“Primary bacterial culture of bile and pancreatic juice in tumor related jaundice (TROJ) - is ascending cholangitis always our fault?”

Abstract

Introduction: TROJ (tumor-related obstructive jaundice) is one of the most common indications for endoscopic retrograde choleopancreatography (ERCP) with endoscopic biliary stenting. Despite the effectiveness of this procedure, especially in palliative patients, it is not without flaws. Ascending bacterial cholangitis, a common stenting complication, occurs in about 0.5–1.7% of cases. The authors’ intention was to investigate whether this complication occurs solely due to the procedure or whether it is a result of an underlying bacterial infection in the dilated, obstructed bile and pancreatic ducts.

Methods: Sixteen patients with painless obstructive jaundice related to a tumor located in or in the proximity of the bile duct were enrolled for this study. Prior to endoscopic palliative stenting we harvested bile and pancreatic fluid and the proceeded with the initial procedure.

Results: In 14 cases (87.5%) we managed to restore the patency of the bile duct endoscopically. Additionaly, we observed that in 13 cases (81.25%) bacteria were present in the bile and/or pancreatic fluid. The most common pathogen was Streptococcus mitis - present in 7 cases (43.75%). The most effective antibiotics for discovered S. mitis strains were cefuroxime and vancomycin.

Conclusion: Primal bacterial pathogenes may be present in obstructed bile and pancreatic ducts prior to endoscopic intervention. The connection between Streptocccus mitis and TROJ needs further investigation.

Keywords:

• ERCP
• biliary stenting
• obstructive jaundice
• biliary and pancreatic bacterial culture

Disclosure statement

Dr Tomasz Klimczak has nothing to disclose.

Dr Krzysztof Kaczka has nothing to disclose.

Dr Jerzy Klimczak has nothing to disclose.

Dr Ewa Tyczkowska-Sieroń has nothing to disclose.

Dr Anna Tyczkowska has nothing to disclose.

All procedures performed in studies involving human participants were in accordancewith the ethical standards of the institutional and/or national research committee and with the

1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Figure 1. (A) Pancreatic head tumor before stenting (arrow). (B) Pancreatic head tumor after stenting.

Figure 2. (A) Hepatic hilum tumor before stenting (arrow). (B) Hepatic hilum tumor after stenting.