Endoscopic therapy is first-line for biliary leaks after liver transplantation (LT), yet contemporary series report success from ~55% to >90%. We assessed which technical/anatomical factors explain this variability.

We searched PubMed/Embase (Jan 2015–Oct 2025) for peer-reviewed studies on endoscopic treatment of post-LT (or post-hepatic surgery including LT) bile leaks with extractable patient-level outcomes or multivariable analyses. Three studies met criteria (Oh 2015; Sendino 2018; Obata 2025). Management was classified as bridging (stent or nasobiliary tube beyond the leak) vs non-bridging/pressure-reduction only. Additional 2025 LT series/review were screened qualitatively but not pooled (no per-technique denominators).

Across the three pooled studies, endoscopic closure was 190/244 (77.9%). Bridging drainage was the strongest, most consistent predictor: in a two-centre LT series, success was 44/47 (93.6%) with stent vs 19/33 (57.6%) with sphincterotomy alone (OR 8.36; p=0.007); a large postoperative cohort likewise found bridging stent independently associated with closure (OR 12.2; p<0.001). Anatomical complexity reduced success: an LT cohort showed leak-only 17/22 (77.3%) vs leak + anastomotic stricture 10/20 (50.0%). Recent 2025 series confirmed high success (>85%) for stent and ENBD when the leak could be crossed, supporting the bridging effect.

Bridging the leak is the decisive driver of success in post-LT bile leaks: ≈84% when the drainage crosses the defect vs ≈55% when it does not. The variability seen between studies is largely explained by three elements—bridging, absence of an anastomotic stricture, and technical success at the index ERCP. Future reports should mandate “bridged vs not bridged” to make outcomes comparable and actionable.