Bile Leaks Requiring Multiple ERCPs – Risk Factors for Poor Outcomes

Introduction: Bile leaks may require intervention with endoscopic retrograde cholangiopancreatography (ERCP). Success rates with ERCP are reported to be over 90%; however, a subset of patients still require multiple ERCPs to achieve resolution. We investigated demographic and interventional factors necessitating multiple ERCPs to achieve bile leak resolution. Methods: We retrospectively reviewed cases from 2014–2024 at our institution that involved bile leaks requiring an ERCP. We categorized leaks into those that required two or less ERCPs for resolution versus those that required three or more ERCPs while examining the demographic and interventional risk factors between the two groups. Results: A total of 143 cases were included in our analyzed sample. 83.2% (n = 119) required two or less ERCPs for resolution while 16.8% (n = 24) required three or more ERCPs until resolution. We did not find a difference between the etiology of the leak or the location when the leak was identifiable; however, we did observe a significantly higher percentage of cases where the leak was not identified in the three or more group compared to the two or less group, 33.33% vs. 14.29% (p = 0.0373). Cases requiring two or less ERCPs more likely used plastic stents, 89.1% vs 66.7% (p = 0.010). Finally, cases requiring three or more ERCPs were more likely managed with a sphincterotomy without stent placement, 12.5% vs 1.7% (p = 0.033). Conclusions: Performing stent placement AND biliary sphincterotomy at time of index ERCP led to more rapid resolution of bile leaks, irrespective of patient characteristics or type of leak.