Tringali A, Costa D, Ramai D. Endoscopic management of biliary leaks: Where are we now? World J Gastrointest Endosc 2025; 17(7): 107587 [DOI: 10.4253/wjge.v17.i7.107587]
Corresponding Author of This Article
Alberto Tringali, MD, Honorary Research Fellow, Lecturer, Department of Digestive Endoscopy and Gastroenterology, ULSS2, Conegliano Hospital, Via Brigata Bisagno, Conegliano 31015, Italy. albtri10@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 107587 Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.107587
Endoscopic management of biliary leaks: Where are we now?
Alberto Tringali, Deborah Costa, Daryl Ramai
Alberto Tringali, Deborah Costa, Department of Digestive Endoscopy and Gastroenterology, ULSS2, Conegliano Hospital, Conegliano 31015, Italy
Daryl Ramai, Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, MA 02115, United States
Author contributions: Tringali A conceived the idea for the manuscript; Tringali A and Costa D reviewed the literature and drafted the manuscript; Ramai D reviewed the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflicts of interest relevant to the content of this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alberto Tringali, MD, Honorary Research Fellow, Lecturer, Department of Digestive Endoscopy and Gastroenterology, ULSS2, Conegliano Hospital, Via Brigata Bisagno, Conegliano 31015, Italy. albtri10@gmail.com
Received: March 31, 2025 Revised: April 17, 2025 Accepted: May 21, 2025 Published online: July 16, 2025 Processing time: 102 Days and 16 Hours
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.
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.
