Factors Associated with Persistent Biliary Leaks After Successful ERCP in Trauma Patients

Purpose Biliary leaks are commonly caused by abdominal trauma, which can be managed by endoscopic retrograde cholangiopancreatography (ERCP). The data on factors associated with persistent biliary leaks after successful ERCP is scarce. We aimed to describe the factors associated with persistent biliary leaks. Methods A retrospective study of an academic level 1 trauma center was conducted on patients presenting with abdominal trauma and had a biliary leak managed with ERCP. The primary outcome was a persistent biliary leak, defined as needing an additional ERCP excluding stent removal. Results A total of 76 patients were included, 15.8% of which had a persistent biliary leak requiring additional ERCP. A higher INR at admission (1.6 vs 1.3, p = 0.035), lower sodium at ERCP (135 vs 137 mEq/L, p = 0.045), longer percutaneous abdominal drain time (66 vs 27 days, p = 0.006), longer biliary stent time (98 vs 67 days, p = 0.071), longer ICU stay (17 vs 10 days, p = 0.077), and longer post-ERCP hospital stay (24 vs 11 days, p = 0.078) were associated with a persistent biliary leak. The type of surgery on admission, liver injury grade, and biliary leak site were not associated with a persistent biliary leak. Conclusions Persistent biliary leaks occurred in 15.8% of trauma patients even after successful ERCP. A longer time of either internal or external biliary drainage time along with extended hospital stay was associated with a persistent biliary leak, however type of surgery on admission, liver injury grade, and biliary leak site were not associated with a persistent biliary leak.