Endoscopic biliary stenting for treatment of bile leakage after hepatic resection

BACKGROUND/AIMS: Persistent bile leakage after hepatic resection may cause intraperitoneal sepsis and hepatic failure. Surgical treatment for bile leakage carries a high risk. Endoscopic treatment has only infrequently been documented. METHODOLOGY: Ten patients underwent endoscopic biliary stenting without sphincterotomy for persistent (9-138 days; median, 19 days) bile leakage after hepatic resection. Bile leakage was complicated by intraperitoneal sepsis in seven patients. RESULTS: ERCP showed bile leakage from the bile duct stump in nine patients. Stent placement was successful without complications in all 10 patients. Bile leakage disappeared within 1-17 days (mean, 5 days) in all patients. After 55-91 days, the stent was removed and ERCP confirmed disappearance of the leak. No patients have developed recurrent bile leakage for a mean of 4.1 years of follow-up after stent removal. CONCLUSIONS: Endoscopic biliary stenting is a safe and effective treatment for persistent bile leakage after hepatic resection. Endoscopic treatment may eliminate the need for difficult operations in high risk postoperative cases.