Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management

Table 1 Endoscopic Retrograde Cholangio-Pancreatography management of iatrogenic bile duct injuries in the literature

Ref.	Time to ERCP/day	ERCP success rate	ERCP management	Comments
Hii et al[10]	8 (1-35)	93.1%	Of the successful cases 100% of cases had stents, 63% had EST, 66.7% had 10 Fr stents	2 cases of PEP; median time of leak resolution was 4 d (1-35)
Abdel-Raouf et al[7]	29 (2-54)	93.9%	Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option	Complications include mild acute pancreatitis, cholangitis and post-sphinctertomy bleeding
Yehia[9]	-	88.9%	ERCP was used as a diagnostic test for the site of injury in this study with success rate of 93.3%, and as therapeutic option for cases of leak and biliary strictures	Closure of the fistula and complete relieve of jaundice in all patients within 2 wk
Emara et al[4]	7 (0-21)	88.46%	It was possible to notice the site and type of injury in the 26 patients. In this study, 18 patients (69.2%) had a plastic stent inserted, whereas 8 (30.8%) had no stents and managed with sphincterotomy alone. There were no adverse events related to the ERCP procedure	There were no differences between patients treated by early (first week) versus late (after the first week) ERCP regarding the needed interventions, type of BDIs, type and diameter of the inserted stents, and the overall success
Ghazanfar et al[8]	27 (2-210)	87.8%	Patients with postoperative biliary leaks fare much better than those with complete cutoff or strictures. MRCP should be done in all patients where ERCP shows loss of biliary continuity	The leak stopped 48-72 h of combined EST and stenting
Mavrogiannis et al[21]	-	100%	Endoscopic therapy of biliary leaks with a small-diameter biliary stent alone is as effective and safe as EST followed by insertion of a large-diameter stent	7.7% complication rate; Time to clinical improvement 2-6 d

BDI: Bile duct injuries; ERCP: Endoscopic Retrograde Cholangio-Pancreatography; MRCP: Magnetic Resonance Cholangio-Pancreatography; EST: Endoscopic sphincterotomy; PEP; Post-ERCP Pancreatitis.