title: Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction - a prospective, randomized controlled study.
abstract: BACKGROUND
  Air cholangiogram has been used in patients with malignant hilar obstruction to reduce cholangitis after endoscopic retrograde cholangiopancreatography (ERCP). However, it still remains unclear whether CO2 could be used as an alternative for air cholangiography in such patients.
  
  
  OBJECTIVE
  To investigate the effect of CO2 cholangiogram on post-ERCP complications.
  
  
  METHODS
  Prospective, randomized controlled study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  36 patients with Bismuth type II, III or IV were randomized into CO2 group or iodine contrast group (control group).
  
  
  METHODS
  Cholangiography was performed by injection of either CO2 or iodine contrast through a sphincterotome. One or two metal stents were placed.
  
  
  METHODS
  Post-ERCP complications, length of hospital stay after ERCP, 1-month and 1-year mortality.
  
  
  RESULTS
  There was no significant difference in age, gender, symptoms, liver function tests, type of tumor origin and Bismuth type between patients in CO2 and contrast groups (p > 0.05). Compared with one-stent placement, more volume of CO2 and longer operation time were observed when performing two-stent placement (both p < 0.05). The rate of cholangitis in CO2 group was significantly lower than that in control group (5.6% vs. 33.3%, p = 0.04). After ERCP, mean hospital stay time was shorter in CO2 group compared with control (p < 0.05). The difference of 1-month and 1-year mortality between two groups was not significant (both p > 0.05).
  
  
  CONCLUSIONS
  CO2 cholangiogram could be a safe method to visualize intrahepatic bile duct with low incidence of post-ERCP cholangitis, which could be considered for the patients with malignant hilar obstruction.
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Rongchun
authors.initials: R
authors.lastname: Zhang
authors.forename: Lina
authors.initials: L
authors.lastname: Zhao
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Liu
authors.forename: Biaoluo
authors.initials: B
authors.lastname: Wang
authors.forename: Na
authors.initials: N
authors.lastname: Hui
authors.forename: Xiangping
authors.initials: X
authors.lastname: Wang
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.forename: Hui
authors.initials: H
authors.lastname: Luo
authors.forename: Daiming
authors.initials: D
authors.lastname: Fan
authors.forename: Yanglin
authors.initials: Y
authors.lastname: Pan
authors.forename: Xuegang
authors.initials: X
authors.lastname: Guo
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002245:Carbon Dioxide; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002761:Cholangitis / Q000209:etiology* / Q000517:prevention & control; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000601:surgery; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods; D007455:Iodine / Q000009:adverse effects; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D015607:Stents
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide; D007455:Iodine