Role of ERCP in the management of bile duct lesions post bile duct surgery.

Introduction: Therapeutic Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an established mode of treatment for bile duct lesions. Aim: This paper reviews the role of ERCP in the management of bile duct lesions developing after biliary surgery. Patients and Methods: Of the 894 ERCPs performed in our department between January 1990 and May 1992, 23 (13 female, 10 male were for patients with post-operative bile duct lesions. The mean age of these 23 patients was 59 years (range 38-91 years). The previous biliary surgical procedures were conventional cholecystectomy (n=19), laparoscopic cholecystectomy (n=19 and a cholecystectomy with choledochojejunostomy. Associated medical conditions of ischaemic heart disease, unstable angina, hypertensive heart disease, chronic obstructive airway disease and hepatitis B cirrhosis were present in 7 of these patients. Results: Ten patients had benign biliary strictures. Endoscopic stenting (with one or 2 stents) was successful in 9. The strictures reopened in 2 patients after a total stenting duration of 12 and 18 months respectively. Four patients had biliary leakages that were successfully treated with stenting. Two patients had spontaneous sealing of biliary leak at 3 and 6 months respectively. Nine patients had retained stones (7 with solitary stone, 2 with multiple stones) that were successfully removed with Dormia basket after sphincterotomy. Complications were few and manageable. Conclusions: Therapeutic ERCP is safe and effective. It is a useful adjunct in the management of patients with post-operative biliary lesions