Risk Factors for Early Cholangitis Following Biliary Plastic Stent Placement

Background and study aim Biliary plastic stents are widely used for biliary drainage but are prone to dysfunction and causing cholangitis. The aim of this study was to identify the risk factors for early post-ERCP cholangitis in patients with biliary plastic stents, assess clinical impact, and evaluate changes in bile composition associated with indwelling stents. Patients and methods We conducted a prospective, longitudinal observational study including consecutive patients with native papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary plastic stent placement at a tertiary referral center. Bile was aspirated at index ERCP prior to contrast injection and processed for microbiologic and chemical analysis. A follow-up procedure was scheduled at 3 months when we retrieved the stent for patency analysis and obtained a new bile sample. The primary outcome was early cholangitis after the index procedure (<3 months). Secondary outcomes included bile culture positivity, bile composition changes, stent occlusion degree, and cholangitis-related mortality. Multivariable binary logistic regression was used to identify independent predictors of early cholangitis, with results expressed as odds ratios (ORs) with 95% confidence intervals. Results A total of 159 patients were included, with malignant strictures accounting for 84.4% of indications. Complete follow-up was available for 136 patients, of whom 47 (34.6%) developed early cholangitis after a median of 32.5 days. On multivariable analysis, a positive bile culture at index ERCP was the only independent predictor of early cholangitis (OR 4.71, 95% CI 1.69-13.17). Degree of stent occlusion, stent characteristics, and bile duct obstruction severity were not associated with cholangitis. Seven deaths were directly attributable to cholangitis. Conclusions Early cholangitis after biliary plastic stenting is frequent and associated with positive bile cultures at index ERCP. Bile culture obtained at stent placement may help identify patients at increased risk of early cholangitis.