Endoscopic Management of Biliary Leakages.

Background: Biliary leakages are notable complications that can occur following hepatobiliary surgery, traumatic injury, or iatrogenic causes related to medical interventions. The management of biliary leaks is critical as untreated leaks can result in severe complications such as biliary peritonitis, abscess formation, and sepsis. Summary: Treatment approaches for biliary leaks are highly variable and depend on the severity and anatomical location of the leak. Options range from conservative management and endoscopic interventions to surgical repair in more severe cases. A clear understanding of the classification of biliary leaks - whether anatomical, etiological, or severity-based - is essential to guide appropriate treatment strategies and improve clinical outcomes. Notably, several endoscopic techniques are now available and have significantly enhanced patient outcomes, even in complex surgical anatomies. Key Messages: The management of biliary duct leaks requires a comprehensive approach that includes endoscopic, percutaneous, and surgical interventions. The choice of treatment is determined by the severity of the leak, the patient's overall condition, and the specific context of the injury. Endoscopic retrograde cholangiopancreatography in combination with sphincterotomy and stent placement is widely regarded as the first-line treatment when the papilla is conventionally accessible.