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

Autor:	Bonomi AM; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands. Electronic address: alessandro.bonomi@unimi.it., Overdevest AG; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Fritzsche JA; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Busch OR; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Daams F; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands., Kazemier G; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands., Swijnenburg RJ; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Beuers U; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Zonderhuis BM; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands., van Wanrooij RLJ; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Gastroenterology and Hepatology, the Netherlands., Erdmann JI; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Voermans RP; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands., Besselink MG; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands; Cancer Center Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamUMC.nl.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1016/j.hpb.2024.10.016
Abstrakt:	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. (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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