PMID- 30986401
OWN - NLM
STAT- MEDLINE
DCOM- 20200226
LR  - 20200226
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 90
IP  - 2
DP  - 2019 Aug
TI  - Endoscopic management of postcholecystectomy biliary leak: When and how? A 
      nationwide study.
PG  - 233-241.e1
LID - S0016-5107(19)31589-5 [pii]
LID - 10.1016/j.gie.2019.03.1173 [doi]
AB  - BACKGROUND AND AIMS: ERCP is considered the first-line therapy for biliary duct 
      leaks (BDLs). However, the optimal ERCP timing and endotherapy methods remain 
      controversial. Our aim was to evaluate these factors as predictors of poor 
      clinical outcomes after BDLs. METHODS: Adults who underwent ERCP for BDLs after 
      cholecystectomy were identified from the Nationwide Inpatient Sample from 2000 to 
      2014. ERCP was classified as emergent, urgent, and expectant if it was done 
      within 1 day, after 2 to 3 days, or >3 days after BDLs, respectively. Endotherapy 
      was classified into sphincterotomy, stent, or combination. Post-ERCP adverse 
      events (AEs) were defined as requiring pressor infusion, endotracheal intubation, 
      invasive monitoring, or hemodialysis. Early endotherapy failure was defined as 
      the need for salvage surgical or radiology-percutaneous biliary intervention 
      after ERCP. RESULTS: A total of 1028 patients with a median age of 56 years were 
      included. ERCP was done emergently (19%), urgently (30%), and expectantly (51%). 
      Endotherapy procedures were sphincterotomy (24%), biliary stent (24%), and 
      combination (52%). Post-ERCP AEs were 11%, 10%, and 9% for emergent, urgent, and 
      expectant ERCP, respectively (P = .577). In-hospital mortality showed a U-shape 
      trend of 5%, 0%, and 2% for emergent, urgent, and expectant ERCP, respectively 
      (P < .001). Combination and stent monotherapy had lower failure rates of 3% and 
      4%, respectively as compared with sphincterotomy monotherapy with failure rate of 
      11% (P < .001). When multivariate analysis was used, both combination (odds 
      ratio, .2; 95% confidence interval, .1-.5) and stent monotherapy (odds ratio, .4; 
      95% confidence interval, .2-.9) were less likely to fail as compared with 
      sphincterotomy monotherapy. There were no statistically significant differences 
      between combination therapy and stent monotherapy in the univariate and the 
      multivariate analyses. CONCLUSIONS: Although limited by retrospective design and 
      the possibility of selection bias, this analysis suggests that the timing of ERCP 
      is not a significant predictor of post-ERCP AEs after BDLs. Furthermore, 
      combination or stent monotherapy had lower failure rates as compared with 
      sphincterotomy monotherapy.
CI  - Copyright (c) 2019 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Abbas, Ali
AU  - Abbas A
AD  - Division of Digestive Diseases & Nutrition, University of South Florida Morsani 
      College of Medicine, Tampa, Florida, USA.
FAU - Sethi, Sajiv
AU  - Sethi S
AD  - Division of Digestive Diseases & Nutrition, University of South Florida Morsani 
      College of Medicine, Tampa, Florida, USA.
FAU - Brady, Patrick
AU  - Brady P
AD  - Division of Digestive Diseases & Nutrition, University of South Florida Morsani 
      College of Medicine, Tampa, Florida, USA.
FAU - Taunk, Pushpak
AU  - Taunk P
AD  - Division of Digestive Diseases & Nutrition, University of South Florida Morsani 
      College of Medicine, Tampa, Florida, USA.
LA  - eng
PT  - Journal Article
DEP - 20190412
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Adult
MH  - Aged
MH  - Bile
MH  - Biliary Tract Diseases/*surgery
MH  - *Cholangiopancreatography, Endoscopic Retrograde/methods
MH  - *Cholecystectomy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*surgery
MH  - Retrospective Studies
MH  - Sphincterotomy
MH  - Stents
MH  - Time Factors
EDAT- 2019/04/16 06:00
MHDA- 2020/02/27 06:00
CRDT- 2019/04/16 06:00
PHST- 2018/09/24 00:00 [received]
PHST- 2019/03/27 00:00 [accepted]
PHST- 2019/04/16 06:00 [pubmed]
PHST- 2020/02/27 06:00 [medline]
PHST- 2019/04/16 06:00 [entrez]
AID - S0016-5107(19)31589-5 [pii]
AID - 10.1016/j.gie.2019.03.1173 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2019 Aug;90(2):233-241.e1. doi: 10.1016/j.gie.2019.03.1173. 
      Epub 2019 Apr 12.