Related Experiment Video
Updated: May 18, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Pre-Endoscopic Retrograde Cholangiopancreatography Cholangitis and Stent Outcomes in Malignant Distal Biliary
Fumitaka Niiya1, Tatsunori Satoh2, Yosuke Kobayashi3
1Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, Japan. f.niiya@med.showa-u.ac.jp.
Background:
Clinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis on time to recurrent biliary obstruction (TRBO) and early post-ERCP infection in patients with distal malignant biliary obstruction (DMBO).
Methods:
We retrospectively reviewed consecutive patients with DMBO who underwent their first ERCP-guided stenting at five Japanese centers (January 2020-August 2024). Patients were classified by pre-ERCP cholangitis status and matched at a 2:1 ratio of noncholangitis to cholangitis using propensity scores (PSM). The primary outcome was TRBO; secondary outcomes were post-ERCP infection, clinical success, and RBO rates. TRBO was analyzed using Kaplan-Meier, log-rank, and multivariable Cox analyses; sensitivity analyses yielded concordant results.
Results:
Of 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114 d (p = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, p = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, p < 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, p = 0.46). Infections occurred in 9.6 and 4.4% (p = 0.33). Independent infection predictors were dilated bile duct (protective; odds ratio: 0.26, p = 0.02) and prolonged procedures (odds ratio: 3.73, p = 0.03).
Conclusions:
Pre-ERCP cholangitis did not reduce stent patency or increase early infection rates in patients with DMBO. TRBO-depended primarily on stent type; nondilated ducts and prolonged procedures were predictive of infection. These findings support possible internal drainage during index ERCP with contemporary periprocedural management.
