caa a22 4500 445796766 CHVBK 20180317145128.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s10620-010-1448-2 doi (NATIONALLICENCE)springer-10.1007/s10620-010-1448-2 Role of Symptoms, Trend of Liver Tests, and Endotherapy in Management of Post-Cholecystectomy Biliary Leak [Elektronische Daten] [P. Cantù, A. Tenca, C. Caparello, A. Grigolon, L. Piodi, I. Bravi, E. Avesani, D. Conte, R. Penagini] Aim: Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak. Materials and Methods: Twenty-one patients (8M, 26-77years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients. Results: Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n=10), accessory duct (n=4), or cystic duct stump (n=3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n=8), stone (n=2), or cholangiocarcinoma (n=1) and underwent stenting (n=4), naso-biliary drainage, NBD (n=3), or surgery (n=4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic. Conclusions: Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes. Springer Science+Business Media, LLC, 2010 ERCP nationallicence Biliary leak nationallicence Stenting nationallicence Naso-biliary drainage nationallicence ERCP : Endoscopic retrograde cholangiopancreatography nationallicence LTs : Liver tests nationallicence NBD : Naso-biliary drainage nationallicence Cantù P. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Tenca A. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Caparello C. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Grigolon A. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Piodi L. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Bravi I. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Avesani E. Department of Emergency Surgery, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Conte D. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Penagini R. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/5(2011-05-01), 1565-1571 0163-2116 56:5<1565 2011 56 10620 https://doi.org/10.1007/s10620-010-1448-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-010-1448-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Cantù P. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Tenca A. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Caparello C. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Grigolon A. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Piodi L. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Bravi I. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Avesani E. Department of Emergency Surgery, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Conte D. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 700 1- Penagini R. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/5(2011-05-01), 1565-1571 0163-2116 56:5<1565 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer