Mo1268 ENDOSCOPIC BILIARY STENTING IS SIGNIFICANTLY ASSOCIATED WITH CHOLANGITIS AFTER ENDOSCOPIC ULTRASOUND IN PATIENTS WITH BILIARY STRICTURES

Abstract

Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) are considered as a safe modality for the diagnosis of pancreatobiliary lesions because of low risk of complications such as bleeding, perforation and pancreatitis. However, the risk of cholangitis after EUS/EUS-FNA in patients with biliary strictures has not been fully investigated. In this study, we examined the rate of cholangitis after EUS/EUS-FNA in these patients and investigated associated risk factors. We retrospectively reviewed the data of the inpatients with biliary strictures who underwent EUS/EUS-FNA at our institution between April 2013 and September 2017. We excluded 8 cases with percutaneous biliary drainage and 4 cases with difficulty in reaching duodenum. Cholangitis and its severity were diagnosed based on Tokyo Guidelines 2013. 114 patients (133 cases in total) were included; 59.4% were male; median age was 71; 85 patients (72.2%) were malignant (pancreatic cancer 46, distal cholangiocarcinoma 12, hilar cholangiocarcinoma 17, intrahepatic cholangiocarcinoma 2, gallbladder cancer 3 and the others 5) and 29 were benign (IgG4-related disease 11, primary sclerosing cholangitis 1, tumor-forming pancreatitis 1 and the others 16). The location of biliary strictures was 93 cases in distal (69.9%), 29 in hilar (21.8%), 4 in intrahepatic (3.0%) and 7 in spreading (5.3%). Endoscopic biliary stenting (EBS) had been already performed before EUS/EUS-FNA in 79 cases (59.4%). Median time from EBS to EUS/EUS-FNA was 20 days (range; 1-125 days). EUS-FNA was performed in 53 cases (39.8%). Cholangitis was observed in 4.6% (6/133). The severity was mild in 2, moderate in 3 and severe in 1 case. The patient who suffered from severe cholangitis underwent urgent endoscopic nasal biliary drainage at the day of EUS. The incidence of cholangitis in the cases with EBS was significantly higher than those without EBS (7.6% (6/79) vs. 0% (0/54), p=0.041). Other statistically significant risk factors of cholangitis were gamma-GTP levels (higher (7.7%, 6/78) vs. lower (0%, 0/55), p=0.037) and ALP levels (higher (11.3%, 6/53) vs. lower (0%, 0/80), p=0.003). Age, gender, malignant/benign disease, the location of biliary strictures, endoscopic sphincterotomy, examination time, examination with/without EUS-FNA, WBC, CRP, AST and ALT were not significant risk factors. Cholangitis occurred in 17.6% of the cases with EBS and higher ALP levels (6/34), while no cholangitis occurred in the cases only with higher ALP levels (0/19). Cholangitis after EUS/EUS-FNA occurred in 4.6% of the cases with biliary strictures. The use of prophylactic antibiotics might be beneficial in these cases, especially with EBS and biliary enzyme elevation. Further prospective study in a larger scale is required.