The outcome of endoscopic management of bile leakage after hepatobiliary surgery

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Ten Years Retrospective Study about Helicobacter pylori Eradication Rate

BACKGROUND/AIMS: Eradication of Helicobacter pylori is a main treatment of peptic ulcer disease. A triple therapy comprised of a proton pump inhibitor, clarithromycin, and amoxicillin is the most commonly used treatment for H. pylori eradication. The eradication of H. pylori infection requires combination of antibiotics. However, development of antibiotic resistance is a major cause of treatment failure. MATERIALS AND METHODS: This study was to observe H. pyrori eradication rate change for 10 years. From August 2005 to June 2014, a total of 4,891 patients with H. pylori infection were treated with standard H. pylori triple eradication therapy (proton pump inhibitor, amoxicillin, clarithromycin) and were analyzed by urea breath test. RESULTS: The overall rates of eradication with standard triple therapy was 82.8% (4,048/4,891). H. pylori eradication rates decreased from 92.2% in 2005 to 80.2% in 2014 (P=0.037). CONCLUSIONS: This study shows that the overall rate of H. pylori eradication with standard triple therapy decreased meaningfully for 10 years.