Outcome Of Ercp Intervention In The Management Of Postoperative Biliary Leakage

Background/Aim: Biliary leakage is a well‑known complication of cholecystectomy, which may be associated with considerable morbidity and mortality. The study's objective is to assess the location of the biliary leak and the outcome of endoscopic treatment for biliary leakage that occurs after surgery. Method: It is an observational cross-sectional prospective study conducted in a tertiary care center, between January, 2021 to March, 2023, in the Department of Gastroenterology, Gauhati Medical College and Hospital, Assam. Out of total 53 patients, 51patients of postoperative biliary leakage underwent endoscopic retrograde cholangiopancreatography (ERCP) with CBD stenting. Patients with biliary strictures were excluded from the study. All the patients were followed up after the procedure to look for clinical improvement (cessation of bile output from drain, absence of symptoms, improvement in liver function tests) which was confirmed after 8 weeks by absence of biliary leak in repeat ERCP followed by removal of CBD stent. Results: Patients aged between 31 to 40 years constituted the majority of our study cohort, representing 45.10% of the total. The female population demonstrated a higher susceptibility to post-cholecystectomy biliary leakage, accounting for 56.90% of cases. Among the various clinical manifestations, abdominal pain was predominant, noted in 64.7% of patients, closely followed by abdominal distension in 70.6%. The ERCP intervention stood out as an efficacious therapeutic strategy, resolving biliary leakage in an impressive 92.1% of patients. Notably, the most frequent site of leakage was identified as the cystic duct stump, accounting for 31.4% of cases. The study revealed that ERCP within the first week post-cholecystectomy had a slightly higher success rate of 93.3% compared to 90.5% in delayed interventions, although this was not statistically significant (p=0.77). The study underscores that males have a significant 1.68 times higher odds of successful ERCP outcomes, and interventions conducted within 7 days post-cholecystectomy are associated with a substantial increase in success (OR: 0.51) compared to delayed procedures. Conclusion: Biliary leak is more frequent after laparoscopic than open cholecystectomy. Earlier endoscopic intervention shows significant and higher success rate.