From the Research
The answer is A. Type A in the Strasberg Bismuth classification for biliary ductal injury will appear normal on ERCP. Type A injuries represent bile leaks from minor ducts that are still in continuity with the main biliary system, typically from the cystic duct stump or small ducts in the liver bed. Since these injuries don't involve the main bile ducts and the biliary tree remains intact, the ERCP examination will show normal main biliary anatomy. The bile leak occurs from peripheral branches that may not be visualized during routine cholangiography. In contrast, Types B through E involve various degrees of major bile duct injuries or strictures that would be evident on ERCP as filling defects, strictures, or complete transections. Type B shows isolation of a segment of the biliary tree, Type C involves leakage from a duct not communicating with the common bile duct, Type D shows lateral injuries to major bile ducts, and Type E represents various levels of circumferential injuries or strictures of the main hepatic ducts.
Key Points
- Type A injuries are characterized by bile leaks from minor ducts still in continuity with the main biliary system 1.
- ERCP is effective in diagnosing and treating biliary duct injuries, including those with bile leaks 2, 3.
- The Strasberg Bismuth classification is used to categorize biliary duct injuries, with Type A being the least severe and Type E being the most severe 4.
- ERCP can help decide the best therapeutic approach for biliary duct injuries, including the use of endobiliary stents and sphincterotomy 5, 1.
Evidence Summary
The provided evidence supports the use of ERCP in diagnosing and treating biliary duct injuries, including those classified as Type A in the Strasberg Bismuth classification. Studies have shown that ERCP is effective in managing bile leaks and strictures, and can help determine the best course of treatment 2, 1, 3. The most recent and highest quality study, 3, demonstrates the effectiveness of ERCP in treating bile leaks after severe liver trauma, with a 100% success rate in controlling bile leak. Overall, the evidence suggests that Type A injuries will appear normal on ERCP, and that ERCP is a valuable tool in the diagnosis and treatment of biliary duct injuries.