Chloe K. Tom, MD1, Aneesa Chowdhury, MD1, Mimi Xu, MD1, Rachan Narala, MD1, Jin Sun Kim, MD1, Richard Mclean I, MD1, Denis Nguyen, MD1, Amy Chatfield, MLS2, James Buxbaum, MD, MS1 1Keck School of Medicine of USC, Los Angeles, CA; 2University of Southern California, Norris Medical Library, Los Angeles, CA
Introduction: Bile leaks are a relatively rare, yet serious complication of cholecystectomy and other types of hepatobiliary surgery. The primary treatment approach for post-operative leaks is endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. However, it is unclear whether the biliary stent must be placed crossing the leak or whether a shorter stent improving flow across the papilla is adequate. In this systematic review and meta-analysis, our goal was to provide the best comparison of the efficacy and safety of these strategies by synthesizing contemporary evidence.
Methods: In collaboration with an information specialist, we performed a systematic review and identified comparative studies of stenting across the leak site versus the papilla in PubMed and Embase from inception through January 1, 2023.
The primary outcome was the likelihood of leak resolution following the first ERCP with stent placement. The rate of adverse events which included pancreatitis, cholangitis, perforation, and bleeding was a secondary outcome. Given anticipated heterogeneity, harmonization of the data was conducted using random-effects models.
Results: We identified 5 comparative studies published between 1995 and 2017 with 82 (55.8%) patients managed by stenting across the leak site and 65 (44.2%) at the papilla. Studies included patients with bile leaks post-cholecystectomy (n=90) and other biliary surgery (liver transplant or resection) (n=57).
Stent placement across the bile leak increased the resolution of the bile leak versus the strategy of crossing the papilla only, odds ratio (OR) 4.67; 95% confidence interval (CI) 1.00-21.78. There was no difference in adverse events, OR 0.54; 95% CI 0.04-8.58.
Discussion: The results of this meta-analysis suggest ERCP with stent placement across the leak itself is the favored technique versus crossing the papilla only as it improves resolution without increased adverse events. Larger comparative and randomized trials however are needed.
Figure: Odds ratio (OR) of bile leak resolution with stent crossing the leak site versus papilla only.
Disclosures:
Chloe Tom indicated no relevant financial relationships.
Aneesa Chowdhury indicated no relevant financial relationships.
Mimi Xu indicated no relevant financial relationships.
Rachan Narala indicated no relevant financial relationships.
Jin Sun Kim indicated no relevant financial relationships.
Richard Mclean I indicated no relevant financial relationships.
Denis Nguyen indicated no relevant financial relationships.
Amy Chatfield indicated no relevant financial relationships.
James Buxbaum: Boston Scientific – Consultant. Olympus – Consultant.
Chloe K. Tom, MD1, Aneesa Chowdhury, MD1, Mimi Xu, MD1, Rachan Narala, MD1, Jin Sun Kim, MD1, Richard Mclean I, MD1, Denis Nguyen, MD1, Amy Chatfield, MLS2, James Buxbaum, MD, MS1. P3695 - Endoscopic Stenting Across the Papilla vs the Leak Site to Treat Bile Leak: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
