Endoscopic management of bile duct leaks: Current strategies and controversies

Bile duct leak (BDL) is a common complication of hepatobiliary surgery, including cholecystectomy, hepatic resection, and liver transplantation. Timely recognition and effective management are essential to prevent serious complications such as peritonitis, intra-abdominal abscesses, and sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line diagnostic and therapeutic approach. Despite the high overall success rate, the optimal treatment strategies remain a subject of ongoing debate. This review summarizes the existing classification systems and current endoscopic management of BDLs, including drainage strategies, optimal timing of ERCP and stent removal, and approaches for complex cases.