Cholangitis after endoscopic retrograde cholangiopancreatography: a rare complication?

Abstract

Cholangitis does not often occur after endoscopic retrograde cholangiopancreatography (ERCP), but it can be a serious complication of this procedure (1). Its clinical features, management and outcome are poorly characterized in the literature (2). In a recent study in a low-volume center (200 procedures in 22 months) the reported rate of this complication was less than 5%, with a tendency to reduce with increased experience of the practicioner (3). From a total of 487 ERCP performed in two years in our center, 24 patients developed cholangitis after the procedure (4.9% incidence). The majority of patients (54%) were female, with a median age of 60 year of age (interquartile range [IQR]: 42-72 years). The diagnosis was made after a median period of two days (IQR: 1-3 days), with a mortality of 29.2%. The median number of hospitalization days was seven (IQR: 4-16 days), and the majority of patients were attended in the outpatient clinic (71%). Ten patients had already undergone ERCP with sphincterotomy (43%) and seven patients were under antibiotic therapy or had received antibiotics in the previous three months (29%). The main reasons for the procedure were choledocholitiasis (38%) and obstructive jaundice (29%). A dominant stricture was present in 37.5% of cases and one or more biliary stents were placed in eleven patients (46%). Fever (75%), abdominal pain (50%) and jaundice (42%) were the main clinical manifestations. However, Charcot's triad was only present in three patients (13%). Almost all patients (92%) were treated with antibiotics, and this was within the first 24 hours in 86% of cases. Half of the patients had positive blood cultures. The duration of hospitalization (17 vs 6 days, p = 0.001) and higher levels of gamma-glutamyl transferase (651 vs 137 U/L, p = 0.04), alkaline phosphatase (459 vs 180 U/l, p = 0.03) and total bilirubin (12 vs 3 mg/dl, p = 0.02) were significantly associated with mortality.In our experience, post-ERCP acute cholangitis developed in approximately 5% of cases with a not negligible mortality of nearly 30% in spite of antibiotic therapy. Analytical factors can help to identify the most serious cases that could benefit from a more aggressive approach.

Adverse Outcomes of Endoscopic Retrograde Cholangiopancreatography at Gastroenterology and Hepatology Centers in Sulaymaniyah and Duhok City

“…Our study revealed post-ERCP cholangitis in 9 (4.5%) patients. This finding is close to the Peixoto et al (32) study in Brazil, which found that post-ERCP cholangitis occurred in (4.9%) of patients. The mortality rate of ERCP in the present study was (0.5%).…”

Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography

“…However, imaging may not specify all cases where biliary drainage is required. Few authors advocate a more aggressive approach in patients with post-ERCP cholangitis (20). Our study shows that PTBD is useful in the management of patients with post-ERCP cholangitis.…”

Burdens of Postoperative Infection in Endoscopic Retrograde Cholangiopancreatography Inpatients

“…Its clinical features, management, and the outcome are poorly characterized in the literature [12]. In a recent study, (200 procedures in 22 months) the reported rate of POI was less than 5%, with a tendency to reduce with increased experience of the practitioner [12]. In our study, from a total of 28,525 ERCP performed, only 300 inpatients were diagnosed with comorbid POI.…”

“…Although there is no absolute evidence for the effectiveness of routine antibiotic prophylaxis on the frequency of septic complication after ERCP, the rate of bacteremia seems to decrease significantly. After ERCP, there is often temporary abdominal discomfort, transient fever, and hyperamylasemia [12].…”

“…Mingmei et al suggested that POI occurs irrespective of diagnostic and therapeutic ERCP procedure because they excluded all the infections that occurred preoperatively [13]. Its clinical features, management, and the outcome are poorly characterized in the literature [12]. In a recent study, (200 procedures in 22 months) the reported rate of POI was less than 5%, with a tendency to reduce with increased experience of the practitioner [12].…”