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. 2019 Aug;120(2):249-255.
doi: 10.1002/jso.25485. Epub 2019 May 1.

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra-ampullary cholangiocarcinoma: A SEER-Medicare analysis

Christine M Kariya  1 , Michael M Wach  1 , Samantha M Ruff  1 , Reed I Ayabe  1 , Winifred M Lo  1 , Madeline B Torres  1 , Jessica L Petrick  2 , Timothy S McNeel  3 , Jeremy L Davis  1 , Katherine A McGlynn  2 , Jonathan M Hernandez  1
Affiliations

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra-ampullary cholangiocarcinoma: A SEER-Medicare analysis

Christine M Kariya et al. J Surg Oncol. 2019 Aug.

Abstract

Background: The optimal approach to biliary drainage for patients with supra-ampullary cholangiocarcinoma remains undetermined. Violation of sphincter of Oddi results in bacterial colonization of bile ducts and may increase postdrainage infectious complications. We sought to determine if rates of cholangitis are affected by the type of drainage procedure.

Methods: We examined the Surveillance, Epidemiology, and End Results-Medicare linked database from 1991 to 2013 for cholangiocarcinoma. Biliary drainage procedures were categorized as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP). Patients were stratified by resection.

Results: A total of 1914 patients were included in the final analysis. A total of 1264 patients did not undergo a postdrainage resection (SOP 83, SOV 1181) while 650 did undergo a postdrainage resection (SOP 26, SOV 624). For those patients not undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was 19% compared with 34% in the SOV cohort (P = 0.007). For those patients undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was less than 42.3% compared with 30% in the SOV cohort (P = 0.66).

Conclusion: For patients with supra-ampullary cholangiocarcinoma that did not undergo resection, biliary drainage procedures that violated the sphincter of Oddi were associated with increased rates of cholangitis.

Keywords: biliary drainage; cholangiocarcinoma; cholangitis; infection.

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Figures

Figure 1:
Figure 1:. Rates of cholangitis for patients that did not undergo a post-drainage resection.
Patients that underwent biliary drainage but did not undergo a subsequent resection of their cholangiocarcinoma were stratified into those who underwent drainage via a Sphincter of Oddi preserving approach versus those who underwent a Sphincter of Oddi violating approach. A significant difference was noted in 90-day infection rates (p=0.0074).
See this image and copyright information in PMC

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