title: Poor Results of Pancreatoduodenectomy in High-Risk Patients with Endoscopic Stent and Bile Colonization are Associated with E. coli, Diabetes and Advanced Age.
abstract: Endoscopic stenting has spread as bridge management before pancreatoduedenectomy (PD) to resolve jaundice, but its role is nowadays challenged as it is reported to increase morbidity. Although bile sampling is increasingly performed, its clinical role is unclear. The objective of the study is to assess bile colonization's impact on outcome.
  
  
  
  Results of pancreatoduodenectomy after endoscopic stenting are analyzed in 61 high-risk patients presenting bacterial bile colonization. The impact of 11 demographic, clinical, infectious, and laboratory parameters and outcome, including pancreatic leakage, morbidity, and mortality, is analyzed.
  
  
  
  All stented patients present bacterial bile colonization and PD mortality approaches 10 %. The presence of E. coli in the bile is significantly related to poor outcome, including 23.5 % mortality (p = 0.034), whereas age (≥70 years) and diabetes present borderline results (p < 0.070 and p < 0.066, respectively). E. coli (p = 0.002) and age (p = 0.017) are also related to grade C pancreatic fistula.
  
  
  
  In high-risk patients undergoing PD, bile colonization inevitably occurs after endoscopic stenting and is a major risk factor of poor outcome, reaching its maximum in the case of E. coli colonization and elderly patients, where the indication to stent and/or to perform PD should be accurately evaluated. E. coli-targeted antibiotic prophylaxis should be administered.
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia. renatocosti@hotmail.com.|Service de Chirurgie Digestive et Cancérologique, Hôpital Lariboisière, AP-HP, Université Paris 7 "Diderot", Paris, France. renatocosti@hotmail.com.|Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Via Gramsci 14, 43100, Parma, Italia. renatocosti@hotmail.com.
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.
authors.forename: Matteo
authors.initials: M
authors.lastname: De Pastena
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.|Unità Operativa di Chirurgia del Pancreas, Casa di Cura "Pederzoli", Peschiera sul Garda, Verona, Italia.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Via Gramsci 14, 43100, Parma, Italia.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Violi
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.affiliation: Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico "G.B. Rossi", Università degli Studi di Verona, Verona, Italia.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019072:Antibiotic Prophylaxis; D001646:Bile / Q000382:microbiology*; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality; D004724:Endoscopy; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D019919:Prosthesis Implantation / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
keywords: Complications; Endoscopic stent; Infection; Mortality; Pancreatoduodenectomy