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Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study

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Abstract

Background

Postoperative cholangitis is one of the major late complications after pancreaticoduodenectomy (PD), and recurrent cholangitis has a negative impact on patients’ quality of life. However, detailed reports are scarce. The aim of this study was to investigate the clinical features of postoperative cholangitis after PD.

Methods

Between January 2007 and December 2013, 155 consecutive patients underwent PD. Of these, 113 patients were included in this study. Cholangitis was diagnosed according to the criteria in the revised Tokyo Guidelines 2013, and repeated cholangitis with three or more episodes was defined as ‘refractory cholangitis’. Data from patients with refractory cholangitis were retrospectively analyzed.

Results

Refractory cholangitis was observed in 21 patients (18.6%). Of these, 17 patients experienced cholangitis within 1 year after PD, and 10 patients had biliary strictures. These patients required an average of two interventional or endoscopic treatments for stricture dilatation, which led to remission. The 2-year cumulative incidence rate for refractory cholangitis was 18.9% (95% CI 11.65–26.15). Multivariate analysis revealed five risk factors for developing refractory cholangitis: benign disease (odds ratio [OR] 18.52; P = 0.001), long operation time (OR 18.73; P = 0.002), elevated C-reactive protein (OR 6.55; P = 0.014), elevated alkaline phosphatase (OR 6.03; P = 0.018), and the presence of pneumobilia (OR 28.81; P = 0.009).

Conclusions

Postoperative refractory cholangitis after PD usually developed within a year. Almost half of the patients had biliary strictures, and aggressive dilatation might be effective to achieve remission in these patients.

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Acknowledgements

We would like to thank the radiologists and gastroenterologists at our hospital who greatly contributed to the clinical diagnosis and treatment of cholangitis in this study.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hiroki Ueda, Daisuke Ban, Atsushi Kudo, Takanori Ochiai & Minoru Tanabe

  2. Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Shinji Tanaka

Authors
  1. Hiroki Ueda
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  2. Daisuke Ban
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  3. Atsushi Kudo
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  4. Takanori Ochiai
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  5. Shinji Tanaka
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  6. Minoru Tanabe
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Corresponding author

Correspondence to Daisuke Ban.

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The authors declare that they have no conflict of interest.

Additional information

Meeting presentation information: Presented as a poster presentation at the Society for Surgery of the Alimentary Tract poster session (Poster ID: Tu1504) in Digestive Disease Week 2016, May 24, 2016, San Diego, California, and at the 50th Annual Pancreas Club poster session (Poster ID: P073), May 20, 2016, San Diego, California.

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Ueda, H., Ban, D., Kudo, A. et al. Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study. World J Surg 41, 1882–1889 (2017). https://doi.org/10.1007/s00268-017-3912-z

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  • DOI: https://doi.org/10.1007/s00268-017-3912-z

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