Endoscopic resolution of refractory postoperative bile leak from bile duct with fully covered self-expandable metallic stent

Abstract

The role of endoscopic therapy in the treatment of bile leaks is well established. Therapeutic endoscopic retrograde cholangiography with biliary sphincterotomy, placement of a transpapillary plastic biliary stent, or a combination of biliary sphincterotomy and stenting has become the first-line intervention in the treatment of a bile leak. For high-grade bile leaks, sphincterotomy alone has been shown to be less effective than transpapillary biliary stenting, and combined biliary sphincterotomy and transpapillary stenting is preferable in such situations. We present a clinical case of a 56-year-old woman with bile leak after open cholecystectomy and choledochotomy for cholecystolithiasis and choledocholithiasis with stenotic distal common bile duct due to chronic calcifying pancreatitis, in whom previous transpapillary insertion of plastic stent was not succesfull, but following temporary transpapillary insertion of fully covered self-expandable metallic biliary stent led to closure of a refractory bile leak.