Patient selection: stent placement for bile leak following hepatobiliary surgery.
Four items for the clinical prediction rule (CPR):
(1) The surgery was laparoscopic cholecystectomy.
(2) The postsurgical alkaline phosphatase is normal.
(3) The bile leak is minor with no other pathology seen on the initial ERCP.
(4) The interval from initial ERCP to follow-up was 4-8 weeks.
A patient with all 4 items from the CPR:
(1) is at low risk for persistent bile leak or other pathology (negative predictive value 93%)
(2) can have the stent removal by upper GI endoscopy
(3) probably does not need a second ERCP
An additional finding associated with an absence of bile leak or other pathology on follow-up is the time interval from surgery to first ERCP is less than 8 days.
