Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Operative Bile Duct Injuries: Experience of a Tertiary Center in Turkey

Abstract

Objective: The aim of this study was to determine the effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of post-operative bile duct injuries and to share our experience of a tertiary referral center. Methods: Patients who underwent ERCP in our hospital due to biliary injuries after biliary surgery between January 2017 and March 2020 were included in this study. Demographic data, etiologies, clinical conditions, endoscopic treatment methods, and results of the patients were analyzed. Results: A total of 30 patients (16 females and 14 males) were included in this study. Twenty-six patients experienced bile leakage or stenosis after cholecystectomy, and four patients had hepatic hydatid cyst surgery. ERCP was successful in 25 patients (83.3%), but four (13.3%) patients underwent surgery and one patient (3.3%) underwent percutaneous transhepatic cholangiography after failed ERCP. Among the patients who had biliary stenting, biliary leakage was recovered in all of the patients, and repeat ERCP revealed that 18.2% of the patients had stones or mud in the common bile duct. The median time to ERCP was 6.5 days, and there was no difference between early (first 10 days) or late (10-30 days) ERCPs in terms of effectiveness and safety. Conclusion: ERCP is a safe and effective method that should be considered before percutaneous procedures and surgery, whether surgery to ERCP time is early or late. Biliary stenting effectively recovers biliary leakage, and stent removal by repeat ERCP should be performed to check the common bile duct for stones or mud, instead of solely stent removal.