The role of endoscopy in noniatrogenic injuries of the liver

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• 作者：Jasmohan S. Bajaj MD
  Kulwinder S. Dua MD ; DMSc ; FRCP (Edin) ; FRCP (London) (1)
  
• 刊名：Current Gastroenterology Reports
• 出版年：2007
• 出版时间：May 2007
• 年：2007
• 卷：9
• 期：2
• 页码：147-150
• 全文大小：109KB
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• 作者单位：Jasmohan S. Bajaj MD
  Kulwinder S. Dua MD, DMSc, FRCP (Edin), FRCP (London) (1)
  
  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
  

文摘

Traumatic noniatrogenic biliary injuries, unlike iatrogenic injuries, are usually complex in nature and are frequently associated with other multiorgan trauma and infection. Bile leaks following these injuries are an important source of short-and long-term morbidity. Repeat surgery for primary repair of complex bile leaks is difficult and can be complicated by anastomotic leakage and biliary stricture formation. Endoscopic retrograde cholangiopancreatography (ERCP) was initially used only as a diagnostic technique to guide surgical repair in this setting. However, with the high success rates observed in treatment of iatrogenic bile leaks, ERCP has emerged as a nonoperative treatment option for noniatrogenic biliary leaks as well. Recent data show that ERCP is effective in managing bile leaks after blunt and sharp liver injuries, using transpapillary stenting, endoscopic sphincterotomy, or both, with greater than 80% healing rates. The evidence is not clear regarding which ERCP maneuver—endoscopic sphincterotomy, transpapillary stenting, or both—should be used.