Introduction and objectives:

Benign biliary leaks are a rare complication. Approximately 1% to 3% of all cholecystectomies occur and are less likely to be related to trauma, biliary tract exploration with choledochotomy, placement of a T-tube or instrumentation of the bile duct. To compare the therapeutic results obtained with endoscopic retrograde cholangiopancreatography (ERCP) between biliary sphincterotomy and/or biliary prosthesis placement in patients with benign biliary leak.

Material and methods:

Retrospective, comparative, retrolective, longitudinal study of consecutive patients with endoscopic diagnosis by ERCP of benign bile leak in the Gastrointestinal Endoscopy Division of the General Hospital “Dr. Manuel Gea González” from January 2012 to August 2018. Endoscopic therapeutic success was defined as cases in which the cessation of biliary leakage was corroborated with a single endoscopic procedure for the EE group and two endoscopic procedures for the EE + PB group (the second indicated for the removal of biliary prostheses). Failure was defined as those cases in which more endoscopic procedures were needed than previously established or surgical treatment.

Results:

We identified 92 (2.18%) patients with biliary leaks. One case was excluded due to hemodynamic instability that did not allow endoscopy. Of the 91 patients, 49 (53.8%) were women with an average age of 47.8 ± 18.9 years. Endoscopic precut was performed in 29 (31.9%) patients (4 vs 25, p = 0.72). In 67 patients (73.6%) was identified by ERCP low-cost leak (13 vs. 54, p = 0.55). Regarding the leak site, 78 patients (85.7%) had a cystic stump (11 vs 67 p = 0.053), 7 cases (7.7%) in the right hepatic duct. It was not possible to determine a leakage site in 3 cases (3.3%). In the EE + PB group, the biliary prosthesis was removed in an average of 90.9 ± 57.4 days. The global endoscopic therapeutic success for the resolution of benign bile leak and associated choledocholithiasis was 100%.

Conclusions:

No differences were found in the rates of therapeutic success in the biliary sphincterotomy group compared with sphincterotomy + prosthesis placement; both treatments showed low rates of complications.

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