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Original Article
Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center
Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia
Clin Endosc 2020;53(6):727-734.   Published online August 21, 2020
AbstractAbstract PDFPubReaderePub
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.


Citations to this article as recorded by  
  • A critical appraisal of the ISGLS definition of biliary leakage after liver resection
    Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
    Langenbeck's Archives of Surgery.2023;[Epub]     CrossRef
  • Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
    燕泽 林
    Advances in Clinical Medicine.2023; 13(03): 4013.     CrossRef
  • Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study
    Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
    Journal of Trauma and Acute Care Surgery.2022; 93(6): 813.     CrossRef
  • Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
    Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
    Medicine.2021; 100(46): e27877.     CrossRef
  • The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
    Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
    Clinical Endoscopy.2020; 53(6): 633.     CrossRef
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Case Report
Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer
Joon Seop Lee, Yong Hwan Kwon
Clin Endosc 2019;52(6):620-623.   Published online July 30, 2019
AbstractAbstract PDFPubReaderePub
Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4- cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.
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A Case of Steroid Treated Amebic Colitis Misdiagnosed as Eosinophilic Colitis
Eun Sun Cheong, M.D., Yun Ju Jo, M.D., Sang Bong An, M.D., Seong Hwan Kim, M.D., Young Sook Park, M.D., Won Mi Lee, M.D.* and Young Ok Hong, M.D.*
Korean J Gastrointest Endosc 2011;43(1):42-46.   Published online July 28, 2011
AbstractAbstract PDF
Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection. (Korean J Gastrointest Endosc 2011;43:42-46)
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A Case of Liver Abscess Associated with Duodenal Perforation by a Toothpick
Sang Jun Park, M.D., Chang Goo Lee, M.D., Sang Eok Kim, M.D., Jung Hyun Kim, M.D., Kwang Hee Lee, M.D., Ki Yong Kim, M.D., Jin Woo Yun, M.D. and Sun Young Kim, M.D.*
Korean J Gastrointest Endosc 2008;36(6):390-394.   Published online June 30, 2008
AbstractAbstract PDF
The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature. (Korean J Gastrointest Endosc 2008;36:390-394)
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A Case of Liver Abscess Caused by Toothpick Penetrating Gastric Wall
Hyun Cheol Koo, M.D., Jae Pil Han, M.D., Ick Keun Kim, M.D., In Il Park, M.D., Jue Yong Lee, M.D., Kyung Min Sohn, M.D., Kwang Ho Baik, M.D., Jin Bong Kim, M.D. and Dong Jun Kim, M.D.
Korean J Gastrointest Endosc 2006;33(2):94-99.   Published online August 30, 2006
AbstractAbstract PDF
The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare. (Korean J Gastrointest Endosc 2006;33:94⁣99)
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화농성 간농양 환자에서 내시경적 역행성 담도 조영술의 유용성에 관한 연구 ( A Study on the Usefulness of ERCP in Patients with Pyogenic Liver Abscess )
Korean J Gastrointest Endosc 2000;20(2):113-118.   Published online November 30, 1999
AbstractAbstract PDF
/Aims : This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. Methods: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69:1, and the peak incidence was in the sixth decade. Results : The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. Conclusions : The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess. (Korean J Gastrointest Endosc 2000;20:113-118)
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증례 : 화농성 심낭염 , 간농양 및 농흉을 야기한 총담관 거대결석 치유 1예 ( Case Reports : A Case of Large Bile Duct Stones Complicated by Pyogenic Pericarditis , Liver Abscess , and Pyothorax )
Korean J Gastrointest Endosc 1994;14(3):380-385.   Published online November 30, 1993
AbstractAbstract PDF
The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
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  • 1 Download
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