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Cumulative incidences of biliary infection after endoscopic stent placement using Kaplan‐Meier method in regular and non‐regular users of proton pump inhibitors.
Source publication
Objectives:
Proton pump inhibitors (PPIs) are widely prescribed medications for gastric acid-induced diseases. Despite the effectiveness of PPIs, recent evidence suggested an increased risk of various bacterial infections in PPI users. The current study was conducted to evaluate the risk of biliary infection after endoscopic biliary stent placemen...
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Background:
The etiological diagnosis of biliary stricture remains a clinical challenge. Currently, endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary biopsy is the most commonly used technique. This retrospective study aimed to evaluate the clinical value of percutaneous transhepatic intraluminal forceps biopsy (TIFB) in patient...
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreatic and biliary disease. The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and complications. Aiming to reduce procedure failure rates and comp...
Objectives Biliary obstruction is a common problem encountered in postsurgical anatomy, which may lead to serious complications if not treated promptly. Endoscopic drainage is a minimally invasive and effective treatment option for such patients. However, the optimal route of endoscopic drainage, either SBE-ERCP (single-balloon enteroscopy with end...
Background:
There are conflicting data on the frequency and variability of endoscopic retrograde cholangiopancreatography (ERCP) outcomes in patients with cirrhosis. Our aim was to systematically review the literature on the incidence of post-ERCP adverse events in cirrhotic patients and to examine the differences across continents.
Methods:
We...
Subcapsular liver hematoma is a rare complication of endoscopic retrograde cholangiopancreatography. It can be potentially fatal and may result in rupture, massive bleeding, compression of the portal vein with thrombosis, necrosis and serious infections that require aggressive management. We report the case of a patient with acute cholangitis who d...
Citations
... [20] Thus, the antibiotic sensitivity pattern will direct the identification of the antibiotic coverage that needs to be provided for prophylactic treatment of risk factors like surgical procedures of the biliary tract that may lead to biliary tract infection. [27][28][29][30] This study facilitates to enhance the knowledge of the general or family physicians for the causative pathogens of bacteriobilia along with their antibiotic susceptibility pattern and also demonstrates the causes of biliary obstruction, co-morbid conditions, and risk factors along with the outcome of patients suffering from MDR bacteriobilia. ...
A BSTRACT
Introduction
Bile is deemed a sterile fluid, with the presence of clinical conditions like cholelithiasis, cholecystitis, previous biliary interventions, biliary strictures, and so on, leading to bile stasis, and increases the chances of bacteriobilia. In this study, we recognize the bacterial spectrum of microorganisms isolated from bile samples, diagnostic parameters, and antibiotic sensitivity patterns.
Methods
A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2021 to 2022 to evaluate biliary infections in patients who underwent surgical procedures related to the biliary tract and associated organs.
Results
A total of 234 patients’ bile samples were included in our study. The mean age of patients was 48.04 ± 14.74 years, with more patients below the age of 65 years among those with infected bile samples. One hundred and sixty-three (163/234, 69.66%) patients infected by 209 pathogenic microorganisms were recognized. The most common microorganism isolated was Escherichia coli (83/209, 39.71%), followed by Pseudomonas aeruginosa (37/209, 17.7%). Acinetobacter baumannii and Klebsiella pneumoniae isolate owed to more than 90% penicillin, extended-spectrum beta-lactamase, carbapenem, and fluoroquinolone resistance among all isolates. Length of hospital stay, malignant obstruction, and chronic kidney disease were identified as statistically significant risk factors that lead to the isolation of multi-drug-resistant isolates from bile culture.
Conclusion
We recognized the spectrum of pathogens causing biliary tract infections at our center along with the antibiotic resistance pattern to guide and facilitate prompt and appropriate treatment by primary health care professionals and family medicine practitioners.
... However, these indicators are easily affected by some conditions, such as cholangitis, leading to biased results and difficulty in interpretation [29,32]. Patients with BTC are prone to biliary bacterial infection preoperatively, in particular after biliary intervention for obstructive jaundice [33]. In the present study, patients in the low-GNRI group more frequently received biliary stenting and had elevated CRP levels than those in the high-GNRI group. ...
Introduction
The geriatric nutritional risk index (GNRI) is an index of nutritional status associated with clinical outcomes in various cancers; however, its prognostic value in biliary tract cancer (BTC) remains to be elucidated. This retrospective study aimed to investigate the association between preoperative GNRI and long-term prognosis of patients with BTC undergoing surgical resection.
Material and methods
A total of 213 patients were included. The relationships between GNRI and clinicopathological variables, including inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lympho-cyte ratio, were analysed. The impact of GNRI on overall survival (OS) and relapse-free survival (RFS) was investigated by Kaplan-Meier curves and Cox proportional hazards models.
Results
Applying a GNRI cut-off of 98, the low-GNRI group comprised 135 patients (63%). The low-GNRI group had elevated carbohydrate antigen 19-9 and CRP levels, high rates of preoperative biliary stenting, lymph node metastases, and perineural invasion, and a lower rate of R0 resection than the high-GNRI group. Both OS and RFS in the low-GNRI group were significantly lower. In multivariate analysis, low GNRI was a significant predictor of poor OS (hazard ratio [HR], 1.731; 95% CI: 1.111–2.696; p = 0.015) and RFS (HR, 1.900; 95% CI: 1.231–2.931; p = 0.004), independently of inflammatory and tumour markers, as well as of pathological features.
Conclusions
Preoperative GNRI may be an easily accessible predictor of poor prognosis in patients with BTC undergoing surgical resection.
Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of acute pancreatitis patients with potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (matured PFC with necrosis) and pancreatic pseudocysts (matured PFC without necrosis). In the management of necrotizing pancreatitis and walled-off necrosis, endoscopic ultrasound (EUS)-guided transluminal drainage combined with on-demand endoscopic necrosectomy (i.e., the step-up approach) is increasingly utilized as a less invasive treatment modality compared to a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g., lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished, and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of non-interventional supportive treatment (e.g., antibiotics, nutritional support, irrigation of the cavity), there has been only a limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.
