Endoscopic management of post-cholecystectomy complications: Experience of Endoscopic Retrograde Cholangioprancreaticography (ERCP) at a tertiary care referral center
Arif Amir Nawaz, Shahid Sarwar, Khubaib Shahid, Waqas Iqbal, Atiqa Batul M, Salwa Hussain, Zarmeena Aly.
To study the the short and long term role of ERCP in management of patients with post-cholecystectomy complications.
Patients and Methods
Patients with post-cholecystectomy complications including abdominal distension, fever, and jaundice were included. All underwent ERCP followed by therapeutic intervention, as was indicated. They were followed for up to six months to assess the effectiveness of intervention, any procedure related complication and morbidity/ mortality.
Total of 59 patients with female to male ratio 3.92 (47/12) were included with majority in 20-60 years age group. Jaundice, abdominal pain and abdominal distension were major symptoms. Predominant post-cholecystectomy complications included were choloedocholithiasis in 16 (27%), Biliary leak in 16 (27%), biliary stricture in 11 (19%) patients and CBD ligation in 9 (15%) patients. Endoscopic CBD stone extraction was possible in 14/16 patients (88%) of choledocholithiasis, while sphincterotomy with or without stenting was done in 13(81%) patients with biliary leak. Dilatation and stenting was possible in 6/11(55%) patients with biliary channel stricture while none of the 9 patients with CBD ligation was amenable to endoscopic therapy. Long-term follow-up in 25 patients revealed highly successful outcome of endoscopic therapy.
Retained CBD stones, biliary leaks, biliary strictures and CBD ligation were predominant post-cholecystectomy complications and ERCP was an effective mode of treatment for them with good long term outcome except for complete CBD ligation and to some extent CBD strictures. (Rawal Med J 2011;36:79-82).
Biliary fistula, biliary stricture, ERCP, post-cholecystectomy.