Introduction:

Biliary fistulas occur mainly as a surgical complication, especially after cholecystectomy, liver transplantation or partial hepatic resection. The first line for the treatment of biliary leaks is endoscopic cholangiography. A variety of techniques can be used, such as sphincterotomy, placement of biliary prostheses, a combination of both techniques, or nasobiliary drainage.1

Material and methods:

A retrospective, single-center study of 104 patients with post-surgical biliary fistula diagnosis who underwent endoscopic management with sphincterotomy and/or biliary prosthesis placement.

Objectives:

To determine the clinical success of endoscopic biliary fistula management, which was defined as fistula closure, prognostic factors for closure, duration of treatment and complications.

Results:

The clinical success of endoscopic cholangiography for resolution of biliary fistula was demonstrated in 98 patients (94.2%), sphincterotomy was performed in 87 patients (83.7%), 16 had previous sphincterotomy (15.4%) and prosthesis placement was performed biliary to 70 patients (67.3%). Of the variables evaluated, the site of biliary leak, stenosis and associated choledocholithiasis proved to be statistically significant predictors for the failure of the endoscopic treatment of biliary fistula. Multivariate analysis shows that stenosis was the only prognostic factor associated with treatment failure. (OR = 16.33, 95% CI 7.52-35.46, p <0.001).

Conclusion:

Endoscopic cholangiography in the treatment of biliary fistula using standardized management has a success rate of 94.2% in patients with post cholecystectomy biliary fistula.

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