{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:20:55Z","timestamp":1789762855005,"version":"4.0.1"},"reference-count":25,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["GE Port J Gastroenterol"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>Postcholecystectomy leaks may occur in 0.3\u20132.7% of patients. Bile leaks associated with laparoscopy are often more complex and difficult to treat than those occurring after open cholecystectomy. Furthermore, their incidence has remained unchanged despite improvements in laparoscopic training and technological developments. The management of biliary leaks has evolved from surgery into a minimally invasive endoscopic procedural approach, namely, endoscopic retrograde cholangiopancreatography (ERCP), which decreases or eliminates the pressure gradient between the bile duct and the duodenum, thus creating a preferential transpapillary bile flow and allowing the leak to seal. For simple leaks, the success rate of endotherapy is remarkably high. However, there are more severe and complex leaks that require multiple endoscopic interventions, and clear strategies for endoscopic treatment have not emerged. Therefore, there is still some debate regarding the optimal time point at which to intervene, which technique to use (sphincterotomy alone or in association with the placement of stents, whether metallic or plastic stents should be used, and, if plastic stents are used, whether they should be single or multiple), how long the stents should remain in place, and when to consider treatment failure. Here, we review the types and classification of postoperative biliary injuries, particularly leaks, as well as the evidence for endoscopic treatment of the latter. <\/jats:p>","DOI":"10.1159\/000511527","type":"journal-article","created":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T22:03:32Z","timestamp":1607465012000},"page":"265-273","source":"Crossref","is-referenced-by-count":34,"title":["Endoscopic Treatment of Post-Cholecystectomy Biliary Leaks"],"prefix":"10.1159","volume":"28","author":[{"given":"Ricardo","family":"Rio-Tinto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Canena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Canena J, Horta D, Coimbra J, Meireles L, Russo P, Marques I, et al. Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients. BMC Gastroenterol. 2015 Aug;15(1):105.","DOI":"10.1186\/s12876-015-0334-y"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Sandha GS, Bourke MJ, Haber GB, Kortan PP. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc. 2004 Oct;60(4):567\u201374.","DOI":"10.1016\/S0016-5107(04)01892-9"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Canena J, Liberato M, Horta D, Rom\u00e3o C, Coutinho A. Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations. Surg Endosc. 2013 Jan;27(1):313\u201324.","DOI":"10.1007\/s00464-012-2368-3"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Abbas A, Sethi S, Brady P, Taunk P. Endoscopic management of postcholecystectomy biliary leak: when and how? A nationwide study. Gastrointest Endosc. 2019 Aug;90(2):233\u2013241.e1.","DOI":"10.1016\/j.gie.2019.03.1173"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg. 2014 Aug;18(3):69\u201372.","DOI":"10.14701\/kjhbps.2014.18.3.69"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Baron TH, Poterucha JJ. Insertion and removal of covered expandable metal stents for closure of complex biliary leaks. Clin Gastroenterol Hepatol. 2006 Mar;4(3):381\u20136.","DOI":"10.1016\/j.cgh.2005.11.001"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. 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Gut. 2007 Nov;56(11):1599\u2013605.","DOI":"10.1136\/gut.2007.123596"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"McMahon AJ, Fullarton G, Baxter JN, O\u2019Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg. 1995 Mar;82(3):307\u201313.","DOI":"10.1002\/bjs.1800820308"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Bektas H, Schrem H, Winny M, Klempnauer J. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg. 2007 Sep;94(9):1119\u201327.","DOI":"10.1002\/bjs.5752"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Adler DG, Papachristou GI, Taylor LJ, McVay T, Birch M, Francis G, et al. Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. Gastrointest Endosc. 2017 Apr;85(4):766\u201372.","DOI":"10.1016\/j.gie.2016.08.018"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Bhattacharjya S, Puleston J, Davidson BR, Dooley JS. Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endosc. 2003 Apr;57(4):526\u201330.","DOI":"10.1067\/mge.2003.148"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Dolay K, Soylu A, Aygun E. The role of ERCP in the management of bile leakage: endoscopic sphincterotomy versus biliary stenting. J Laparoendosc Adv Surg Tech A. 2010 Jun;20(5):455\u20139.","DOI":"10.1089\/lap.2009.0308"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Rainio M, Lindstr\u00f6m O, Udd M, Haapam\u00e4ki C, Nordin A, Kyl\u00e4np\u00e4\u00e4 L. Endoscopic Therapy of Biliary Injury After Cholecystectomy. Dig Dis Sci. 2018 Feb;63(2):474\u201380.","DOI":"10.1007\/s10620-017-4768-7"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Mavrogiannis C, Liatsos C, Papanikolaou IS, Karagiannis S, Galanis P, Romanos A. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study. Eur J Gastroenterol Hepatol. 2006 Apr;18(4):405\u20139.","DOI":"10.1097\/00042737-200604000-00014"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Haidar H, Manasa E, Yassin K, Suissa A, Kluger Y, Khamaysi I. Endoscopic treatment of post-cholecystectomy bile leaks: a tertiary center experience. Surg Endosc. 2020. DOI: 10.1007\/s00464-020-07472-0.","DOI":"10.1007\/s00464-020-07472-0"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc. 2005 Feb;61(2):269\u201375.","DOI":"10.1016\/S0016-5107(04)02468-X"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Vlaemynck K, Lahousse L, Vanlander A, Piessevaux H, Hindryckx P. Endoscopic management of biliary leaks: a systematic review with meta-analysis. Endoscopy. 2019 Nov;51(11):1074\u201381.","DOI":"10.1055\/a-0835-5940"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Germanidis G, Zavos C, et al. A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc. 2008 Jan;22(1):101\u20136.","DOI":"10.1007\/s00464-007-9381-y"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Sachdev A, Kohli D. A prospective randomized study comparing different endoscopic techniques for treating biliary leaks. Gastrointest Endosc. 2012;75(4):AB374\u20135.","DOI":"10.1016\/j.gie.2012.03.987"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Wang AY, Ellen K, Berg CL, Schmitt TM, Kahaleh M. Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data - a case series. Endoscopy. 2009 Sep;41(9):781\u20136.","DOI":"10.1055\/s-0029-1215050"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Canena J, Liberato M, Meireles L, Marques I, Rom\u00e3o C, Coutinho AP, et al. A Non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks submitted to endoscopic management using multiple plastic stents or fully covered self-expandable metal stents. Gastrointest Endosc. 2015;82:70\u20138.","DOI":"10.1016\/j.gie.2014.11.038"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Kasher JA, Corasanti JG, Tarnasky PR, McHenry L, Fogel E, Cunningham J. A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP. 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