Endoscopic management of bile duct leaks: Current strategies and controversies

Table 3 Factors of endoscopic success in bile duct leaks

Ref.	Study design (n)	Key findings	Conclusion	Quality1
Leak-Bridging vs short stent
Obata et al[37], 2025	Single-center, retrospective (122)	Bridging stents (P < 0.001), percutaneous drainage (P = 0.0025), and leak severity (P = 0.015) were independent predictors of endoscopic success	Bridging stents across the leak are key to clinical success	Medium
Schaible et al[36], 2017	Single-center, retrospective (35)	Bridging stents achieved 100% success (13/13) vs only 52.6% (10/19) for non-bridging stents	Bridging stents > non-bridging stents	Low
Quintini et al[42], 2024	Dual-center, retrospective (65)	Success rate higher with bridging vs. non-bridging stents (91% vs 53%, P = 0.005)	Bridging stents more effective	Low
Stent diameter
Katsinelos et al[40], 2008	RCT (63)	Success: 93.5% (7 Fr) vs 96.9% (10 Fr)	Stent diameter did not impact outcome	High
Vlaemynck et al[28], 2019	Meta (331)	Success: 95.4% (<10 Fr) vs 97.8% (≥10 Fr).	Stent size did not affect efficacy	High
Predictors
Yabe et al[17], 2017	Single-center, retrospective (58)	Success: 88% (low-grade) vs 59% (high-grade)	High-grade leak predicts failure	Medium
Quintini et al[42], 2024	Dual-center, retrospective (65)	Success: 67% (main duct) vs 90%-100% (others); bridging stents superior (91% vs 53%)	Leak location and bridging predict success	Low
Schaible et al[36], 2017	Single-center, retrospective (35)	Success: 64% (peripheral) vs 92% (central); not significant (P = 0.059); best with bridging at hepatic ducts	Peripheral leaks respond poorly	Low
Tewani et al[1], 2013	Single-center, retrospective (223)	ERCP is more effective for cystic/Luschka leaks (P = 0.028)	Leak site and stenting predict success	Medium
Chen et al[7], 2024	Multicenter, retrospective (106)	Positive: Bridging and cystic duct; Negative: SIRS, high-grade leaks	Location, severity, bridging stent, and systemic status are key predictors	Medium

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].

BDLs: Bile duct leaks; ERCP: Endoscopic retrograde cholangiopancreatography; RCT: Randomized controlled trial; SIRS: Systemic inflammatory response syndrome; Fr: French.