BIODEGRADABLE BILIARY STENTS ARE A USEFUL TOOL IN ENDOSCOPIC TREATMENT OF BILE LEAKS

Introduction

Biodegradable biliary stents (BDBS) have been introduced in the last few years and studies have shown them to be beneficial in the endoscopic treatment of bile leaks¹ as it could avoid a repeat ERCP for traditional stent removal. This could be useful in the current climate where access to endoscopy is yet to fully return to pre-pandemic levels. We conducted a multi-tertiary-centre retrospective study looking at outcomes of endoscopic management for post-cholecystectomy bile leaks.

Methods

All ERCPs performed between 01/01/2020 and 31/12/2021 were reviewed and all cases of bile leaks post-cholecystectomy were included. Patient records and endoscopy reports were analysed.

Results

A total of 52 patients (median age 56.5 ± 19y, 30 females) with post-cholecystectomy bile leak were referred for ERCP. Treatment included endoscopic sphincterotomy (ES) alone (6); plastic stent (PS) alone (13) or with ES (22); metal stent (SEMS) alone (1) or with ES (1); BDBS with ES (9). ES alone with duct clearance was performed in cases where no high grade leak was seen, minimal drain output and choledocholithiasis was deemed to be the cause of the leak. All patients with temporary stent placement had a repeat ERCP for removal apart from one who refused and another who was intentionally not repeated due to frailty. Four patients needed 3 ERCPs for on-going leak but none in the BDBS group. Bile leak resolved in all endoscopically treated patients. No severe complications were observed.

Conclusions

BDBS offers a safe and useful alternative to traditional plastic stents for the endoscopic management of post-cholecystectomy bile leaks. Benefits include reducing the risks associated with repeat endoscopy, exposure to hospital environments, redistribution of limited resources and minimising patient cost (time off work, travel and aftercare arrangements). Although our numbers are small, our data indicates the potential cost savings of BDBS.

References

Siiki, A., Vaalavuo, Y., Antila, A., Ukkonen, M., Rinta-Kiikka, I., Sand, J. and Laukkarinen, J. 2018. Biodegradable biliary stents preferable to plastic stent therapy in post-cholecystectomy bile leak and avoid second endoscopy. Scandinavian Journal of Gastroenterology, 53(10-11), 1376-1380.