Recanalization of the bile duct by using percutaneous and endoscopic methods after iatrogenic injury

Post written by Arjun R. Sondhi, MD, from the Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.

An 87-year-old man who suffered a complete common bile duct (CBD) transection after a cholecystectomy presented to our institution for care. To treat his bile leak, we used a combined interventional radiology approach (percutaneous transhepatic biliary drain) and endoscopic approach (ERCP with cholangioscopy) to recanalize the bile duct and avoid long-term percutaneous biliary drainage or a significant surgical intervention. A fully covered self-expanding metal stent was placed as a long-term therapy during this multidisciplinary approach.

Inadvertent complete CBD transection during hepatobiliary surgery is quite uncommon. Patients often require surgical biliary bypass or long-term percutaneous biliary drainage, both of which carry additional morbidity and can negatively impact quality of life.

Complete CBD transection is not a lost cause for a therapeutic endoscopist but certainly represents a technical and cognitive challenge which should include a multi-disciplinary approach. A combined case with interventional radiology will be required for biliary recanalization in most patients.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

2 thoughts on “Recanalization of the bile duct by using percutaneous and endoscopic methods after iatrogenic injury

  1. Hugh Mai,MD

    This approach may not be successful if the CBD/CHD was completely transected by clips and there is no leakage to the subhepatic collection/leak.

    1. Arjun Sondhi

      We agree our approach would not succeed in the setting of complete transection in the absence of a concomitant leak and collection. That situation may require cholangioscopy or interventional radiology to possibly thread a wire across the transected duct versus alternate biliary drainage maneuvers (EUS-guided hepaticogastrostomy aided by likely substantial biliary dilation in the absence of a leak, percutaneous drainage, surgical biliary bypass, or a combined approach) depending on the specific patient scenario, comorbidities, age, and local expertise.

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