Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent in resolving cystic duct leaks in a canine model

Abstract

Background: Current management of biliary fistulae includes percutaneous drainage and transpapillary endoscopic biliary stent placement. This study compared time to bile leak resolution for endoscopic stent insertion versus injection of botulinum toxin into the sphincter of Oddi.

Methods: Thirty dogs underwent laparotomy and cholecystectomy without cystic duct closure. After a duodenotomy, dogs were randomized to the control group (Group 1) or one of two treatment groups. Treated dogs either underwent transpapillary stent placement (Group 2) or botulinum toxin injection into the sphincter of Oddi (Group 3). Drains were placed adjacent to the cystic duct stump and output was recorded daily. Resolution of bile leaks was defined as an output of less than 10 mL/day. Necropsy was performed to identify undrained intraperitoneal bile.

Results: Data from 28 dogs were available for analysis. The numbers of days for resolution of bile leaks in Groups 1, 2, and 3 were, respectively, 9.3 (2.1) days, 2.3 (1.1) days, and 2.6 (1.1) days. There were significant differences in time to resolution of bile leak between Group 1 and both Groups 2 (p < 0.001) and 3 (p < 0.001). There was no significant difference between Groups 2 and 3 (p > 0.25).

Conclusion: Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent placement in resolving cystic duct leaks in this canine model.