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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2014; 05(02): 067-068
DOI: 10.4103/0976-5042.144830
Original Article
Society of Gastrointestinal Endoscopy of India

Long-term endoscopic management for primary recurrent pyogenic cholangitis

James L. Buxbaum
Departments of Medicine, Division of Gastroenterology, University of Southern California, San Francisco, CA, United States
,
Christianne J. Lane
Departments of Medicine, Division of Gastroenterology, University of Southern California, San Francisco, CA, United States
,
Karen C. Bagatelos
1   Department of Medicine, Division of Gastroenterology University of California, San Francisco, CA, United States
,
James W. Ostroff
1   Department of Medicine, Division of Gastroenterology University of California, San Francisco, CA, United States
› Author Affiliations
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Publication History

Publication Date:
26 September 2019 (online)

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Abstract

Background: Primary recurrent pyogenic cholangitis (RPC) is characterized by relentless suppurative cholangitis in those with a suspected parasitic injury of the biliary tree. Prior work has demonstrated that the infections recur following “definitive” biliary surgery and long-term percutaneous biliary catheters are poorly tolerated. The aim of this study was to assess whether scheduled surveillance endoscopic retrograde cholangiopancreatography (ERCP) prevents cholangitis in those with RPC. Materials and Methods: Following initial biliary decompression and stone clearance, patients with RPC were offered serial ERCP every 3-6 months to remove accumulating stony debris and to dilate incipient strictures. Review of a large series managed using this approach at the University of California, San Francisco Medical Center was performed. The principle outcome was the development of acute cholangitis requiring hospitalization and whether the episode occurred, while the RPC patient was in compliance with endoscopic surveillance recommendations. Results: Over a period of 10 years, 66 patients with primary RPC were managed for RPC at the University of California, San Francisco. The patients were comprised primarily of first-generation immigrants from Asia though one-quarter had migrated from Latin America and Russia. Episodes of cholangitis were significantly less likely to occur in those undergoing surveillance biliary endoscopy than in those who were not (odds ratio 5.3; P = 0.005). The mean follow-up was 36.1 months. Conclusions: Serial endoscopic treatment of RPC may be used to systematically clear biliary debris and decreases the risk of cholangitis requiring hospitalization. It represents a reasonable initial management strategy for these patients. Surgery and percutaneous management may also be required, but are best performed as part of a multidisciplinary approach.

Key words

Bile ducts - choledocholithiasis - endoscopic - intrahepatic - sphincterotomy
 

  • References

  • 1 Cook J, Hou PC, Ho HC, McFadzean AJ. Recurrent pyogenic cholangeitis. Br J Surg 1954;42:188-203.
  • 2 Ong GB. A study of recurrent pyogenic cholangitis. Arch Surg 1962;84:199-225.
  • 3 Lo CM, Fan ST, Wong J. The changing epidemiology of recurrent pyogenic cholangitis. Hong Kong Med J 1997;3:302-04.
  • 4 Al-Sukhni W, Gallinger S, Pratzer A, Wei A, Ho CS, Kortan P, et al. Recurrent pyogenic cholangitis with hepatolithiasis–The role of surgical therapy in North America. J Gastrointest Surg 2008;12:496-503.
  • 5 Stain SC, Incarbone R, Guthrie CR, Ralls PW, Rivera-Lara S, Parekh D, et al. Surgical treatment of recurrent pyogenic cholangitis. Arch Surg 1995;130:527-32.
  • 6 Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R. Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula. Ann Surg 1984;199:637-47.
  • 7 Lai EC, Ngai TC, Yang GP, Li MK. Laparoscopic approach of surgical treatment for primary hepatolithiasis: A cohort study. Am J Surg 2010;199:716-21.
  • 8 Harris HW, Kumwenda ZL, Sheen-Chen SM, Shah A, Schecter WP. Recurrent pyogenic cholangitis. Am J Surg 1998;176:34-7.
  • 9 Huang MH, Chen CH, Yang JC, Yang CC, Yeh YH, Chou DA, et al. Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis. Am J Gastroenterol 2003;98:2655-62.
  • 10 Lam SK, Wong KP, Chan PK, Ngan H, Ong GB. Recurrent pyogenic cholangitis: A study by endoscopic retrograde cholangiography. Gastroenterology 1978;74:1196-203.
  • 11 Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37:383-93.
  • 12 Cosenza CA, Durazo F, Stain SC, Jabbour N, Selby RR. Current management of recurrent pyogenic cholangitis. Am Surg 1999;65:939-43.
  • 13 Nguyen T, Powell A, Daugherty T. Recurrent pyogenic cholangitis. Dig Dis Sci 2010;55:8-10.
  • 14 Lam SK. A study of endoscopic sphincterotomy in recurrent pyogenic cholangitis. Br J Surg 1984;71:262-6.
  • 15 Sperling RM, Koch J, Sandhu JS, Cello JP. Recurrent pyogenic cholangitis in Asian immigrants to the United States: Natural history and role of therapeutic ERCP. Dig Dis Sci 1997;42:865-71.
  • 16 Chen YK, Parsi MA, Binmoeller KF, Hawes RH, Pleskow DK, Slivka A, et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011;74:805-14.
  • 17 Mönkemüller K, Fry LC, Bellutti M, Neumann H, Malfertheiner P. ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis. Surg Endosc 2009;23:1961-7.