CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2019; 10(02): 136
DOI: 10.1055/s-0039-1693239
Letter to the Editor
Society of Gastrointestinal Endoscopy of India

Successful Endoscopic Management of Bile Leak: A Single Centre Experience

Sanjeev Kumar Thakur
1  Gastrocare and Endoscopy Center, Patna, Bihar, India
› Author Affiliations
Further Information

Address for correspondence

Dr. Sanjeev Kumar Thakur, MD, DM
202A, Kumar Ranjan Enclave, Opp. Bahadurpur Gumti, Kankarbagh Main Road, Patna 800 020, Bihar
India   

Publication History

Publication Date:
07 August 2019 (online)

 

Sir,

I read with interest the article by Pawar et al in the recent issue of the journal.[1] This article discusses about endoscopic management of bile leaks secondary to laparoscopic cholecystectomy and following percutaneous drainage of liver abscess.

There are a few points where more clarification was needed like opting for percutaneous transhepatic biliary drainage over endoscopic retrograde cholangiopancreatography (ERCP) in a case of ascites, where it is considered a relative contraindication.[2]

Indication in six patients of percutaneous drainage of liver abscess needs further discussion as most the published studies have used the presence of jaundice and prolonged bile drainage as a threshold for ERCP as most of such cases resolve on their own.[3]

Furthermore, the leaks in the cases of amoebic liver abscess (ALA) are usually from intrahepatic ductules, and the leaks, especially from the mid-common bile duct and common hepatic duct, need elucidation about the possible mechanism of injury.[3] [4]

In the three postcholecystectomy cases where no leak could be identified, the operators may have injected more dye after gaining access as therapy for narrowing, that is, dilatation could be performed in all the cases. If not, these cases should have been excluded from the final analysis of efficacy.

In a country with a huge load of ALA, a soft indication for ERCP in biliary leak may result in a large procedure burden with its antecedent cost and complications.

Financial Support and Sponsorship

Nil.


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Conflicts of Interest

None.


Address for correspondence

Dr. Sanjeev Kumar Thakur, MD, DM
202A, Kumar Ranjan Enclave, Opp. Bahadurpur Gumti, Kankarbagh Main Road, Patna 800 020, Bihar
India