Bacteribilia and cholangitis after percutaneous transhepatic biliary drainage for malignant biliary obstruction

Cholangitis often develops after percutaneous transhepatic biliary drainage (PTBD) for malignancy. The aims of this retrospective study were to clarify whether or not bacteribilia and cholangitis increase with time after PTBD and to define the pathogenesis of bacteribilia and cholangitis after PTBD. One hundred twenty-eight patients underwent PTBD for malignancy. Both the cumulative incidences of bacteribilia (77%) and cholangitis (28%) showed an increase with time after PTBD. In 78% of patients with bacteribilia, bacteria from intestinal flora were detected in bile. Catheter malfunction (N = 17) or the presence of undrained bile ducts (N = 7) induced cholangitis. Proximal obstruction, because it often accompanied undrained ducts, had higher incidences of bacteribilia (P = 0.04) and cholangitis (P < 0.0001) than did distal obstruction. In conclusion, bacteribilia and cholangitis increase in incidence with time after PTBD. The primary cause of bacteribilia is the transpapillary reflux of intestinal flora. Catheter malfunction or undrained ducts cause cholangitis, provided underlying bacteribilia is present.