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. 2020 Jul;35(7):1150-1157.
doi: 10.1111/jgh.14954. Epub 2019 Dec 28.

The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: A large comprehensive study

Ming-Xing Xia  1 , Shu-Ping Wang  1 , Jun Wu  2 , Dao-Jian Gao  1 , Xin Ye  1 , Tian-Tian Wang  1 , Yi Zhao  2 , Bing Hu  1   2
Affiliations

The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: A large comprehensive study

Ming-Xing Xia et al. J Gastroenterol Hepatol. 2020 Jul.

Abstract

Background and aim: Endoscopic stenting for unresectable malignant hilar biliary strictures (MHBS) remains challenging. Post-endoscopic retrograde cholangiopancreatography cholangitis (PEC) can be the most common and fatal adverse event. In the present study, we aimed to systematically evaluate the incidence, severity, risk factors, and consequences of PEC after endoscopic procedures for advanced MHBS.

Methods: Of 924 patients, we identified 502 patients with MHBS (Bismuth types II to IV) who underwent endoscopic stenting as the primary therapy at two centers over 16 years. PEC and its severity were verified according to the current Tokyo guidelines.

Results: A total of 108 patients (21.5%) experienced acute PEC. Mild, moderate, and severe cholangitis were encountered in 51 (10.1%), 42 (8.4%), and 15 (3.0%) patients, respectively. Multivariate analyses showed that metal stenting (verse plastic stenting) (OR 0.328, 95% CI 0.200-0.535, P < 0.001) and Bismuth classification (IV vs III/II) (OR 2.499, 95% CI 1.150-5.430) were independent predictors for PEC and the moderate/severe type. Patients with PEC had significantly lower clinical success rates (86.3% vs 41.7%, P < 0.001), a higher rate of early death (6.5% vs 0.5%, P < 0.001), a shorter median stent patency (4.9 vs 6.4 months, P < 0.001), and shorter overall survival (2.6 vs 5.2 months, P < 0.001) compared with the noncholangitis group.

Conclusions: After endoscopic stenting for advanced MHBS, cholangitis may occur in as many as 21.5% of patients, which may be associated with a poor prognosis. The risk is high in patients with Bismuth type IV and may be reduced by using metal stents.

Keywords: acute cholangitis; adverse event; bile duct neoplasms; endoscopic retrograde cholangiopancreatography (ERCP); stent.

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References

    1. Cheng JL, Bruno MJ, Bergman JJ, Rauws EA, Tytgat GN, Huibregtse K. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic wallstents. Gastrointest. Endosc. 2002; 56: 33-39.
    1. Dumonceau JM, Tringali A, Papanikolaou IS et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline - updated October 2017. Endoscopy 2018; 50: 910-930.
    1. Uppal DS, Wang AY. Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma. World J Gastrointest Endosc 2015; 7: 675-687.
    1. Hong W, Sun X, Zhu Q. Endoscopic stenting for malignant hilar biliary obstruction: should it be metal or plastic and unilateral or bilateral? Eur. J. Gastroenterol. Hepatol. 2013; 25: 1105-1112.
    1. Lee TH. Technical tips and issues of biliary stenting, focusing on malignant hilar obstruction. Clin Endosc 2013; 46: 260-266.

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