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The role of ERCP in the management of bile leakage: endoscopic sphincterotomy versus biliary stenting.

INTRODUCTION
Bile leakage is a common complication of cholecystectomy. The aim of this study was to compare endoscopic sphincterotomy (EST) and biliary stenting (BS) in the treatment of bile leaks after cholecystectomy.


PATIENTS AND METHODS
Twenty-seven patients with bile leakage following cholecystectomy underwent endoscopic retrograde cholangiography (ERCP). Patients were randomized into two groups (EST and BS +/- EST), according to the initial therapeutic endoscopic intervention. The patients were allocated into subgroups once more, according to diameter of the common bile duct (CBD). Outcomes and efficacy of BS and EST on fistula closure and the time to fistula closure were investigated.


RESULTS
The median time between cholecystectomy and ERCP in the EST and BS groups was 6.45 +/- 3.41 and 4.50 +/- 1.99 days, respectively. The mean daily amount of biliary leakage in the EST and BS groups was 376.92 +/- 243.77 and 441.07 +/- 216.08 cc/day, respectively. The diameter of the distal part of CBD in the EST and BS groups was 9.07 +/- 3.84 and 8.28 +/- 4.04 mm, respectively. Mean fistula closure was achieved in 6.45 +/- 3.41 in 11 of 13 patients in the EST group and 4.50 +/- 1.99 days in the BS group in all patients. However, mean time of closure was significantly shorter in the BS 4.71 +/- 2.14 group, compared to EST (9.67 +/- 2.51), among patients with distal CBD diameter (< or =8 mm).


CONCLUSIONS
BS seems to be a more effective method than EST in the management of postcholecystectomy among patients with bile leakage and without CBD dilatation. BS might be the first-line treatment among such patients. However, further prospective, randomized, clinical trials regarding CBD dilatation are warranted.