Cholangitis after endoscopic biliary drainage for hilar lesions

Abstract

Background/aims: Cholangitis is a morbid complication following endoscopic biliary drainage. This study was undertaken to determine the subgroup of patients more likely to develop cholangitis after endoscopic drainage and to determine how to manage this complication.

Methodology: Although we have used transhepatic biliary drainage as the procedure of choice for relieving obstructive jaundice, we recently encountered ten patients who underwent endoscopic drainage before referral.

Results: Three patients with a hilar obstruction developed cholangitis and cholangiolytic liver abscesses after endoscopic drainage, while seven with a distal obstruction did not develop cholangitis following drainage. Thus, the incidence of cholangitis in patients with a hilar obstruction (100%) was significantly higher than that (0%) in patients with a distal obstruction (p = 0.008). Cholangitis in the three patients was managed with percutaneous drainage without mortality, although this procedure was technically difficult because of the presence of collapsed intrahepatic bile ducts following the endoscopic drainage.

Conclusions: Hilar lesions present a higher risk of cholangitis after endoscopic biliary drainage than distal lesions. Hence, percutaneous, rather than endoscopic, drainage is indicated for such lesions. Percutaneous drainage is the procedure of choice for the management of cholangitis after endoscopic drainage.