55 - Infections of the Biliary Tract

Abstract

Biliary tract infections are encountered frequently in gastrointestinal (GI) practice. Cholangitis is a clinical syndrome comprising fever, pain, and jaundice. Obstruction and stasis in the biliary tract leads to raised intrabiliary pressure, which subsequently results in bacteremia. There are various etiological factors for cholangitis, such as biliary calculi, strictures, parasites, post-endoscopic retrograde cholangiopancreatography (ERCP), postoperative, etc. In contrast to other causes, biliary parasitoses is more common in Southeast Asia. Common parasites involving the biliary tract include Ascaris lumbricoides, liver flukes, and Echinococcus. The incidence of acquired immune deficiency syndrome–related cholangiopathy has decreased after the availability of potent antiretroviral regimens. More recently, improper reprocessing of the endoscopes has been implicated in outbreaks of multidrug-resistant organisms. With the availability of excellent less invasive or noninvasive modalities like endoscopic ultrasound and magnetic resonance cholangiopancreatography, ERCP is now mainly performed with therapeutic intent. Irrespective of the etiology, the mainstay of management of an infected biliary tract is drainage of infected biliary system. The availability of endoscopic ultrasound (EUS)–guided biliary drainage and enteroscopy-assisted ERCP has allowed safe and easy access to the biliary tree in cases of inaccessible papillae. Therefore, most cases of biliary tract infections can be managed nonoperatively. However, a multidisciplinary approach involving endoscopists, interventional radiologists, and surgeons may be required in some cases, such as recurrent pyogenic cholangitis and hydatid disease of liver.