PMID- 27569859 OWN - NLM STAT- MEDLINE DCOM- 20171011 LR - 20171011 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 85 IP - 4 DP - 2017 Apr TI - Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. PG - 766-772 LID - S0016-5107(16)30524-7 [pii] LID - 10.1016/j.gie.2016.08.018 [doi] AB - BACKGROUND AND AIMS: Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events (AEs). Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, AEs, and long-term results of endoscopic therapy. METHODS: We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014. Data were assembled on patient demographics, etiology of BDL, and procedural details. Endotherapy for BDLs were classified a priori into 3 groups based on timing of ERCP from time of biliary injury: within 1 day of BDL, on day 2 or 3 after BDL, and greater than 3 days after BDL. The relationship among timing of ERCP after BDL injury and outcomes, procedure-related AEs, and patient AEs and mortality were evaluated. RESULTS: From February 2006 to June 2014, 518 patients (50% male; mean age, 51.7 years) underwent ERCP for therapy of BDLs. The etiology of the BDL was laparoscopic cholecystectomy (70.7%), post-liver transplantation (11.2%), liver resection (14.1%), trauma (2.5%), and other causes (1.5%). Endotherapy was performed by placing a transpapillary stent alone (73.5%) or with a sphincterotomy (26.5%). The timing of ERCPs was as follows: 3 days = 321 patients. There was no statistical difference in patient demographics, etiology/site of BDL, or type of endotherapy performed among the 3 groups. On multivariate analysis there was no statistically significant difference in BDL success rate for ERCPs performed within 1 day compared with those performed on day 2 or 3 or after 3 days of bile duct injury (91.2%, 90%, and 88.5%, respectively; P = .77). Similarly, there was no significant difference in the overall patient AE rate among the 3 groups (21.1%, 22.9%, and 24.6%, respectively; P = .81). AEs in men occurred significantly more frequently when compared with women, even after adjusting for age, BDL etiology, and location of leak (27.6% vs 19.9%; OR, 1.53; P = .04). Patients whose BDL was due to a cholecystectomy had a lower AE and mortality rate compared with those who had biliary injury from other etiologies (OR, .42; P < .001). CONCLUSIONS: The overall success rates and AEs after ERCP were not dependent on the timing of the procedure relative to the discovery of the bile leak. This suggests that ERCP in these patients can usually be performed in an elective, rather than an urgent, manner. CI - Copyright (c) 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Adler, Douglas G AU - Adler DG AD - Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. FAU - Papachristou, Georgios I AU - Papachristou GI AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Taylor, Linda Jo AU - Taylor LJ AD - Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. FAU - McVay, Tyler AU - McVay T AD - Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. FAU - Birch, Madeleine AU - Birch M AD - Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. FAU - Francis, Gloria AU - Francis G AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Zabolotsky, Andrew AU - Zabolotsky A AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Laique, Sobia N AU - Laique SN AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Hayat, Umar AU - Hayat U AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Zhan, Tingting AU - Zhan T AD - Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Das, Rohit AU - Das R AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Slivka, Adam AU - Slivka A AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Rabinovitz, Mordechai AU - Rabinovitz M AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Munigala, Satish AU - Munigala S AD - Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Siddiqui, Ali A AU - Siddiqui AA AD - Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20160826 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM MH - Adult MH - Aged MH - Bile Duct Diseases/*surgery MH - Bile Ducts/*injuries/surgery MH - Biliary Tract Surgical Procedures/adverse effects/methods MH - Cholangiopancreatography, Endoscopic Retrograde/*methods MH - Cholecystectomy, Laparoscopic/adverse effects MH - Choledocholithiasis/surgery MH - Cystic Duct/injuries/surgery MH - Female MH - Hepatectomy/adverse effects MH - Humans MH - Liver/injuries MH - Liver Transplantation/adverse effects MH - Male MH - Middle Aged MH - Postoperative Complications/epidemiology/etiology/*surgery MH - Retrospective Studies MH - Sphincterotomy, Endoscopic/*methods MH - *Stents MH - Time Factors EDAT- 2016/10/30 06:00 MHDA- 2017/10/12 06:00 CRDT- 2016/08/30 06:00 PHST- 2016/04/06 00:00 [received] PHST- 2016/08/17 00:00 [accepted] PHST- 2016/10/30 06:00 [pubmed] PHST- 2017/10/12 06:00 [medline] PHST- 2016/08/30 06:00 [entrez] AID - S0016-5107(16)30524-7 [pii] AID - 10.1016/j.gie.2016.08.018 [doi] PST - ppublish SO - Gastrointest Endosc. 2017 Apr;85(4):766-772. doi: 10.1016/j.gie.2016.08.018. Epub 2016 Aug 26.