scholarly journals Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kenan Buyukasik ◽  
Ahmet Burak Toros ◽  
Hasan Bektas ◽  
Aziz Ari ◽  
Mehmet Mehdi Deniz

Cholangitis, with a clinical spectrum between acute ascending cholangitis and acute fulminant cholangitis, the mildest and the most severe forms, respectively, is the infection of bile ducts with a potential of serious mortality and morbidity. Obstruction of the bile ducts followed by infection, with E. coli being the most commonly isolated agent, is common to all forms of cholangitis. Biliary obstruction is caused by choledocholithiasis mostly. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25 cm H2O, which is the critical value, immune dysfunction ensues. Sepsis is common if the infection of biliary ducts is suppurative. Mortality and morbidity are inevitable if left untreated or drained late. The objective of this study is, in the stand point of the current literature, to analyse the diagnostic, therapeutic success and complication rates of ERCP (Endoscopic retrograde cholangiopancreatography) in patients with a diagnosis of acute purulent cholangitis with no response to medical treatment.

2021 ◽  
Vol 88 (3-4) ◽  
pp. 80-86
Author(s):  
O. I. Dronov ◽  
I. O. Kovalska ◽  
I. L. Nastashenko ◽  
T. O. Kondratiuk ◽  
L. V. Levchenko

Objective. Determination of impact of combination, consisted of 3% solution of silicon dioxide and antibacterial preparations, on bacterial cultures of S. aureus, P. aeruginosa, E. coli. Materials and methods. Clean cultures of bacteria, kept in Collection of Microorganisms in Department of Microbiology and Immunology of Training–Scientific Centre «Іnstitute of Biology and Medicine» of Taras Shevchenko National University: S. aureus (Rosenbach, 1884), P. aeruginosa (Schröter, 1872; Migula, 1900), E. coli (Migula, 1895; Castellani і Chalmers, 1919) were applied. Action of antibacterial preparations cefoperazon, cefoperazon–sulbactam, ampicillin–sulbactam, amicacin, as well as enterosorbent 3% solution of silicon dioxide, was investigated. In the investigation the impact of antibacterial preparations and silicon dioxide together with antibacterial preparations on test–cultures of bacteria was studied, using broth and agarised medium of Muller–Hinton. Results. The data, obtained in the investigation, trust efficacy of combined application of 3% solution of silicon dioxide, owing sorption capacity, with antibacterial preparations in reduction or elimination of subsequent growth of bacterial test–cultures of S. aureus, P. aeruginosa, E. coli. Combination of 3% solution of silicon dioxide with ampicillin–sulbactam in dilutions 64 and 32 mg/l promotes reduction of the E. coli growth on surface of agarised medium in comparison with the investigation variant without application of 3% solution of silicon dioxide. While polyresistence of P. aeruginosa revealed, 3%solution of silicon dioxide together with cefoperazon–sulbactam in concentrations 8 and 16 mg/l and ceftazidime in concentrations 8, 16, 32, 64 mg/l guarantees bactericidal effect for this microorganism. Growth of P. aeruginosa while application of 3% solution of silicon dioxide in combination with ampicillin–sulbactam in dilutions 8, 16, 32, 64 mg/l was arrested. Application of 3% solution of silicon dioxide in combination with amicacin–sulbactam 16 mg/l inhibits the S. aureus growth, what is observed, when combination of 3% solution of silicon dioxide with amicacin in dilutions 8, 16 mg/l and cefoperazon–sulbactam in dilutions 8, 16 mg/l are exploited. Growth of the microorganism do not evolve in variants of the investigation without 3% solution of silicon dioxide, as well as with him, if amikacin is applied in concentrations 64 and 32 mg/l. Conclusion. The biliary ducts drainage in obturative jaundice of tumoral genesis and subsequent presence of drainage (internal or external) constitute the main risk factors for their colonization by multiresistant microorganisms. At the same time, the biliary ducts drainage in combination with antibioticotherapy is estimated as an urgent method for control of the infection primary focus in an acute cholangitis. Establishing of procedure for application of 3% solution of silicon dioxide in combination with certain groups of antibacterial preparations for microorganisms revealed constitute important measure for bacteriobilia prophylaxis. The further investigations conduction with wider spectrum of antibacterial preparations and 3% solution of silicon dioxide for control of clinically significant species of microorganisms is necessary and perspective.


2020 ◽  
Author(s):  
Chih-Ming Liang ◽  
Yi-Chun Chiu ◽  
Lung-Sheng Lu ◽  
Cheng-Kun Wu ◽  
Fai-Meng Sou ◽  
...  

