title: Outcomes and risk factors for cancer patients undergoing endoscopic intervention of malignant biliary obstruction.
abstract: BACKGROUND
  Malignant bile duct obstruction is a common problem among cancer patients with hepatic or lymphatic metastases. Endoscopic retrograde cholangiography (ERC) with the placement of a stent is the method of choice to improve biliary flow. Only little data exist concerning the outcome of patients with malignant biliary obstruction in relationship to microbial isolates from bile.
  
  
  METHODS
  Bile samples were taken during the ERC procedure in tumor patients with biliary obstruction. Clinical data including laboratory values, tumor-specific treatment and outcome data were prospectively collected.
  
  
  RESULTS
  206 ERC interventions in 163 patients were recorded. In 43 % of the patients, systemic treatment was (re-) initiated after successful biliary drainage. A variety of bacteria and fungi was detected in the bile samples. One-year survival was significantly worse in patients from whom multiresistant pathogens were isolated than in patients, in whom other species were detected. Increased levels of inflammatory markers were associated with a poor one-year survival. The negative impact of these two factors was confirmed in multivariate analysis. In patients with pancreatic cancer, univariate analysis showed a negative impact on one-year survival in case of detection of Candida species in the bile. Multivariate analysis confirmed the negative prognostic impact of Candida in the bile in pancreatic cancer patients.
  
  
  CONCLUSIONS
  Outcome in tumor patients with malignant bile obstruction is associated with the type of microbial biliary colonization. The proof of multiresistant pathogens or Candida, as well as the level of inflammation markers, have an impact on the prognosis of the underlying tumor disease.
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. GeorgMartin.Haag@med.uni-heidelberg.de.
authors.forename: Georg-Martin
authors.initials: GM
authors.lastname: Haag
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. THerrmann@wkk-hei.de.|Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. THerrmann@wkk-hei.de.|Department of Internal Medicine I, Gastroenterology, Hematology and Medical Oncology, Hospital Heide, Heide, 25746, Germany. THerrmann@wkk-hei.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Herrmann
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. Dirk.Jaeger@med.uni-heidelberg.de.|Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. Dirk.Jaeger@med.uni-heidelberg.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Jaeger
authors.affiliation: Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. Wolfgang.Stremmel@med.uni-heidelberg.de.|Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. Wolfgang.Stremmel@med.uni-heidelberg.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.affiliation: Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany. Peter.Schemmer@med.uni-heidelberg.de.|Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. Peter.Schemmer@med.uni-heidelberg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.affiliation: Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. Peter.Sauer@med.uni-heidelberg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Sauer
authors.affiliation: Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. Daniel.Gotthardt@med.uni-heidelberg.de.|Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. Daniel.Gotthardt@med.uni-heidelberg.de.
authors.forename: Daniel Nils
authors.initials: DN
authors.lastname: Gotthardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000382:microbiology*; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D014408:Biomarkers, Tumor / Q000032:analysis / Q000276:immunology; D002175:Candida; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor