Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy. Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP). Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87% of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13% (8/61). Leak resolution was evident at first follow-up ERCP in 96% of subjects (26/27) who had undergone total cholecystectomy and 91% of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96% (23/24) of those who had undergone total cholecystectomy and 90% (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62). Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.