Update: A Review on Biliary Sepsis

Purpose Biliary procedures are commonly performed in interventional radiology (IR) practice. The hospital course of patients undergoing this manipulation can be complicated by biliary sepsis. This entity has significant morbidity and requires prolonged hospital stay and possible additional procedures. Here we review the pathophysiology of biliary sepsis, the prevalence of it in IR, and the treatment options by integrating the framework of the updated surviving Sepsis-3 guidelines, including the new Sequential Organ Failure (SOFA) score.

Material and Methods This extensive review is a systemic, comprehensive analysis of publications from 2000 to 2017, identified via MEDLINE, Embase, and Web of Science searches conducted with the aid of an expert reference librarian.

Results The disruption of normal physiology and architecture of the biliary system, due to ductal obstruction or iatrogenic causes (endoscopic retrograde cholangiopancreatography [ERCP], sphincterectomy, choledochal surgery, and percutaneous manipulations), increases the opportunity for bacteria to translocate from the biliary tree to the systemic circulation. The average rate of biliary sepsis in this systematic review of percutaneous biliary interventions is consistent with the previously reported range of 2 to 3% (Table 1). Risk factors for biliary sepsis include previous ERCP manipulations, underlying malignancies, and lack of antibiotic prophylaxis. Furthermore, palliative interventions are closely associated with higher mortality. The quick SOFA (qSOFA) is shown to have greater validity for in-house mortality than both SOFA and systemic inflammatory response syndrome (SIRS) inside and outside of the intensive care unit (ICU) setting. Moreover, qSOFA and the Sepsis-3 criteria are more accurate than SIRS while identifying adverse outcomes in cirrhosis and bacteria/fungal infections, allowing for earlier detection and transfer to the ICU.

Conclusion Biliary sepsis is not uncommon in the angiosuite, and thus, early identification is necessary for minimizing mortality. SOFA and qSOFA have greater discrimination for in-house mortality than SIRS and can be a useful tool in IR practices.

Table 1 (P005) Note: A portion of this table was adapted from Smith et al (2004).

No conflict of interest has been declared by the author(s).