Bret T. Petersen, MD, FASGE

Associate Editor



Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



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Declining Rates of Bile Duct Injury During Laparoscopic Cholecystectomy

Bret T. Petersen, MD, FASGE reviewing Mangieri CW, et al. Surg Endosc 2019 Mar.

Laparoscopy is the preferred approach to cholecystectomy in most circumstances; however, the commonly quoted 0.5% rate of bile duct injury (BDI) is three-fold greater than for open cholecystectomy. The authors retrospectively queried the National Surgical Quality Improvement Program (NSQIP) registry from 2012 to 2016 to characterize the rate of BDI in North America during the modern era. Among 217,774 cases, ICD9 and ICD10 codes identified a BDI rate of 0.19%, with 77% diagnosed subsequent to the original surgical admission. BDI was associated with cholecystitis at the time of surgery (Relative Risk (RR) score 1.20; P value < 0.0001), while involvement of a resident in training appeared protective (RR 0.56; P value < 0.0001). Overall the rate of conversion to open cholecystectomy was low, but among those converted, the rate of BDI was quite high (15%, p < 0.0001). Performance of intra-operative cholangiography (IOC) was associated with both a higher BDI rate and a higher rate of identification during the index procedure (P value < 0.0001).

The incidence of bile duct injury during laparoscopic cholecystectomy is now approximately equivalent to long-established rates of 0.1-0.2% for traditional open cholecystectomy. Whether conversion to open surgery was a response to suspected injury or a potential complicating intervention during the initial procedure cannot be answered from these administrative data. Hence, it remains to be seen whether conversion from laparoscopic to open cholecystectomy during difficult procedures will continue to be regarded as advisable.

Bret T. Petersen, MD, FASGE
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Mangieri CW, Hendren BP, Strode MA, et al. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 2019;33:724–730. (