Outcome of a 'step-up approach' for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2024-11-06 DOI:10.1016/j.hpb.2024.10.016

Alessandro M Bonomi, Anouk G Overdevest, Jeska A Fritzsche, Olivier R Busch, Freek Daams, Geert Kazemier, Rutger-Jan Swijnenburg, Ulrich Beuers, Babs M Zonderhuis, Roy L J van Wanrooij, Joris I Erdmann, Rogier P Voermans, Marc G Besselink

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Abstract

Background: Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.

Methods: A retrospective single center series including patients with recurrent cholangitis with a non-stenotic HJ after hepato-pancreato-biliary surgery was conducted (2015-2022). Primary outcome was resolution of NSC (i.e. free of NSC during six months). Secondary outcomes included reduction of NSC monthly episode frequency and secondary sclerosing cholangitis.

Results: Overall, 50 of 1179 (4.2%) patients with HJ developed NSC. Treatment included a 'step-up approach' with short-course antibiotics (n = 50, 100 %), prolonged antibiotics (n = 26, 52%), and revisional surgery (n = 7, 14 %). Resolution of NSC was achieved in 15 patients (30%) and reduction of NSC frequency in an additional 21 patients (42%). Concomitant ursodeoxycholic acid use and discontinuation of proton pump inhibitors was the only predictor for resolution (OR 4.229, p = 0.035). Secondary sclerosing cholangitis occurred in 12 patients (24%) and was associated with the number of NSC episodes (OR 1.2, p = 0.050).

Conclusion: A 'step-up approach' to recurrent NSC after HJ resulted in 30 % resolution and further 42 % reduced frequency of NSC although still a quarter of patients developed secondary sclerosing cholangitis. Future prospective studies should assess whether a protocolized approach could improve outcomes.

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肝-胰-胆手术后非狭窄性肝空肠吻合术患者复发性胆管炎的 "升级方法 "疗效：单中心系列研究。

背景：复发性非狭窄性胆管炎（NSC）是外科肝空肠吻合术（HJ）的一种具有挑战性且鲜为人知的并发症。最佳治疗方法仍不明确：进行了一项回顾性单中心系列研究（2015-2022 年），研究对象包括肝胰胆手术后 HJ 非狭窄的复发性胆管炎患者。主要结果是NSC缓解（即6个月内无NSC）。次要结果包括减少 NSC 每月发作频率和继发性硬化性胆管炎：总的来说，1179 名 HJ 患者中有 50 人（4.2%）出现了 NSC。治疗方法包括使用短程抗生素（50 人，100%）、长程抗生素（26 人，52%）和翻修手术（7 人，14%）的 "渐进方法"。有 15 名患者（30%）的 NSC 得到了缓解，另有 21 名患者（42%）的 NSC 发生率有所下降。同时使用熊去氧胆酸和停用质子泵抑制剂是唯一预测NSC缓解的因素（OR 4.229，P = 0.035）。12名患者（24%）出现了继发性硬化性胆管炎，且与NSC发作次数有关（OR 1.2，p = 0.050）：结论：对 HJ 后复发性 NSC 采取 "阶梯式治疗 "可使 30% 的患者病情得到缓解，NSC 的发病率进一步降低了 42%，但仍有四分之一的患者发展为继发性硬化性胆管炎。未来的前瞻性研究应评估规范化方法是否能改善疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).