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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Optimal timing of endoscopic biliary drainage for bile duct leaks: A multicenter, retrospective, clinical study
De-Xin Chen, Kai-Xuan Fang, Sheng-Xin Chen, Sen-Lin Hou, Gui-Hai Wen, Hai-Kun Yang, Da-Peng Shi, Qing-Xin Lu, Ya-Qi Zhai, Ming-Yang Li
De-Xin Chen, Kai-Xuan Fang, Sheng-Xin Chen, Ya-Qi Zhai, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
De-Xin Chen, Kai-Xuan Fang, Graduate School, Chinese PLA General Hospital, Beijing 100853, China
Kai-Xuan Fang, Department of Gastroenterology and Hepatology, The 960th Hospital of PLA, Jinan 050035, Shandong Province, China
Sen-Lin Hou, Department of Gastroenterology and Hepatology, The Second Hospital of Hebei Medical University, Hebei 050035, China
Gui-Hai Wen, Department of Gastroenterology and Hepatology, Handan Central Hospital, Hebei 056001, China
Hai-Kun Yang, Department of Gastroenterology and Hepatology, Shanxi Provincial People’s Hospital, Shanxi 030012, China
Da-Peng Shi, Department of Gastroenterology and Hepatology, First Affiliated Hospital of Army Medical University of PLA, Chongqing 400042, China
Qing-Xin Lu, Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Army Medical University of PLA, Chongqing 400042, China
Ming-Yang Li, Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: De-Xin Chen and Kai-Xuan Fang.
Co-corresponding authors: Ya-Qi Zhai and Ming-Yang Li.
Author contributions: Chen DX and Fang KX contributed to analysis, interpretation of data, drafting the article, they contributed equally to this article, they are the co-first authors of this manuscript; Chen SX, Hou SL, Wen GH, Yang HK, Shi DP, and Lu QX contributed to acquisition of data; Li MY is designated as the primary contact for all correspondence with the journal; Zhai YQ and Li MY contributed to revising, editing and drafting article, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
Supported by the National Key Research and Development Program, China, No. 2022YFC2503603.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the General Hospital of the People’s Liberation Army, approval No. S2023-067-01.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data sets used and analyzed during the current study are available from the corresponding author at
mingyangli_pla@163.com.
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: Ming-Yang Li, MD, PhD, Chief Physician, Department of Gastro
enterology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
mingyangli_pla@163.com
Received: July 22, 2024
Revised: January 14, 2025
Accepted: February 5, 2025
Published online: March 27, 2025
Processing time: 216 Days and 16.7 Hours
BACKGROUND
Bile duct leaks (BDLs) are serious postsurgical adverse events. Typically, conservative management with abdominal drainage is the initial treatment option. However, prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography (ERCP).
AIM
To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable, balancing ERCP success and the risk of biliary strictures.
METHODS
We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022. The patients were divided into four groups based on the timing of ERCP: 3 days, 7 days, 14 days, and 21 days. The primary outcome was clinical success, defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage, surgery, or death. The secondary outcome was incidence of biliary strictures. Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.
RESULTS
In a cohort of 448 consecutive patients diagnosed with BDLs, 354 were excluded, leaving 94 patients who underwent ERCP. Clinical success was achieved in 84% of cases (79/94), with a median ERCP timing of 20 days (9.5-35.3 days). Biliary strictures were identified in 29 (30.9%) patients. Performing ERCP within 3 weeks, compared to after 3 weeks, was associated with higher success rates [92.0% (46/50) vs 75.0% (33/44), P = 0.032] and a lower incidence of biliary stricture incidence [18.0% (9/50) vs 45.5% (20/44), P = 0.005]. Subsequent multivariate analysis confirmed the association with higher success rates (odds ratio = 4.168, P = 0.045) and lower biliary stricture rates (odds ratio = 0.256, P = 0.007).
CONCLUSION
Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate. If patients with BDLs do not respond to conservative treatment, ERCP is suggested to be performed within 3 weeks.
Core Tip: In this multicenter study, 94 patients with bile duct leaks who underwent endoscopic retrograde cholangiopancreatography (ERCP) were retrospectively analyzed. We found that performing ERCP within 3 weeks was associated with higher success rates and a lower incidence of biliary stricture than later interventions. Multivariate analysis confirmed that early ERCP was a key factor for improved outcomes. If patients with bile duct leaks do not respond to conservative treatment, ERCP is suggested to be performed within 3 weeks.