Abstract Background: In this study, we aimed to compare the efficacy and safety of removing a single-stage, retrograde, endoscopic common bile duct stone in patients with mild and moderate acute cholangitis associated with choledocholithiasis.Methods: We enrolled 196 endoscopic retrograde cholangiopancreatography (ERCP)-naïve patients diagnosed with acute cholangitis and choledocholithiasis between September 2018 and February 2020 at a single hospital. For eligible patients, single-stage treatment involved stone removal at initial ERCP. Early ERCP was defined as ERCP performed ≤ 72 hours following diagnosis in the emergency room.Results: The final analysis included 138 patients. The success rate of complete stone extraction was similar in patients with mild and moderate cholangitis (88.5% vs. 91.7%; p = 0. 536). Complication rates were also comparable between the two groups. In the moderate cholangitis group, the length of hospitalization declined significantly among patients who underwent early single-stage ERCP (10.6 ± 6.1 vs. 18.7 ± 12.5 days; p = 0.001) compared with patients treated with delayed ERCP. In the multivariate analysis, early ERCP indicated shorter hospitalization times (≤ 10 days) (odds ratio (OR), 7.689; p = 0.030), while endoscopic retrograde biliary drainage, for acute cholangitis only, indicated longer hospitalization times (OR, 0.358; p = 0.030). A stone size larger than 1.5 cm was an independent risk factor for stone extraction failure (OR, 24.507; p = 0.009).Conclusions: Single-stage, retrograde, endoscopic common bile duct stone removal may be safe and effective for patients with mild and moderate cholangitis. The benefit of early single-stage ERCP (≤ 72 hours) was reflected mainly by reduced hospitalization time and costs.Trial registration: ClinicalTrials.gov: NCT03754491.


2018 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Subhash Chandra ◽  
Jagpal Singh Klair ◽  
Kaartik Soota ◽  
Daniel J. Livorsi ◽  
Frederick C. Johlin

Background: Only a small proportion of patients with biliary tree infection grow microorganisms in blood cultures. Antibiotics chosen or tailored based on organisms identified on blood cultures have a potential for under-treatment and unfavorable outcomes, including recurrent infection and early stent occlusion. In our current practice, we collect bile for culture if an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is performed in patients with suspected cholangitis. In this study, we compare the microbial yield of blood cultures and ERCP-obtained bile cultures in patients with ascending cholangitis. Methods: We reviewed medical records of all the patients treated for ascending cholangitis who had blood cultures and ERCP-obtained bile cultures at a tertiary care center between 2010 and 2016. Bile was collected for culture before injecting contrast, via a catheter after discarding the initial 3 mL. Results: Ninety-three patients were included with mean age of 71 (±15) years. Out of 93 patients, 11 (12%) had prior sphincterotomy, 29 (31%) had an indwelling biliary stent, and malignant obstruction was the most common etiology (34%). ERCP-obtained bile cultures were positive in 90 out of 93 (97%) patients with monomicrobial growth in 34 out of 93 (39%) patients. Mixed intestinal flora was noted in 3 patients. Blood cultures were positive in only 30 out of 93 patients (32%) and 24 out of 93 (26%) patients had monomicrobial growth. Totally 26 out of 30 patients (87%) grew the same organism as the bile culture, 3 grew an organism different from bile cultures, and one had no growth in the bile culture. On multivariable analysis, the presence of an indwelling biliary stent was the lone factor associated with polymicrobial growth, 83 vs. 52%, p = 0.007. Conclusion: ERCP-obtained bile cultures are a reliable and feasible mechanism to evaluate patients with suspected biliary tree infection. This technique has a significantly higher yield when compared to blood culture. Selection and tailoring of antibiotics based on bile culture in the management of ascending cholangitis are advised.


Author(s):  
Phillip Linholm ◽  
Patrick E. Young ◽  
Walter Reed

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common.Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition.Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.


2018 ◽  
Vol 2 (2) ◽  
pp. 126-135
Author(s):  
Phillip Lindholm ◽  
Patrick E. Young ◽  
Walter Reed

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common.Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition.Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.


1981 ◽  
Vol 194 (2) ◽  
pp. 171-175 ◽  
Author(s):  
SEIYO IKEDA ◽  
MASAO TANAKA ◽  
HIDEO YOSHIMOTO ◽  
HIDEAKI ITOH ◽  
FUMIO NAKAYAMA

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Tatsuki Ueda ◽  
Masataka Kikuyama ◽  
Yuzo Kodama ◽  
Takafumi Kurokami

Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST) on common bile duct stones (CBDS) disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS.Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP) was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP.Results. CBDS disappearance was observed in 32 (48.5%) of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007andp<0.001, resp.). Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002).Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.


Gut ◽  
1997 ◽  
Vol 41 (4) ◽  
pp. 545-548 ◽  
Author(s):  
G T Deans ◽  
P Sedman ◽  
D F Martin ◽  
C M S Royston ◽  
C K Leow ◽  
...  

Background—Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endo- scopic sphincterotomy in this age group, relative to that in older patients, is unknown.Aim—To determine whether the development of short term complications following endoscopic sphincterotomy is age related.Patients and methods—A prospective multicentre audit of 958 patients (mean age 73, range 14–97, years) undergoing a total of 1000 endoscopic sphincterotomies.Results—Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41–1.67, p=0.74).Conclusion—Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Namyoung Park ◽  
Sang Hyub Lee ◽  
Min Su You ◽  
Joo Seong Kim ◽  
Gunn Huh ◽  
...  

Abstract Background There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. Methods A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. Results The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant. Conclusions In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.


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