Strasberg severity predicts 30-day loss of bile duct patency after ERCP in post-cholecystectomy bile duct injury.

AIM: This study evaluated the prognostic value of Strasberg classification on 30-day bile duct patency and explored relevant clinical and procedural factors.

BACKGROUND

Bile duct injury (BDI) is a serious complication of cholecystectomy that may influence early outcomes after endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

We retrospectively reviewed 33 patients with BDI treated with ERCP at Dr. Moewardi Hospital from January 2023 to May 2025. Data included demographics, laboratory results, cholecystectomy type, timing of diagnosis and repair, and injury severity (minor: A-C; major: D-E). The primary outcome was bile duct patency at 30 days, assessed by imaging and clinical indicators. Statistical analyses included chi-square, Fisher's exact, Kaplan-Meier survival, and ROC curves.

RESULTS

Patients had a mean age of 45.9 years; 54.5% were female, and 54.5% had laparoscopic cholecystectomy. Minor and major injuries were observed in 51.5% and 48.5%, respectively. 63.6% achieved bile duct patency by day 30. No significant associations were found between demographic, laboratory, procedural variables, and either injury severity or outcomes (all p>0.05). Kaplan-Meier analysis revealed significantly longer patency in minor injuries compared to major injuries (mean 25.88 vs. 20.88 days, p=0.030).

CONCLUSION

This study highlights Strasberg classification as an independent predictor of early bile duct patency after ERCP. Other common clinical factors did not significantly influence outcomes. These findings underscore the importance of Strasberg classification not only for injury assessment but also for guiding early postoperative management and monitoring. Larger prospective studies are needed to confirm these results and to optimize prognostic tools for BDI care.