Optimal timing of endoscopic biliary drainage for bile duct leaks:A multicenter,retrospective,clinical study  

作　　者：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 

机构地区：[1]Department of Gastroenterology and Hepatology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China [2]Graduate School,Chinese PLA General Hospital,Beijing 100853,China [3]Department of Gastroenterology and Hepatology,The 960th Hospital of PLA,Jinan 050035,Shandong Province,China [4]Department of Gastroenterology and Hepatology,The Second Hospital of Hebei Medical University,Hebei 050035,China [5]Department of Gastroenterology and Hepatology,Handan Central Hospital,Hebei 056001,China [6]Department of Gastroenterology and Hepatology,Shanxi Provincial People’s Hospital,Shanxi 030012,China [7]Department of Gastroenterology and Hepatology,First Affiliated Hospital of Army Medical University of PLA,Chongqing 400042,China [8]Department of Gastroenterology and Hepatology,Second Affiliated Hospital of Army Medical University of PLA,Chongqing 400042,China [9]Department of Gastroenterology,Chinese PLA General Hospital,Beijing 100853,China

出　　处：《World Journal of Gastrointestinal Surgery》2025年第3期139-149,共11页世界胃肠外科杂志(英文)

基　　金：Supported by the National Key Research and Development Program,China,No.2022YFC2503603.

摘　　要：BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal 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

关 键 词：Endoscopic retrograde cholangiopancreatography Bile duct leaks Endoscopic nasobiliary drainage Endoscopic biliary stent drainage Optimal timing Biliary stricture 

分 类 号：R65[医药卫生—外科学]