Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence

Abstract

Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both; nonoperative options include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) guided procedures. This current study compares the operative and the nonoperative management outcomes in patients with RPC in 80 consecutive patients. In addition, we aim to evaluate our approach to the management of RPC over the past decade, according to the various degrees of severity and extent of the disease, and identify the patterns of recurrence in this complex clinical condition. Initial failure rate in terms of residual stone of operative compared with nonoperative treatment was 10.2% versus 32.3% (P = 0.020). Long-term failure rate for operative compared with non-operative treatment was 20.4% versus 61.3% (P = 0.010). Based on multivariate logistic regression, the only significant factors associated with failure were bilaterality of disease (OR: 8.101, P = 0.007) and nonoperative treatment (OR: 26.843, P = 0.001). The median time to failure of the operative group was 48 months as compared to 20 months in the nonoperative group (P < 0.010). Thus operative treatment is a durable option in long-term resolution of disease. Hepatectomy is the preferred option to prevent recurrent disease. However, biliary drainage procedures are also an effective treatment option. The utility of nonoperative treatment can achieve a reasonable duration of disease free interval with minimal complications, albeit inferior to operative management.

Outcome of surgery for recurrent pyogenic cholangitis: a single center experience

“…Although non-operative treatments provide good short-term control of disease, 5,15,16 long-term outcomes are hindered by the high incidence of recurrent stones (20%-50%) and cholangitis, with biliary strictures predicting recurrence. [4][5][6]15,16 Surgical treatment of RPC generally yields better results than non-operative techniques because of removal or bypass of the diseased biliary tract along with the eradication of stones. 6 In the current study like other studies, 17,18 isolated left sided involvement was more common (49%).…”

“…[4][5][6]15,16 Surgical treatment of RPC generally yields better results than non-operative techniques because of removal or bypass of the diseased biliary tract along with the eradication of stones. 6 In the current study like other studies, 17,18 isolated left sided involvement was more common (49%). However, the frequency of left-sided involvement in the present study was lower than those reported by Chen et al (77%) 19 and Jiang et al (72%).…”

“…Minimally invasive procedures include percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) and per-oral cholangioscopic lithotripsy (POCSL), extracorporeal shock wave lithotripsy, endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction etc. [4][5][6][7] However, the incidence of residual and recurrent stones remains high (20%-50%) with these therapies. [4][5][6] Surgical treatment of RPC generally yields better results than non-operative techniques.…”

“…[4][5][6][7] However, the incidence of residual and recurrent stones remains high (20%-50%) with these therapies. [4][5][6] Surgical treatment of RPC generally yields better results than non-operative techniques. 6 RPC involving the first order ducts is mainly treated by biliary enteric by-pass procedures.…”

“…[4][5][6] Surgical treatment of RPC generally yields better results than non-operative techniques. 6 RPC involving the first order ducts is mainly treated by biliary enteric by-pass procedures. Whereas, associated liver atrophy, liver abscesses, third order ductal calculi, and intrahepatic cholangiocarcinoma are best treated with partial hepatectomy.…”