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Strasberg Type A biliary leak, Huge common bile duct dilation, Forward-viewing endoscope, Billroth II reconstruction, Esophageal fully-covered metal stent, Rescue therapy
Treatment of biliary leaks is challenging and complex. Even if endoscopic sphincterotomy with biliary stenting is usually resolutive in restoring the original bile flow, common bile duct (CBD) diameter is crucial in defining the size and features of the stent. Additional factors, such as uncommon anatomical reconstructions due to a previous abdominal surgery, could make the endoscopic approach more difficult, therefore increasing the risk of failure. Many articles deal with uncommon technique adopted to allow an optimal healing of biliary leaks but, thus far, only two reports of biliary stent using an esophageal through-the-scope (TTS), partially-covered, self-expandable metal stent (SEMS) exist in the current literature. This article describes the deployment of an esophageal SEMS into the CBD for a refractory type A Strasberg fistula in a Billroth-II reconstruction. To our knowledge, this is the first report concerning the use of an esophageal stent for CBD drainage in a Billroth-II reconstruction.
2) Buonocore MR, Germani U, Castellani D, et al. Timing of endoscopic therapy for acute bilio-pancreatic diseases: a practical overview. Ann Gastroenterol. 2021;34(2):125-129.
3) Chandra S, Murali AR, Masadeh M, Silverman WB, Johlin FC. Comparison of Biliary Stent versus Biliary Sphincterotomy Alone in the Treatment of Bile Leak. Dig Dis. 2020;38(1):32-37.
4) Nelson DB, Sawhney MS. Endoscopic sphincterotomy vs. stent placement for postcholecystectomy bile leak. Gastrointest Endosc. 2005 Aug;62(2):329–30.
5) Agarwal N, Sharma BC, Garg S, Kumar R, Sarin SK. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int. 2006 May;5(2):273-7.
6) Cantù P, Tenca A, Parzanese I, Penagini R. Covered metal stents in endoscopic therapy of biliary complications after liver transplantation. Dig Liver Dis. 2016 Aug;48(8):836-42.
7) Adler DG, Papachristou GI, Taylor LJ, 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):766-772.
8) 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):233-241.
9) Desai A, Twohig P, Trujillo S, Dalal S, Kochhar GS, Sandhu DS. Clinical efficacy, timing, and outcomes of ERCP for management of bile duct leaks: a nationwide cohort study. Endosc Int Open. 2021 Feb;9(2):E247-E252. doi: 10.1055/a-1322-2425. Epub 2021 Feb 3. Erratum in: Endosc Int Open. 2021 Feb;9(2):C2.
10) Dechêne A, Jochum C, Fingas C, et al. Endoscopic management is the treatment of choice for bile leaks after liver resection. Gastrointest Endosc. 2014 Oct;80(4):626–633.e1.
11) Di Lascia A, Tartaglia N, Fersini A, Petruzzelli F, Ambrosi A. Endoscopy for treating minor post-cholecystectomy biliary fistula A review of the literature. Ann Ital Chir. 2018;89:270-277. PMID: 30588923.
12) Pinkas H, Brady PG. Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int. 2008 Dec;7(6):628-32. PMID: 19073409.
13) Chinnery GE, Krige JE, Bornman PC, et al. Endoscopic management of bile leaks after laparoscopic cholecystectomy. S Afr J Surg. 2013 Oct 25;51(4):116-21. doi: 10.7196/sajs.1829. PMID: 24209694.
14) Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg. 2014 Aug;18(3):69-72.
15) Mutignani M, Dioscoridi L, Dokas S, et al. Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure. World J Gastrointest Endosc. 2016 Aug 10;8(15):533-40.
16) Desai A, Kumta NA, Reinoso PJ Jr, Tyberg A, Kahaleh M. Use of an esophageal stent for successful treatment of significant choledocholithiasis to facilitate direct cholangioscopy. Gastrointest Endosc. 2016 Oct;84(4):730.
17) Karia K, Tyberg A, Rodarte-Shade M, Zerbo S, Sharaiha RZ, Kahaleh M. Successful decompression of a massively dilated bile duct by use of a through-the-scope esophageal stent. Gastrointest Endosc. 2015 Apr;81(4):999.
18) Park TY, Bang CS, Choi SH, et al. Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis. Surg Endosc. 2018 Nov;32(11):4598-4613..
19) Park TY, Song TJ. Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review. World J Gastroenterol. 2019 Jun 28;25(24):3091-3107.
20) Coşkun O, Ödemiş B. A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. Surg Endosc. 2020 Aug 28.
21) Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy. 1997 Feb;29(2):82-5.