UNVEILING COMPLEXITY IN THE MANAGEMENT AND OUTCOMES OF TRAUMATIC VERSUS NON-TRAUMATIC BILE LEAKS – A COMPARATIVE ANALYSIS

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial diagnostic and therapeutic modality for managing bile leaks, particularly in the context of traumatic etiologies. Here, we aimed to contribute to this body of knowledge by providing a comprehensive analysis of ERCP outcomes in patients with confirmed bile leaks, encompassing both traumatic and non-traumatic etiologies.
METHODS: This cross-sectional study investigated ERCP outcomes in patients with confirmed bile leaks from 2017-2023. The study categorized patients into non-traumatic (N=141) and traumatic (N=47) groups, collecting variables encompassing demographics, clinical parameters, and intervention details. The comparison between these groups utilized Chi-square or Fisher’s exact tests for categorical variables.
RESULTS: We identified patients presenting with bile leaks (N=188) showcasing diverse characteristics. Females constituted 44.1% and 55.9% were males. Leading ERCP indications were post cholecystectomy (51.1%) and gunshot wounds (18.1%). Post-surgical injuries accounted for 66.0%, with 25.0% trauma involvement. In 141 non-traumatic and 47 traumatic injuries, trauma patients were younger (30.2 vs 54.43, p<0.001) with more males (83% vs 47%, OR:5.5, p<0.001). Traumatic injuries exhibited elevated WBC (p<0.001), lower Hgb (p<0.001), and increased AST (p=0.006) and ALT (p=0.004). Interventional Radiology (IR) involvement was higher in trauma (59.6% vs 40.4%, OR:2.9, p=0.002), with JP drains being more common (86% vs 58%, OR:4.3, p=0.018). Lengthier hospital stays were noted in trauma (21.26 vs 12.38 days, p=0.002). High-grade injuries prevailed in trauma (42.6% vs 2.1%, OR:15.99, p<0.001). Mortality and complications did not significantly differ, although bleeding and infarction were more frequent in trauma (Table 1). Comparing traumatic with post-surgical patients revealed similar associations. Trauma patients were younger (29 vs 57.5) and more male (83% vs 47%, OR:5.2, p<0.001). Significant differences in laboratory values included higher WBC (p<0.001), lower Hgb (p<0.001), and increased AST (p=0.004) and ALT (p=0.008). IR involvement was more frequent in trauma (59.6% vs 33.9%, OR:2.9, p=0.003), with JP drains more common (86% vs 60%, OR:3.9, p=0.028). High-grade injuries were more common in trauma (42.6% vs 15.3%, OR:15.8, p<0.011). Mortality and complications did not significantly differ between the groups.
CONCLUSION: In conclusion, our findings underscored a higher frequency of IR involvement in traumatic injuries, indicating the complexity of these cases. Despite these differences, the study revealed that mortality and complications do not significantly differ between traumatic and non-traumatic groups, emphasizing the need for tailored management strategies to address the distinct clinical characteristics of traumatic and non-traumatic bile leaks.