[State of the art on endotherapy of biliary injuries]

Endoscopic retrograde cholangiopancreatography (ERCP) plays a first role both in the diagnosis and treatment of postoperative biliary leaks as well as of benign strictures. The goal of the endoscopic treatment of biliary leaks is the elimination of the transpapillary pressure gradient, but the choice of the best approach remains to be established. ES should be sufficient to treat the leaks without an associated lesion of the extrahepatic bile ducts. In these cases, placement of a NBD for two to three days has the advantage to allow checking the healing. Placement of a plastic stent is indicated for leaks of the main ducts to remodel the healing process and try to prevent the development of strictures. An endoscopic attempt should be also considered in severely injured bile ducts especially in those cases unfit for surgery. Benign biliary strictures have been traditionally treated by surgical repair but today endoscopy represents the preferred treatment since the stricture can be completely and permanently dilated in a big proportion of patients. The use of rendezvous procedures by combining ERCP and PTC may increase the number of potential candidates for non-operative treatment. The advantages of endoscopy are its simplicity, repeatability and minimal invasiveness; furthermore, surgery after endotherapy is always possible.