Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique.
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).
Pisello
Franco
F
University of Palermo, Palermo, Italy.
Geraci
Girolamo
G
Modica
Giuseppe
G
Sciumè
Carmelo
C
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
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
Surgery. 1989 Mar;105(3):352-9
2646743
Gastrointest Endosc. 2009 Jan;69(1):63-5
19111687
Surg Gynecol Obstet. 1975 Feb;140(2):170-8
1079096
Gastroenterology. 1989 Apr;96(4):1180-6
2925062
Gastrointest Radiol. 1992 Fall;17(4):347-52
1426853
Tech Vasc Interv Radiol. 2008 Mar;11(1):43-50
18725140
Am J Gastroenterol. 2001 Dec;96(12):3458-60
11774984
Gastrointest Endosc. 2001 May;53(6):547-53
11323577
Gastroenterol Hepatol. 1998 May;21(5):218-23
9644874
Am J Surg. 2005 Jun;189(6):702-6
15910723
Dig Surg. 2005;22(5):295-304; discussion 305
16192728
Ann Surg Oncol. 2000 Jan-Feb;7(1):55-66
10674450
World J Gastroenterol. 2007 Aug 7;13(29):3948-55
17663508
J Gastroenterol Hepatol. 2004 May;19(5):589-92
15086605
Gastroenterology. 1991 Nov;101(5):1374-81
1936809
Pancreas. 2009 Mar;38(2):126-30
19238021
Endoscopy. 1999 Feb;31(2):S9
10223386
Surg Oncol. 2005 Aug;14(2):59-74
16019208
Am J Med. 1965 Feb;38:241-56
14256720
AMA Arch Surg. 1957 Sep;75(3):450-60; discussion 460-1
13457619
Dig Liver Dis. 2007 Apr;39(4):375-88
17317347
Gastrointest Endosc. 1988 Mar-Apr;34(2):95-101
2835282
Gastrointest Endosc. 2001 Jan;53(1):40-6
11154487