{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:29:07Z","timestamp":1760524147240},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Endoscopic retrograde cholangiopancreatography (ERCP) can safely and effectively manage postsurgical or traumatic bile duct leaks (BDLs). Standardized guidelines are lacking regarding effective management of BDLs. Our aim was to evaluate the efficacy, clinical outcomes, and complications of different ERCP techniques and intervention timing using a nationwide database. <\/jats:p><jats:p>\n          Patients and methods\u2002We performed a retrospective analysis of the IBM Explorys database (1999\u20132019), a pooled, national, de-identified clinical database of over 64 million unique patients across the United States. ERCP timing after BDL was classified as emergent (&lt;\u200a1 day), urgent (1\u20133 days) or expectant (&gt;\u200a3 days). ERCP technique was classified into sphincterotomy, stent or combination therapy. ERCP complications were defined as pancreatitis, duodenal perforation, duodenal hemorrhage, and ascending cholangitis within 7 days of the procedure. <\/jats:p><jats:p>\n          Results\u2002Expectant ERCP had a decreased risk of adverse events (AEs) compared to emergent and urgent ERCP (P\u200a=\u200a0.004). Rehospitalization rates also were lower in expectant ERCP (P\u200a&lt;\u200a0.001). Patients with COPD were more likely to have an AE if the ERCP was performed emergently compared to expectantly (P\u200a=\u200a0.002). Combination therapy had a lower rate of ERCP failure compared to placement of a biliary stent (P\u200a=\u200a0.02). There was no statistically significant difference in rates of ERCP failure between biliary stent and sphincterotomy (P\u200a=\u200a0.06) or sphincterotomy and combination therapy (P\u200a=\u200a0.74).<\/jats:p><jats:p>\n          Conclusion\u2002Our study suggests that ERCP does not need to be performed emergently or urgently for management of BDLs. Combination therapy is superior to stenting but not  sphincterotomy; however, future prospective studies are needed to validate these findings.<\/jats:p>","DOI":"10.1055\/a-1322-2425","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:53:45Z","timestamp":1612400025000},"page":"E247-E252","source":"Crossref","is-referenced-by-count":8,"title":["Clinical efficacy, timing, and outcomes of ERCP for management of bile duct leaks: a nationwide cohort study"],"prefix":"10.1055","volume":"09","author":[{"given":"Aakash","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Twohig","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaman","family":"Dalal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gursimran S.","family":"Kochhar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dalbir S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States"},{"name":"Division of Gastroenterology, Hepatology & Nutrition, Digestive Disease and SurgeryInstitute, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.gie.2016.08.018","article-title":"Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: A large multicenter study","volume":"85","author":"D G Adler","year":"2017","journal-title":"Gastrointest Endoscop"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1055\/a-0835-5940","article-title":"Endoscopic management of biliary leaks: A systematic review with meta-analysis","volume":"51","author":"K Vlaemynck","year":"2019","journal-title":"Endoscopy"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s10620-017-4768-7","article-title":"Endoscopic therapy of biliary injury after cholecystectomy","volume":"63","author":"M Rainio","year":"2018","journal-title":"Dig Dis Sci"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.gie.2019.03.1173","article-title":"Endoscopic management of postcholecystectomy biliary leak: When and how? A nationwide study.","volume":"90","author":"A Abbas","year":"2019","journal-title":"Gastrointest Endoscop"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07472-0","article-title":"Endoscopic treatment of post-cholecystectomy bile leaks: a tertiary center experience","author":"H Haidar","year":"2020","journal-title":"Surg Endosc"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1159\/000499872","article-title":"Comparison of biliary stent versus biliary sphincterotomy alone in the treatment of bile leak","volume":"38","author":"S Chandra","year":"2020","journal-title":"Dig Dis"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S0016-5107(98)70086-0","article-title":"Long-term consequence of endoscopic sphincterotomy for bile duct stones","volume":"48","author":"M Tanaka","year":"1998","journal-title":"Gastrointest Endosc"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1111\/j.1572-0241.2002.07019.x","article-title":"Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study","volume":"97","author":"M Sugiyama","year":"2002","journal-title":"Am J Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S0016-5107(98)70085-9","article-title":"Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. 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