Risk Factors for Post-ERCP Cholangitis in Patients with Pancreatic Cancer from a Single Referral Center in Iran

Babak Salehimarzijarani,Mirhadi Mousavi,Mohammad Reza Zali,Zohreh Dadvar,Amir Houshang Mohammad Alizadeh,Dariush Mirsattari

doi:10.7314/apjcp.2012.13.4.1539

Abstract

Cholangitis is relatively uncommon but associated mortality is high due to the predisposition in people with underlying disease. For this recognition of contributing risk factors is necessary. Therefore, the present descriptive- analytical cross-sectional survey was designed to determine contributing risk factors for post-ERCP cholangitis in patients with pancreatic cancer. From 2005 to 2010, 110 consecutive cases of pancreatic cancer attending to a tertiary referral centre (Taleghani Hospital), Tehran, Iran were recruited. The patients all underwent stenting via endoscopic retrograde cholangiopancreatography (ERCP). On univariate analysis, a metallic stent type (95% confidence interval (CI) 1.025-11.34, P=0.037), having no jaundice (1.44-2.22, P=0.009), having no pain (1.32-1.91, P=0.026), a history of prior ERCP (1.16-10.37, P=0.020), and having a proximal biliary stone (1.002- 5.93, P=0.046) were related to cholangitis. However on multivariate analysis, none of these factors were found to be contributing risk factors. Cholangitis is avoidable with adequate biliary drainage. Because success rates are higher and complication rates lower for endoscopists performing large volumes of ERCP, performance of the procedure should be concentrated as much as possible in institutions with endoscopists having adequate experience. Patients with a high risk for complications may be best served by referral to an advanced center.

Highlights

Cholangitis is relatively uncommon (Boey & Way, 1980)
From 2005 to 2010, 110 consecutive cases of pancreatic cancer attending to a tertiary referral centre (Taleghani Hospital), Tehran, Iran were recruited
A metallic stent type (95% confidence interval (CI) 1.025-11.34, P=0.037), having no jaundice (1.44-2.22, P=0.009), having no pain (1.32-1.91, P=0.026), a history of prior endoscopic retrograde cholangiopancreatography (ERCP) (1.16-10.37, P=0.020), and having a proximal biliary stone (1.0025.93, P=0.046) were related to cholangitis

Summary

Introduction

Any condition that leads to stasis or obstruction of bile in the common bile duct (CBD), including benign or malignant stricture, parasitic infection, or extrinsic compression by the pancreas, can result in bacterial infection and cholangitis (Lam et al, 1978; Boey & Way, 1980). Choledocholithiasis is the most common cause of acute cholangitis, followed by endoscopic retrograde cholangiopancreatography [ERCP], and tumors. After ERCP 1-3% of patients develop cholangitis (O’Connor et al, 1982a: 1982b). Obstruction of the bile duct by tumor or stones can facilitate bacterial colonization; subsequent instrumentation has resulted in bacteremia rates mean 18.0% (O’Connor et al, 1982a: 1982b; Gerecht et al, 1989). In purely diagnostic ERCP, the bacteremic rate is lower at 8% (O’Connor et al, 1982b; Gerecht et al, 1989). Risk of cholangitis is increased if dye is injected retrograde (Boey & Way, 1980)

Methods

Results

Conclusion