Results of endoscopic biliary drainage in patients with malignant hilar stricture

Antimicrobial therapy outcomes in acute cholangitis: Hilar multiple obstructions versus single hilar and common bile duct obstructions

“…In cases of hilar multiple biliary obstructions, if drainage is achieved in more than 50% of the liver parenchyma's volume, there tends to be an improvement in blood test results, reflected in the bilirubin, alanine aminotransferase, or c-reactive protein levels. 7,[30][31][32] However, some bile duct branches may remain undrained. This study also achieved clinical success with bile duct drainage in most cases in all groups; however, the outcomes for Group 3 were poor.…”

“…In cases of multiple obstructions near the hilar bile ducts, there is a higher clinical failure rate for bile duct drainage when there are more extensive obstructions. 7,8 Moreover, one randomized controlled trial showed that unilateral drainage is related to worse clinical success rates and an increased incidence of stent dysfunction compared with bilateral stenting in patients with hilar multiple biliary obstructions. 29 However, to the best of our knowledge, there are no reports comparing the outcomes of AC with multiple bile duct obstructions with those of AC with simple bile duct obstruction.…”

“…Unlike the simple obstruction in the bile ducts outside the liver, in cases of multiple hilar biliary obstructions, it is sometimes difficult to achieve complete drainage of the entire bile duct. In cases of hilar multiple biliary obstructions, if drainage is achieved in more than 50% of the liver parenchyma's volume, there tends to be an improvement in blood test results, reflected in the bilirubin, alanine aminotransferase, or c‐reactive protein levels 7,30–32 . However, some bile duct branches may remain undrained.…”

“…3 Bismuth-IV obstruction (Figure S1, Supporting information) has been reported to have a higher clinical failure rate for bile duct drainage than other hilar obstruction. 7 In patients with hilar biliary obstruction, the number of patients who required re-drainage of the bile duct was higher in those treated with Bismuth-II (91.9%), Bismuth-IIIa (65.7%), and Bismuth-IV (92.9%) obstruction than in those treated with Bismuth-I (22.2%) obstruction. 8 Therefore, the presence of multiple biliary obstructions may affect AC outcomes.…”

“…[CCI], 14,15 primary disease as a malignant tumor, 16,17 and time from consultation to ERCP 18 ), antimicrobial therapy duration, 7 and NEWS within 24 h before the termination of antimicrobial administration. 7 Cholangitis is frequently associated with polymicrobial infections. Blood cultures exhibit low sensitivity and may fail to detect the causative organism, whereas bile cultures have low specificity and may detect enteric bacteria unrelated to the causative organism.…”