Endoscopic management of bile duct leaks: Current strategies and controversies

Table 2 Comparison of treatment strategies

Ref.	Study design (n)	Key findings	Conclusion	Quality1
EST vs stents
Dolay et al[62], 2010	Single-center, prospective (27)	Stenting led to faster leak resolution than EST (4.5 ± 2.0 days vs 6.5 ± 3.4 days); 2 failures in EST group	Stenting > EST	High
Abbas et al[33], 2019	Multicenter, retrospective (1028)	Stent alone (96%) and stent + EST (97%) had higher success than EST alone (89%)	Stenting ± EST > EST alone	Medium
Rainio et al[32], 2018	Single-center, retrospective (71)	Comparable leak closure time and healing rates between EST and EST + stent	EST and EST + stent offer similar efficacy in type A leaks	Medium
Kaffes et al[63], 2005	Single-center, retrospective (100)	Success: Stent and EST + stent (100%) vs EST alone (78%, P = 0.001)	Stenting ± EST > EST alone	Low
Haidar et al[29], 2020	Single-center, retrospective (100)	Stenting (± EST) had higher success than EST (95.3% vs 72.7%, P < 0.05)	Stenting ± EST > EST alone	Low
Sachdev et al[12], 2012	Single-center, retrospective (65)	EST + stent in 52 (80%), stent alone in 6 (9%), EST alone in 5 (8%), NBD in 2 (3%); all achieved clinical success	EST + stent may be optimal	Low
Sendino et al[64], 2018	Dual-center, retrospective (65)	Stent ± EST (n = 47) led to higher resolution than EST alone (94% vs 58%, P < 0.01). Fewer required percutaneous (4% vs 12%) or surgical intervention (6% vs 42%, P < 0.001)	Stenting ± EST > EST alone	Medium
Chandra et al[31], 2019	Single-center, retrospective (58)	Comparable initial success between EST and EST + stent (92% vs 90%, P = 0.85); stent group had slower resolution (P = 0.02) and more reinterventions (P < 0.01)	EST with or without stent is effective; stenting may delay resolution	Low
Flumignan et al[65], 2021	Single-center, retrospective (31)	EST + stent (n = 22) and EST alone (n = 9) both reduced drainage volume and time to cessation; 2 failures (group unspecified)	No significant difference between EST and EST + stent	Low
NBD vs stent
Raza et al[38], 2019	Systematic review	Stent efficacy: 82.4%; NBD efficacy: 87.2%	Comparable efficacy between NBD and stent	-

¹Quality was assessed using the Newcastle-Ottawa Scale[66] for non-randomized studies: High quality (score ≥ 7), medium quality (score 5-6), low quality (score ≤ 4). Randomized controlled trial was evaluated with Cochrane risk of bias[67].

EST: Endoscopic sphincterotomy; NBD: Nasobiliary drainage; FCSEMS: Fully covered self-expandable metal stent; MPS: Multiple plastic stents; ERCP: Endoscopic retrograde cholangiopancreatography.