Bacteribilia After Preoperative Bile Duct Stenting

Herzog, Torsten; Belyaev, Orlin; Muller, Christophe; Mittelkötter, U.; Seelig, Matthias H.; Weyhe, Dirk; Felderbauer, Peter; Schlottmann, Renate; Schrader, Henning; Schmidt, Wolfgang E.; Uhl, Waldemar

doi:10.1097/mcg.0b013e318186b19b

Cited by 52 publications

(42 citation statements)

References 34 publications

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“…Biliary stenting is associated with bacteriobilia because stenting of the common bile duct remains a cause of ascending cholangitis. 16 Our findings are consistent with the results by Rerknimitr et al 8 In addition, patients receiving repeated interventions are at further risk of monomicrobial, fungal, and multipledrug-resistant organism infections, indicating that microbiological analysis of bile is useful in this patient group.…”

Section: Discussionsupporting

confidence: 93%

Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

Negm¹,

Schott²,

Vonberg

et al. 2010

Gastrointestinal Endoscopy

106

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Section: Discussionsupporting

confidence: 93%

Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

Negm¹,

Schott²,

Vonberg

et al. 2010

Gastrointestinal Endoscopy

106

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“…Although severe complications with ERCP procedures are rare, infectious complications remain prevalent [39]. Although no randomised study has been conducted to test the benefit of peri-interventional infection prophylaxis, antibiotic prophylaxis should be considered since biliary drainage leads to bacterial contamination of the bile ducts in almost 100% of cases [40]. …”

Section: Resultsmentioning

confidence: 99%

Patients with Advanced Pancreatic Cancer and Hyperbilirubinaemia: Review and German Expert Opinion on Treatment with nab-Paclitaxel plus Gemcitabine

Vogel

Kullmann

Kunzmann³

et al. 2015

Oncol Res Treat

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In patients with advanced unresectable pancreatic cancer, the prognosis is generally poor. Within recent years, new treatment options such as the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan and oxaliplatin) or the combination of nanoparticle albumin-bound (nab)-paclitaxel plus gemcitabine have shown a clinically relevant survival benefit over the standard gemcitabine in patients with good performance status. Unfortunately, patients with hyperbilirubinaemia, who constitute a substantial proportion of the pancreatic cancer patients, have been excluded from most clinical studies. Consequently, our knowledge on the appropriate medical treatment of this patient group is limited. In a meeting of German medical oncology experts, the available clinical evidence and own clinical experience regarding the management of patients with advanced pancreatic cancer and hyperbilirubinaemia was discussed. The present publication summarises the discussion outcomes with regard to appropriate management of these patients, including consensus-based recommendations for nab-paclitaxel/gemcitabine treatment, according to the best available evidence. In summary, knowledge of the underlying aetiology of hyperbilirubinaemia and the metabolisation routes of the cytotoxic drugs is crucial before initiating chemotherapy. As effective treatment options should also be made available to patients with comorbid conditions, including hyperbilirubinaemia, the experts provide advice for an initial dose reduction of chemotherapy with nab-paclitaxel/gemcitabine based on the total bilirubin level in patients with biliary obstruction or extensive liver metastasis.

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“…B. Gallengangsabstrich intraoperativ) angepasst ist. Dies gilt besonders für Patienten, die zuvor ein Stenting des DHC erfahren haben, da sich hier häufig multiresistente Keime finden [71]. Bei fortbestehenden Problemen (Grad B) sollte eine weitere Diagnostik mittels Sonografie und Abdomen-CT erfolgen.…”

Section: Pankreasfisteln / Intraabdomelle Abszesse / Anastomoseninsufunclassified

Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie

Sülberg¹,

Chromik²,

Köster³

et al. 2010

Zentralbl Chir

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During the last decades mortality after pancreatic surgery has decreased. Nevertheless, morbidity still remains at a high level. It is important to differentiate between pancreatic head resection and distal pancreatectomy. The complication rates of both procedures are high, however the need for intervention to manage perilous complications is higher after pancreaticoduodenectomy. The main complications after pancreatic surgery are delayed gastric emptying (DGE), pancreatic fistula, anastomotic leakage and bleeding. The current literature on the different techniques of pancreatic anastomosis and pancreatic remnant closure, respectively, does not show consistent results or an advantage for a particular technique. The same is true for the perioperative use of somatostatin and its analogues for the prevention of complications. It is widely agreed that the smooth texture of the pancreas and a small pancreatic duct < 3 mm are risk factors for pancreatic leakage or fistula. Today, the trend is more for conservative or interventional therapy for pancreatic fistulas or intraabdominal collections with, e. g., persisting intraoperative drain, TPN, somatostatin therapy or CT-controlled drainage. The opinions about the optimal treatment of the dreaded postoperative bleeding differ significantly in the surgical community. There are early and late bleedings and the management varies from endoscopical treatment or angiographic coiling / stenting to revision. Nevertheless, every bleeding is accompanied with high mortality. Here we present a review of literature and demonstrate the various strategies for the management of complications.

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Bacteribilia After Preoperative Bile Duct Stenting

Cited by 52 publications

References 34 publications

Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

Patients with Advanced Pancreatic Cancer and Hyperbilirubinaemia: Review and German Expert Opinion on Treatment with nab-Paclitaxel plus Gemcitabine

Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie

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