Endoscopic management of bile duct leaks: Current strategies and controversies

Figure 1 Strasberg and Bismuth classification of bile duct injuries. Type A: Bile leak from a cystic duct stump or Luschka’s duct; Type B: Occlusion of the right posterior sectoral duct; Type C: Bile leak from a transected right posterior sectoral duct; Type D: Bile leak from the main bile duct involving < 50% of its circumference; Type E1: Transection of the main bile duct with a stricture located > 2 cm from the hepatic hilum; Type E2: Stricture located < 2 cm from the hilum; Type E3: Hilar stricture with preserved communication between the right and left hepatic ducts; Type E4: Hilar stricture with complete separation of the right and left hepatic ducts; Type E5: Combined stricture involving the main bile duct and the right posterior sectoral duct. Types E1-E5 correspond to Bismuth types I-V.

Figure 2 Suggested treatment algorithm for bile duct leak. BDL: Bile duct leak; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy; MPS: Multiple plastic stents; FCSEMS: Fully covered self-expandable metal stents.