Journal of Gastrointestinal Surgery

, Volume 20, Issue 8, pp 1428–1434 | Cite as

Use of Prophylactic Antibiotics to Prevent Abscess Formation Following Hepatic Ablation in Patients with Prior Enterobiliary Manipulation

  • Bruno C. OdisioEmail author
  • Michael Richter
  • Thomas A. Aloia
  • Claudius Conrad
  • Kamran Ahrar
  • Sanjay Gupta
  • Jean-Nicolas Vauthey
  • Steven Y. Huang
Original Article



Prior enterobiliary manipulation confers a high risk for liver abscess formation after hepatic ablation. We aimed to determine if prophylactic antibiotics could prevent post-ablation abscess in patients with a history of hepaticojejunostomy.

Materials and Methods

This single-institution retrospective study identified 262 patients who underwent 307 percutaneous liver ablation sessions between January 2010 and August 2014. Twelve (4.6 %) patients with prior hepaticojejunostomy were included in this analysis. Ten (83> %) had received an aggressive prophylactic antibiotic regimen consisting of levofloxacin, metronidazole, neomycin, and erythromycin base. Two (16.6 %) had received other antibiotic regimens. Clinical, laboratory, and imaging findings were used to identify abscess formation and antibiotic-related side effects.


Twelve ablation sessions were performed during the period studied. During a mean follow-up period of 440 days (range, 77–1784 days), post-ablation abscesses had developed in 2 (16.6 %) patients, who both received the alternative antibiotic regimens. None of the 10 patients who received the aggressive prophylactic antibiotic regimen developed liver abscess. One of the 10 patients who received the aggressive prophylactic antibiotic regimen developed grade 2 antibiotic-related diarrhea and arthralgia.


An aggressive regimen of prophylactic antibiotics may be effective in preventing liver abscess formation after liver ablation in patients with prior hepaticojejunostomy.


Abscess Hepaticojejunostomy Liver ablation Antibiotics 



This research was supported, in part, by the National Institutes of Health through MD Anderson Cancer Center’s Support Grant, CA016672. We would like to thank you Amy Ninetto by the scientific edition of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, Lin XJ, Lau WY. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Annals of surgery. 2006;243(3):321–328.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, Bartolozzi C. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005;234(3):961–967.CrossRefPubMedGoogle Scholar
  3. 3.
    Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265(3):958–968.CrossRefPubMedGoogle Scholar
  4. 4.
    Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovascular and interventional radiology. 2010;33(1):11–17.CrossRefPubMedGoogle Scholar
  5. 5.
    de Baere T, Risse O, Kuoch V, Dromain C, Sengel C, Smayra T, Gamal El Din M, Letoublon C, Elias D. Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR American journal of roentgenology. 2003;181(3):695–700.CrossRefPubMedGoogle Scholar
  6. 6.
    Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226(2):441–451.CrossRefPubMedGoogle Scholar
  7. 7.
    Shibata T, Yamamoto Y, Yamamoto N, Maetani Y, Shibata T, Ikai I, Terajima H, Hatano E, Kubo T, Itoh K, Hiraoka M. Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. Journal of vascular and interventional radiology : JVIR. 2003;14(12):1535–1542.CrossRefPubMedGoogle Scholar
  8. 8.
    Choi D, Lim HK, Kim MJ, Kim SJ, Kim SH, Lee WJ, Lim JH, Paik SW, Yoo BC, Choi MS, Kim S. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR American journal of roentgenology. 2005;184(6):1860–1867.CrossRefPubMedGoogle Scholar
  9. 9.
    Iida H, Aihara T, Ikuta S, Yamanaka N. Risk of abscess formation after liver tumor radiofrequency ablation: a review of 8 cases wtih a history of enterobiliary anastomosis. Hepato-gastroenterology. 2014;61(135):1867–1870.PubMedGoogle Scholar
  10. 10.
    Elias D, Di Pietroantonio D, Gachot B, Menegon P, Hakime A, De Baere T. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Gastroenterol Clin Biol. 2006;30(6–7):823–827.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol. 2001;12(8):965–968.CrossRefPubMedGoogle Scholar
  12. 12.
    Geschwind JF, Kaushik S, Ramsey DE, Choti MA, Fishman EK, Kobeiter H. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. Journal of vascular and interventional radiology : JVIR. 2002;13(11):1163–1166.CrossRefPubMedGoogle Scholar
  13. 13.
    Patel S, Tuite CM, Mondschein JI, Soulen MC. Effectiveness of an aggressive antibiotic regimen for chemoembolization in patients with previous biliary intervention. Journal of vascular and interventional radiology : JVIR. 2006;17(12):1931–1934.CrossRefPubMedGoogle Scholar
  14. 14.
    Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology. 1988;166(2):381–387.CrossRefPubMedGoogle Scholar
  15. 15.
    Chuang JH, Chen WJ, Lee SY, Chang NK. Prompt colonization of the hepaticojejunostomy and translocation of bacteria to liver after bile duct reconstruction. Journal of pediatric surgery. 1998;33(8):1215–1218.CrossRefPubMedGoogle Scholar
  16. 16.
    Hitch DC, Lilly JR. Identification, quantification, and significance of bacterial growth within the biliary tract after Kasai’s operation. Journal of pediatric surgery. 1978;13(6D):563–569.CrossRefPubMedGoogle Scholar
  17. 17.
    Deguchi E, Yanagihara J, Shinjo H, Iwai N. Periodic bile cultures and irrigation of the external jejunostomy for cholangitis in biliary atresia. Pediatric surgery international. 1996;11(4):234–236.CrossRefPubMedGoogle Scholar
  18. 18.
    Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, Lee WJ, Lim HK, Nam GJ, Han SS, Kim YH, Park CM, Kim PN, Byun JY. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics : a review publication of the Radiological Society of North America, Inc. 2003;23(1):123–34; discussion 34–36.CrossRefGoogle Scholar
  19. 19.
    DiPiro JT, Patrias JM, Townsend RJ, Bowden TA, Jr., Hooks VH, 3rd, Smith RB, Spiro TE. Oral neomycin sulfate and erythromycin base before colon surgery: a comparison of serum and tissue concentrations. Pharmacotherapy. 1985;5(2):91–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM. Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Annals of surgery. 1973;178(4):453–462.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cannon JA, Altom LK, Deierhoi RJ, Morris M, Richman JS, Vick CC, Itani KM, Hawn MT. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Diseases of the colon and rectum. 2012;55(11):1160–1166.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Bruno C. Odisio
    • 1
    Email author
  • Michael Richter
    • 1
  • Thomas A. Aloia
    • 2
  • Claudius Conrad
    • 2
  • Kamran Ahrar
    • 1
  • Sanjay Gupta
    • 1
  • Jean-Nicolas Vauthey
    • 2
  • Steven Y. Huang
    • 1
  1. 1.Department of Interventional RadiologyThe University of Texas MD Anderson Cancer Center, HoustonHoustonUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center, HoustonHoustonUSA

Personalised recommendations