What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy?

Background and Study Aims: This study was carried out to establish the indications for biliary endoscopy due to biliary complications after laparoscopic cholecystectomy (LC). Patients and Methods: One hundred nineteen patients (36 men, 86 women; median age 59, range 16-93) were referred for endoscopic retrograde cholangiopancreatography (ERCP) to five centers between 1990 and 1994, and included in the study. The delay between LC and ERCP was 105+/-21 days. Results: Four types of complications were observed, a) Fifty-seven patients had residual stones or clip migration into the common bile duct (CBD); all were successfully treated with endoscopic sphincterotomy (ES), b) Twelve major injuries to the CBD were diagnosed by ERCP; successful surgical repair was carried out in most of these cases, c) Twenty patients had a partial biliary structure; endoscopic stenting was attempted as a primary procedure in eight patients, with a satisfactory outcome in five (63%), d) Thirty patients had a bile leak; endoscopic therapy (26 patients) led to recovery in 18 (69%), The benefit of endoscopic treatment was less clear in five (19%); ES failed to bring about improvement in three patients (12 %). Conclusions: ERCP is indicated when a biliary complication is suspected after laparoscopic cholecystectomy Endoscopic sphincterotomy is effective for the treatment of retained stones, clip migration, and bile leakage, Endoscopic stenting may be offered as a primary option in partial CBD strictures.