[Endoscopic management of biliary fistula]

To assess safety and efficacy of endoscopic therapy for patients with a postoperative biliary fistula.

Biliary fistula that occur after operations on the biliary tract may be due to bile duct injury or distal bile duct obstruction. These fistulas has been managed with surgical correction. At present, endoscopic methods of improving biliary drainage has been found to be highly successful in the management of postsurgical biliary leaks. PATIENTS-METHODS-RESULTS: By endoscopic cholangiopancreatography (ERCP) we diagnosed 35 patients (23 females and 12 males) with postoperative biliary fistula. Four patients had history of laparoscopic cholecystectomy. We used endoscopic sphincterotomy (18 cases) or endoprosthesis placement (17 cases) in the treatment. Seventeen patients with fistula plus common bile duct (CBD) stones and one patient with benign papillary stenosis were treated with endoscopic sphincterotomy alone. Seventeen patients without CBD stones were treated with only endoprosthesis placement. A second ERCP confirmed healing of the leakage after 4-16 weeks.

Postoperative bile leakage could be diagnosed safely and effectively by ERCP, subsequent endoscopic management in most cases is successful. Sphincterotomy alone is the preferred treatment for biliary fistula-complicating surgery for gallstone disease. Alternatively, when a fistula is large, endoscopic placement of an endoprosthesis can be proposed as the first treatment.