Endoscopic management of biliary leaks: Where are we now?

Abstract

Biliary leaks can arise as a consequence of cholecystectomy, liver surgery, liver transplant, or, less frequently, trauma. Early identification and characterization of these leaks are crucial, as they can significantly enhance patient outcomes by reducing morbidity and mortality. Traditionally, surgical repair has been the standard treatment; however, advancements in endoscopic techniques and tools have established endoscopic retrograde cholangiopancreatography (ERCP) as the primary approach for managing these often-complicated cases. Interventions such as sphincterotomy, nasobiliary drainage, and stent placement aim to alleviate the pressure within the bile duct, facilitating depressurization and promoting leak healing. Alongside ERCP, endoscopic ultrasound is playing an increasingly vital role in addressing challenging cases. Ongoing improvements in endoscopic technologies and methodologies offer promising prospects, often minimizing the need for invasive surgical interventions. Nonetheless, the management of biliary leaks continues to pose significant challenges for clinicians. An optimal approach for patients experiencing bile leakage should be determined on a case-by-case basis and discussed within a multidisciplinary team involving radiologists, endoscopists, and surgeons. This comprehensive review aims to elucidate the role of endoscopy in the management of various types of biliary leaks, providing clinicians with practical insights to navigate this complex field.

Keywords: Biliary leak; Bile duct injury; Post-cholecystectomy; Liver transplant; Liver trauma; Endoscopic retrograde cholangiopancreatography; Sphincterotomy; Biliary stent

Core Tip: Bile leaks can occur as a complication of abdominal surgery or, less commonly, due to trauma. Timely and accurate diagnosis, along with appropriate treatment, is crucial for improving patient outcomes. With advancements in endoscopic technology and expertise, endoscopic retrograde cholangiopancreatography has emerged as the primary treatment approach, reserving surgical options for more complex or recurrent cases. However, the absence of specific guidelines means that treatment often relies on local resources and professional experience. This review seeks to clarify the role of endoscopy in managing various types of biliary leaks, offering clinicians valuable insights into navigating this challenging field.