Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study

Abstract

ObjectivesTo evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES).SettingA population-based cohort study using data from Taiwans’ National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates.ParticipantsPatients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES.ResultsThe overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4–5 years of follow-up.ConclusionsPatients receiving ES are associated with having a higher risk of PLA.

Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture

“…The advantage of Trefle ® -assisted tissue acquisition lies in its wire-guided system, which can be inserted into the bile duct and reaches the biliary stricture easily. This system allowed us to avoid unnecessary EST, which may help to prevent early adverse events, such as bleeding; and late adverse events, such as liver abscess [20,21].…”

Klebsiella pneumoniaeLiver Abscess

“…The most common etiologies are unknown cryptogenic (primary) origin and infection by biliary route [ 9 10 ]. Biliary infections are associated mostly with stricture subsequent to gallstone disease, malignancy, or hepaticojejunostomy, which is believed to involve bacterial proliferation in the bile duct that causes ascending cholangitis and invasion of the liver parenchyma [ 11 12 ]. Portal venous route may originate from an abdominal infection, where appendicitis, diverticulitis, colorectal cancer, and inflammatory bowel disease may be the cause [ 7 ].…”

Peroral cholangioscopy‐guided forceps biopsy versus fluoroscopy‐guided forceps biopsy for extrahepatic biliary lesions

“…Although whether EST is or not needed to insert a biopsy forceps into the bile duct for the F-FB is controversial, avoiding EST may help prevent early adverse events, including bleeding, and late adverse events, including liver abscess. 16,17 Longitudinal extension is a feature of cholangiocarcinoma, and this was used in 14.6% of patients with cholangiocarcinoma. 18,19 To avoid positive resection margins after surgery, preoperative identification of the exact perihilar and distal margins of resectable ECC is essential.…”

“…For biliary access, EST are is when the cholangioscope is inserted into the bile duct, but as a result, the sphincter of Oddi function is lost entirely. Although whether EST is or not needed to insert a biopsy forceps into the bile duct for the F‐FB is controversial, avoiding EST may help prevent early adverse events, including bleeding, and late adverse events, including liver abscess 16,17 …”