Unveiling the Complexity in the Management and Outcomes of Traumatic Versus Non-Traumatic Bile Leaks-A Comparative...

Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial diagnostic and therapeutic modality for managing bile leaks, particularly in the context of traumatic etiologies. Here, we aimed to contribute to this body of knowledge by providing a comprehensive analysis of ERCP outcomes in patients with confirmed bile leaks, including both traumatic and non-traumatic etiologies.

This retrospective study investigated ERCP outcomes in patients with confirmed bile leaks from 2017 to 2023. Patients were categorized into non-traumatic (N = 124) and traumatic (N = 47) groups, collecting variables encompassing demographics, clinical parameters, and intervention details. The comparisons between groups utilized Chi-square for categorical variables.

This study analyzed 188 bile duct leak cases, comparing 141 non-traumatic and 47 traumatic injuries. Logistic regression identified younger age (< 40 years; aOR:19.75, p < 0.001), male sex (aOR:6.45, p = 0.001), and Black race (aOR:3.41, p = 0.019) as significant predictors of traumatic injury. Hospital stay was significantly longer in traumatic cases (21.3 vs 12.4 days; p = 0.002), reflecting greater injury severity and complexity, including a higher need for interventional radiology (59.6% vs 33.3%; p = 0.001). Despite these differences, clinical outcomes, including stent success and complication rates, were comparable between groups.

Our findings underscored a higher frequency of non-endoscopic involvement in traumatic injuries, indicating the complexity of these cases. Despite these differences, the study revealed that technical success, clinical success, mortality, and complications do not significantly differ between traumatic and non-traumatic groups, emphasizing the need for tailored management strategies outside of ERCP to address the distinct clinical characteristics of traumatic bile leaks.