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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(03): 127-132
DOI: 10.1055/s-0041-1739561
Research Article

Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India

Prasanth Raghhupatruni
1   Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
,
Rajesh Gopalakrishna 
1   Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
,
Vinodkumar Ankarath
1   Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
,
Shine Sadasivan
1   Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
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Abstract

Background The mainstay of management of acute cholangitis includes endoscopic or percutaneous biliary drainage and antimicrobial therapy. We aimed to study the profile and outcomes among patients with acute cholangitis who underwent endoscopic biliary drainage at our center.

Methods Seventy consecutive patients with acute cholangitis diagnosed and managed as per the Tokyo Guidelines 2018 for acute cholangitis between June 1, 2018 to December 31, 2019 were prospectively studied. Clinical, etiological and microbial profile, therapy, and patient outcomes were analyzed.

Results Choledocholithiasis (54.3%) and benign biliary stricture (28.6%) and malignancy (17.1%) were common etiological factors. Thirteen patients (18.6%) had underlying chronic liver disease. Moderate-to-severe cholangitis was seen in 67.7% of patients with high and very high grade as compared with 54.5% with medium grade of Charlson comorbidity index (CCI) and 41.2% of patients with low grade of CCI. Elevated C-reactive protein, low albumin, and prolonged international normalized ratio were associated with severe cholangitis. Bile culture was positive in 62.9% and blood culture was positive in 15.7% of patients. Bile cultures were predominantly polymicrobial in contrast to blood cultures (53.8 vs. 18%). Escherichia coli was the predominant isolate in blood and bile. Multidrug resistant (MDR) organisms were seen in 79.5% of positive bile cultures.

Conclusions A positive blood or bile culture, but not presence of multiple organisms or presence of MDR organisms in bile, was associated with severity of cholangitis. There was no mortality among these patients in-hospital or at 28-days.

Keywords

ERCP - PTBD - bacterobilia - bile culture


Publication History

Article published online:
17 November 2021

© 2021. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am 1990; 70 (06) 1297-1312
    CrossrefPubMedGoogle Scholar
  • 2 Kiriyama S, Kozaka K, Takada T. et al Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25 (01) 17-30
    CrossrefPubMedGoogle Scholar
  • 3 Gomi H, Takada T, Hwang TL. et al Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci 2017; 24 (06) 310-318
    CrossrefPubMedGoogle Scholar
  • 4 Sahu MK, Chacko A, Dutta AK, Prakash JA. Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis. Indian J Gastroenterol 2011; 30 (05) 204-208
    CrossrefPubMedGoogle Scholar
  • 5 Shenoy SM, Shenoy S, Gopal S, Tantry BV, Baliga S, Jain A. Clinicomicrobiological analysis of patients with cholangitis. Indian J Med Microbiol 2014; 32 (02) 157-160
    CrossrefPubMedGoogle Scholar
  • 6 Boey JH, Way LW. Acute cholangitis. Ann Surg 1980; 191 (03) 264-270
    CrossrefPubMedGoogle Scholar
  • 7 Kiriyama S, Takada T, Hwang TL. et al Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci 2017; 24 (06) 329-337
    CrossrefPubMedGoogle Scholar
  • 8 Tsuyuguchi T, Sugiyama H, Sakai Y. et al Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines. J Hepatobiliary Pancreat Sci 2012; 19 (05) 557-565
    CrossrefPubMedGoogle Scholar
  • 9 O’Connor MJ, Schwartz ML, McQuarrie DG, Sumer HW. Acute bacterial cholangitis: an analysis of clinical manifestation. Arch Surg 1982; 117 (04) 437-441
    CrossrefPubMedGoogle Scholar
  • 10 Wada K, Takada T, Kawarada Y. et al Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 52-58
    CrossrefPubMedGoogle Scholar
  • 11 Schwed AC, Boggs MM, Pham XD. et al Association of admission laboratory values and the timing of endoscopic retrograde cholangiopancreatography with clinical outcomes in acute cholangitis. JAMA Surg 2016; 151 (11) 1039-1045
    CrossrefPubMedGoogle Scholar
  • 12 Yeom DH, Oh HJ, Son YW, Kim TH. What are the risk factors for acute suppurative cholangitis caused by common bile duct stones?. Gut Liver 2010; 4 (03) 363-367
    CrossrefPubMedGoogle Scholar
  • 13 Motte S, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology 1991; 101 (05) 1374-1381
    CrossrefPubMedGoogle Scholar