Comment on: our experience with ERCP (endoscopic retrograde cholangiopancreatography) as the first line treatment for simple bile duct leakage

Letter to the Editor

To the Editor,I read with interest the article titled “Our experiences with ERCP (endoscopic retrograde cholangiopancreatography) as first-line treatment for simple bile duct leakage” by Aydogdu at al, and I would like to share my comments on the study results.¹ ERCP (Endoscopic Retrograde Cholangiography) is an advanced endoscopy method used in the treatment of benign and malignant diseases of the biliary tract and pancreatic duct.² Biliary tract injury is a rare but serious complication after surgery and its incidence has been reported to increase especially after the widespread use of laparoscopic cholecystectomy.³ In patients with biliary injury, the volume, size, and location of the leak are determined by the cholangiogram taken during the ERCP procedure. The stent size and type are determined according to the leak location.⁴ The most important cause of procedure failure in biliary leakage is the stent that does not reach the leak site. In this study, 35 of 39 patients with the same type of injury improved after stenting, but four patients did not. Since the type, length, diameter, and number of stents implanted were not specified in the article, it is likely that all of these patients were implanted with standard stents, and four patients failed for this reason. In these four patients, a second procedure performed by experienced endoscopists after the failed ERCP procedure would have been a more appropriate method before surgery. This could have included placing a longer stent proximal to the bile leak, additional stents to prevent migration or the application of a metallic stent.

References

1. Aydoğdu YF, Akay T, Çalta AF, Duran A, Oğuz S. Our experience with ERCP as the first-line treatment for simple bile duct leakage. Ann Clin Anal Med. 2024;15(2):122-125. doi:10.4328/acam.22019
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2. Chen JH, Wang HP. Endoscopic retrograde cholangiopancreatography training and education. Dig Endosc. 2024;36(1):74-85. doi:10.1111/den.14702
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3. Connor S, Garden O. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006;93(2):158-168. doi:10.1002/bjs.5266
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4. Carr-Locke AD. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy bile leaks. Eur J Gastroenterol Hepatol. 2006;18(10):1053-1055. doi:10.1097/01.meg.0000231751.50587.75
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