Insertion and removal of covered expandable metal stents for closure of complex biliary leaks

The traditional endoscopic management of bile leaks involves placement of plastic endoprostheses. The success rate for closure of simple leaks (cystic duct, Luschka's duct) with this approach is high. We describe 3 patients with complex biliary leaks of the gallbladder bed that were successfully closed by using transpapillary placement of covered self-expandable biliary stents. The stents were endoscopically removed after closure of the leak. All 3 patients had previously undergone open subtotal cholecystectomy for severe acute cholecystitis when complete cholecystectomy could not be performed because of dense acute inflammation. In 2 patients the leaks had not responded to traditional plastic biliary stent placement. This novel approach deserves further evaluation.