Incomplete or inappropriate endoscopic and radiological interventions as leading causes of cholangitis

Abstract

Introduction: Iatrogenic factors remain to be the leading causes of cholangitis at referral healthcare centers. Methods: The records of 51 patients treated for cholangitis in the years 2005-2016 due to incomplete or inappropriate nonoperative biliary interventions were evaluated retrospectively. Results: Twenty-nine patients included in the study were men and the median (range) age was 60 (30-90) years old. Incomplete or inappropriate ERCP and percutaneous transhepatic biliary drainage (PTBD) procedures had been performed in 45 and 6 patients, respectively. Inappropriate endoscopic stenting for hilar biliary obstruction (perihilar cholangiocarcinoma: 22 patients and gallbladder carcinoma: 3 patients) was the most common scenario (n: 25, 49%). Twenty other patients underwent ERCP with incomplete (n: 12) or no (n: 8) drainage. Errors which occurred in the course of the PTBD procedure included inserting the catheter to the duodenum in patients with hilar obstruction (n: 4) and incomplete drainage in patients with perihilar cholangiocarcinoma (n: 2). Two patients (4%) died of infection. Surgeries of 6 patients with operable tumors were delayed for a median (range) of 5 (1-7) months. Conclusions: Incomplete or inappropriate nonoperative biliary interventions put patients' lives at risk and delay the introduction of radical treatments.