title: Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique.
abstract: BACKGROUND
  Endoscopic biliary drainage is the treatment of choice for inoperable hilar cholangiocarcinoma (so-called Klatskin tumor). Cholangitis is the main complication post-endoscopic retrograde cholangiopancreatography (ERCP) in Klatskin patients, specially when medium contrast is injected into biliary tree that could not be subsequently drained. Bacterial cholangitis is the principal cause of mortality in these patients. The aim of this study is to analyze cholangitis rate resulting from the use of air versus iodine contrast to obtain cholangiography during ERCP.
  
  
  METHODS
  In 9 years, 188 inoperable Klatskin patients were recruited and divided into two groups: iodine (A) or air (B) contrast cholangiography, respectively. We used air or iodine contrast to obtain cholangiography before hilar stricture stenting. We retrospectively compared these data in both groups.
  
  
  RESULTS
  The group B had a significant lower rate of cholangitis than group A in Bismuth type II (p < 0.05), in Bismuth type III (p < 0.05), and in the Bismuth type IV population (p < 0.05).
  
  
  CONCLUSIONS
  The air contrast cholangiography is a safe and effective method, and it appears justified as a routine procedure to prevent or reduce the risk of post-ERCP cholangitis, specially in Klatskin patients (p < 0.005).
authors.affiliation: University of Palermo, Palermo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Pisello
authors.forename: Girolamo
authors.initials: G
authors.lastname: Geraci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modica
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sciumè
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002761:Cholangitis / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D003287:Contrast Media; D006500:Hepatic Duct, Common; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D018285:Klatskin Tumor / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010166:Palliative Care; D011029:Pneumoradiography; D012189:Retrospective Studies; D015607:Stents
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
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