Findings demonstrate a superior effectiveness of biliary stent ± biliary sphincterotomy [BS] in endoscopic management of post-cholecystectomy bile leak (PCBL) when compared to BS alone. This could be associated with inter-endoscopist variation in completeness of sphincterotomy and post sphincterotomy edema, which has the ability to impact the preferential trans-papillary flow of bile.

• In this systematic review and meta-analysis, the effectiveness as well as safety of the two interventional groups (BS alone vs biliary stent ± BS) were compared in management of PCBL.

• For BS alone (5 studies, 299 patients) and for biliary stent ± BS (5 studies, 864 patients), the pooled clinical success rates were 88% and 97%, respectively.

• Biliary stent ± BS was found to be associated with a significantly higher rate of clinical success than BS alone (OR: 3.91).

• In the biliary stent ± BS group, a numerically lower rate of adverse events was reported than BS alone (3 studies; OR: 0.65) without statistical significance.