Current management of recurrent pyogenic cholangitis

Area of Science:

• Hepatobiliary surgery
• Gastroenterology
• Interventional Radiology

Background:

• Recurrent pyogenic cholangitis (RPC) is a chronic biliary disease characterized by repeated exacerbations.
• Patients often require multiple interventions for biliary dilatation and stone removal, facing disease progression despite drainage.
• Managing RPC involves complex multidisciplinary care due to inaccessible strictures and stones.

Purpose of the Study:

• To evaluate the efficacy of hepaticojejunostomy with a subcutaneous afferent limb for managing recurrent pyogenic cholangitis.
• To highlight the role of trans-stomal cholangioscopy in stricture dilatation and stone removal for RPC.
• To emphasize the importance of diligent surveillance in preventing cholangitis and its complications.

Main Methods:

• Surgical creation of hepaticojejunostomy with a subcutaneous afferent limb for biliary access.
• Trans-stomal cholangioscopy for visualizing and treating intrahepatic strictures and stones.
• Repeated endoscopic and radiological interventions facilitated by the surgical access.

Main Results:

• Hepaticojejunostomy provides safe and effective access to the biliary tree for RPC management.
• Trans-stomal cholangioscopic stricture dilatation and stone removal is a cornerstone therapy.
• Surgical access facilitates repeated interventions, crucial for managing complex RPC cases.

Conclusions:

• Hepaticojejunostomy with a subcutaneous afferent limb is a valuable approach for recurrent pyogenic cholangitis.
• This technique enables effective management of biliary strictures and stones, improving patient outcomes.
• Ongoing surveillance is essential to minimize stone recurrence and prevent cholangitis sequelae.