E0007 - Management of Post-Cholecystectomy Bile Leaks: Predictors for Persistent Leak After Initial ERCP

Mingjun Song, MD¹, Setarah Mohammad Nader, MD¹, Stuart Sherman, MD¹, Evan Fogel, MSc, MD², Mark A. Gromski, MD¹, James Watkins, MD², Jeffrey J. Easler, MD², Aditya Gutta, MD², Yan Tong, PhD², Benjamin Lo Bick, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Indiana University, Indianapolis, IN

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a 1^st-line treatment for post-cholecystectomy bile leaks (PCBL). Despite appropriate initial ERCP interventions that optimize transpapillary bile flow, PCBL can persist. We aim to evaluate baseline clinical factors associated with persistent PCBL after initial ERCP.

Methods: We created a retrospective database of patients with PCBL referred for ERCP at Indiana University Health (IUH) University Hospital. Data collected included endoscopic reports, fluoroscopic imaging, patient demographics, type of PCBL, ERCP timing and interventions, technical success, and treatment outcomes. A high-grade bile leak (HG-BL) was defined as visualization of contrast extravasation from the bile duct before filling of intrahepatic biliary branches with contrast. The PCBL was deemed to be persistent if > 1 interventional ERCP was required for the leak to resolve on cholangiogram.

Results: From 2011 to 2021, 369 cases of PCBL were referred for ERCP. After excluding cases with transected bile ducts (n=21) and patients lost to follow up (n=15), 333 cases were included in data analysis (Image 1). 21 patients received their initial ERCP at an outside hospital. All patients received biliary sphincterotomy with stenting unless there was coagulopathy or Roux-en-Y gastric bypass (n=12). Univariate logistic regression analysis identified male gender, steroids use at time of ERCP, presence of duodenal stricture, a HG-BL, Strasberg class D PCBL, presence of biloma, presence of abdominal drain, presence of biliary stricture, and initial ERCP performed at outside hospital to be significant variables for persistent PCBL (Table 1). On multivariate analysis, presence of a HG-BL (OR 7.08, CI 1.96 – 25.58, p = 0.003) and initial ERCP performed at an outside facility (OR 29.14, CI 3.35 – 253.63, p=0.002) remained significantly associated with persistent PCBL. Being a female gender (OR 0.30, CI 0.11 – 0.85, P = 0.022) remained significant for higher odds of PCBL resolution after initial ERCP.

Discussion: Our study suggests that a HG-BL in a male patient may justify more aggressive ERCP interventions or more prolonged stent indwell time. As a tertiary referral hospital, we had a significant referral bias in our cohort, which could have acted as a confounder causing statistical significance for lower initial ERCP success rates at outside medical facilities. The relatively high volume of ERCP cases at our center may also have contributed to better ERCP outcomes.




Disclosures:


Mingjun Song, MD¹, Setarah Mohammad Nader, MD¹, Stuart Sherman, MD¹, Evan Fogel, MSc, MD², Mark A. Gromski, MD¹, James Watkins, MD², Jeffrey J. Easler, MD², Aditya Gutta, MD², Yan Tong, PhD², Benjamin Lo Bick, MD¹. E0007 - Management of Post-Cholecystectomy Bile Leaks: Predictors for Persistent Leak After Initial ERCP, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.