.

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U2 - 10.1186/s12876-015-0334-y

DO - 10.1186/s12876-015-0334-y

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JO - BMC Gastroenterology

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SN - 1471-230X

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