Efficacy and associated factors of endoscopic transpapillary drainage for postoperative biliary leakage

Jun Murata; Minoru Shigekawa; Shuji Ishii; Takahiro Suda; Kenji Ikezawa; Motohiro Hirao; Kengo Matsumoto; Tadashi Kegasawa; Kiyoshi Iwahashi; Sadaharu Iio; Fumihiko Nakanishi; Shoichi Nakazuru; Yuichi Yoshida; Takuo Yamai; Katsuhiko Sato; Teppei Yoshioka; Hayato Hikita; Tomohide Tatsumi; Tetsuo Takehara

doi:10.1002/deo2.281

Efficacy and associated factors of endoscopic transpapillary drainage for postoperative biliary leakage

DEN Open. 2023 Aug 17;4(1):e281. doi: 10.1002/deo2.281. eCollection 2024 Apr.

Authors

Jun Murata¹, Minoru Shigekawa², Shuji Ishii³, Takahiro Suda⁴, Kenji Ikezawa⁵, Motohiro Hirao⁶, Kengo Matsumoto⁷, Tadashi Kegasawa⁸, Kiyoshi Iwahashi⁹, Sadaharu Iio¹⁰, Fumihiko Nakanishi¹¹, Shoichi Nakazuru¹², Yuichi Yoshida¹³, Takuo Yamai⁵, Katsuhiko Sato², Teppei Yoshioka², Hayato Hikita², Tomohide Tatsumi², Tetsuo Takehara²

Affiliations

¹ Department of Gastroenterology Higashiosaka City Medical Center Osaka Japan.
² Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan.
³ Department of Gastroenterology and Hepatology Osaka General Medical Center Osaka Japan.
⁴ Department of Gastroenterology and Hepatology Kansai Rosai Hospital Hyogo Japan.
⁵ Department of Hepatobiliary and Pancreatic Oncology Osaka International Cancer Institute Osaka Japan.
⁶ Department of Gastroenterology and Hepatology Osaka Rosai Hospital Osaka Japan.
⁷ Department of Gastroenterology and Hepatology Toyonaka Municipal Hospital Osaka Japan.
⁸ Department of Gastroenterology and Hepatology Ikeda Municipal Hospital Osaka Japan.
⁹ Department of Gastroenterology and Hepatology Osaka Police Hospital Osaka Japan.
¹⁰ Department of Gastroenterology and Hepatology Hyogo Prefectural Nishinomiya Hospital Hyogo Japan.
¹¹ Department of Gastroenterology and Hepatology National Hospital Organization Osaka Minami Medical Center Osaka Japan.
¹² Department of Gastroenterology and Hepatology National Hospital Organization Osaka National Hospital Osaka Japan.
¹³ Department of Gastroenterology and Hepatology Suita Municipal Hospital Osaka Japan.

Abstract

Objective: Adequate biliary decompression is important in treating bile leaks, and endoscopic transpapillary drainage is widely used for this purpose. As an indicator to evaluate the usefulness of endoscopic drainage for postoperative biliary leakage, we focused on external drain removability, which affects quality of life, after endoscopic treatment. Our aim was to clarify the success rate of external tube removal after endoscopic drainage for postoperative biliary leakage and to examine associated factors.

Methods: This was a multicenter retrospective study; 99 patients with biliary leakage at 13 institutions were enrolled between April 2014 and March 2019. Among these patients, 66 who were initially treated with endoscopic interventions for biliary leakage after cholecystectomy (n = 17) or hepatectomy (n = 49) were reviewed.

Results: In post-cholecystectomy biliary leakage, the external-drain-free rate at first endoscopic intervention was 100%, and the drains, including transpapillary stents, were successfully removed in almost all cases (16/17). In contrast, in post-hepatectomy biliary leakage, the external-drain-free rate was 44.9% (22/49), with all 22 of those patients eventually becoming entirely drain-free. A lower body mass index was the only significant factor associated with freedom from external drainage in post-hepatectomy biliary leakage (odds ratio 0.18, 95% confidence interval 0.05-0.65).

Conclusions: Initial endoscopic treatment was effective for post-cholecystectomy biliary leakage, while approximately half of the patients with post-hepatectomy biliary leakage required multidisciplinary management. Achieving freedom from external drainage contributes to patients' quality of life and may be a predictor of treatment response after endoscopic therapy for postoperative biliary leakage.

Keywords: biliary fistula; drainage; endoscopic retrograde cholangiopancreatography; post‐cholecystectomy; post‐hepatectomy.