Clinical use of per ERCP bile aspiration in patients with cholangitis: The aspibile study

Bile aspiration during endoscopic retrograde cholangiopancreatography (ERCP) for cholangitis is not systematic and data on its clinical relevance remain limited. The aim of this study was to evaluate the clinical contribution of biliary aspiration in the setting of cholangitis.

Consecutive patients with ERCP performed for cholangitis were included. The primary outcome was the rate of adaptation of antibiotic therapy to biliary aspirations. Secondary outcomes were length of hospitalization, mortality, cholangitis recurrence at 30 days, duration of antibiotic therapy, antibiotic change, agreement between antibiotic therapy and biliary aspiration.

A total of 140 patients were included, 103 (73.6 %) had blood cultures before ERCP. The rate of empiric and adjusted antibiotics effectively targeting bacteria found in bile was 82.1 % and 85.4 %, respectively. The mean length of hospital stay was 15.7 days, cholangitis recurrence rate was 3.2 % and the mortality rate was 5.5 %. The mean duration of antibiotic therapy was 11.3 days with an antibiotic modification rate of 45 %.

Bile aspiration during ERCP for acute cholangitis is a valuable complement to blood culture providing a higher diagnostic yield and enabling targeted antibiotic therapy. The rate of antibiotics effectively targeting bacteria found in bile is higher than 80 %.