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Poor Results of Pancreatoduodenectomy in High-Risk Patients with Endoscopic Stent and Bile Colonization are Associated with E. coli, Diabetes and Advanced Age

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Endoscopic stenting has spread as bridge management before pancreatoduedenectomy (PD) to resolve jaundice, but its role is nowadays challenged as it is reported to increase morbidity. Although bile sampling is increasingly performed, its clinical role is unclear. The objective of the study is to assess bile colonization’s impact on outcome.

Methods

Results of pancreatoduodenectomy after endoscopic stenting are analyzed in 61 high-risk patients presenting bacterial bile colonization. The impact of 11 demographic, clinical, infectious, and laboratory parameters and outcome, including pancreatic leakage, morbidity, and mortality, is analyzed.

Results

All stented patients present bacterial bile colonization and PD mortality approaches 10 %. The presence of E. coli in the bile is significantly related to poor outcome, including 23.5 % mortality (p = 0.034), whereas age (≥70 years) and diabetes present borderline results (p < 0.070 and p < 0.066, respectively). E. coli (p = 0.002) and age (p = 0.017) are also related to grade C pancreatic fistula.

Conclusions

In high-risk patients undergoing PD, bile colonization inevitably occurs after endoscopic stenting and is a major risk factor of poor outcome, reaching its maximum in the case of E. coli colonization and elderly patients, where the indication to stent and/or to perform PD should be accurately evaluated. E. coli-targeted antibiotic prophylaxis should be administered.

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Acknowledgments

The authors thank Miss Deborah Bonamini and Miss Alessandra Ferrari, from the “G.B. Rossi” University Hospital (Verona, Italy), for their timeless efforts in supporting the research activity, and Professor Patrice Valleur, from the “Lariboisière” University Hospital (Paris “Diderot” University, France), for his inestimable contribution in reviewing the paper.

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Authors and Affiliations

  1. Dipartimento di Chirurgia Generale B, Istituto del Pancreas, Policlinico “G.B. Rossi”, Università degli Studi di Verona, Verona, Italia

    Renato Costi, Matteo De Pastena, Giuseppe Malleo, Giovanni Marchegiani, Giovanni Butturini, Roberto Salvia & Claudio Bassi

  2. Service de Chirurgie Digestive et Cancérologique, Hôpital Lariboisière, AP-HP, Université Paris 7 “Diderot”, Paris, France

    Renato Costi

  3. Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria di Parma, Parma, Via Gramsci 14, 43100, Parma, Italia

    Renato Costi & Vincenzo Violi

  4. Unità Operativa di Chirurgia del Pancreas, Casa di Cura “Pederzoli”, Peschiera sul Garda, Verona, Italia

    Giovanni Butturini

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  1. Renato Costi
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Correspondence to Renato Costi.

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Costi, R., De Pastena, M., Malleo, G. et al. Poor Results of Pancreatoduodenectomy in High-Risk Patients with Endoscopic Stent and Bile Colonization are Associated with E. coli, Diabetes and Advanced Age. J Gastrointest Surg 20, 1359–1367 (2016). https://doi.org/10.1007/s11605-016-3158-3

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  • DOI: https://doi.org/10.1007/s11605-016-3158-3

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