Impact of Preoperative ERCP on Laparoscopic Cholecystectomy: A Case-Controlled Study with Propensity Score Matching

Post-ERCP clearance of bile duct stones: should the gallbladder be left in-situ?

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard management for patients who present with common bile duct stone (CBDS). Although laparoscopic cholecystectomy is generally recommended for patients who have CBDS clearance, there is still a significant proportion of patients who are managed expectantly. Our study aimed to evaluate the outcomes of expectant management (EM) versus prophylactic cholecystectomy after initial endoscopic removal of CBDS.

METHOD

We performed a retrospective review of all patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019. Patients were further classified into young or elderly group using age 60 years as the cut-off. Primary outcomes measured biliary-related complications in each interventional group whereas secondary outcomes measured all-cause mortality.

RESULTS

136 patients (51.3%) had EM whereas 129 patients (48.7%) were initially planned for LC. There was 20.6% of recurrence of biliary events in EM group as compared to 3.9% in LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14 months. Overall complications of LC group was low (5.4%) with nil operative-related mortality. However, there was a significant higher proportion of elderly patients in EM group in comparison to LC group (88.2% vs 31%) and 51.4% of EM group died during follow-up period with only one biliary-related death.

CONCLUSION

Prophylactic cholecystectomy should be recommended for patients who have undergone ERCP clearance of CBDS. A watch-and-wait approach may be justified for elderly populations who are not ideal surgical candidates and a follow-up duration of up to 2 years is recommended.

Is It Possible to Predict Difficulties During Laparoscopic Sleeve Gastrectomy? A Single Centre Experience

INTRODUCTION

Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery across the globe. Understanding preoperative risk factors for possible intraoperative complications can aid in predicting surgical outcomes and shaping the approach to the procedure. This study aimed to identify and analyze potential risk factors associated with intraoperative difficulties during LSG.

PATIENTS AND METHODS

The analysis encompassed consecutive patients who underwent LSG from 2017 to 2020. Patients who encountered intraoperative difficulties during the procedure were categorized into Group 1, whereas those who did not experience such complications were placed in Group 2. To identify potential risk factors for intraoperative challenges, a thorough evaluation of demographic characteristics was conducted, including variables such as age, body mass index (BMI), comorbidities, and previous surgical history.

RESULTS

Group 1 included 37 patients (11.71%), while Group 2 comprised 279 patients (88.29%). Apart from higher rates of diabetes, pulmonary disease, and sleep apnea in Group 1, no significant differences were observed between the groups regarding demographic parameters. A univariate logistic regression analysis identified several risk factors associated with intraoperative difficulties, including a body mass index (BMI) greater than 50 kg/m2 (OR 2.15, 95%, CI 1.05-4.39, p = 0.0362), the experience of the operating surgeon (OR 9.22, 95% CI 4.31-19.72, p = 0.0058), the presence of diabetes (OR 2.44, 95% CI 1.19-4.98, p = 0.0146), and pulmonary disease (OR 12.22, 95% CI 1.97-75.75, p < 0.0001). In multivariate logistic regression analysis, only the surgeon's experience (OR 8.61, 95% CI 3.75-19.72, p < 0.0001) remained a significant factor influencing intraoperative difficulties.

CONCLUSIONS

The sole significant factor influencing the occurrence of intraoperative difficulties was the level of the surgeon's experience.

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

BACKGROUND

Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes.

METHODS

The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared.

RESULTS

The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses.

CONCLUSIONS

RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.

Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis

PURPOSES

Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes.

METHODS

A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group.

RESULTS

A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month.

CONCLUSION

Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.

Is early laparoscopic cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography superior?: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

With medical advancement, common bile duct stones were treated by endoscopic retrograde cholangiopancreatography (ERCP), considered the standard treatment. However, ERCP might induce complications including pancreatitis and cholecystitis that could affect a subsequent laparoscopic cholecystectomy (LC), leading to conversion to open cholecystectomy perioperative complications. It is not yet known whether or not the time interval between ERCP and LC plays a role in increasing conversion rate and complications. Bides, in the traditional sense, after ERCP, for avoiding edema performing LC was several weeks later. Even no one study could definite whether early laparoscopic cholecystectomy after ERCP affected the prognosis or not clearly.

OBJECTIVE

Comparing some different surgical timings of LC after ERCP.

METHOD

Searching databases consist of all kinds of searching tools, such as Medline, Cochrane Library, Embase, PubMed, etc. All the included studies should meet the demands of this meta-analysis. In all interest outcomes below, we took full advantage of RevMan5 and WinBUGS to assess; the main measure was odds ratio (OR) with 95% confidence. Moreover, considering the inconsistency of the specific time points in different studies, we set a subgroup to analyze the timing of LC after ERCP. For this part, Bayesian network meta-analysis was done with WinBUGS.

RESULT

In the pool of conversion rate, the result suggested that the early LC group was equal compared with late LC (OR = 0.68, I2 = 0%, P = .23). Besides, regarding morbidity, there was no significant difference between the 2 groups (OR = 0.74, I2 = 0%, P = .26). However, early LC, especially for laparoscopic-endoscopic rendezvous that belonged to performing LC within 24 hours could reduce the post-ERCP pancreatitis (OR = 0.16, I2 = 29%, P = .0003). Considering early LC included a wide time and was not precise enough, we set a subgroup by Bayesian network, and the result suggested that performing LC during 24 to 72 hours was the lowest conversion rate (rank 1: 0%).

CONCLUSION

In the present study, LC within 24 to 72 hours conferred advantages in terms of the conversion rate, with no recurrence of acute cholecystitis episodes.

Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes

BACKGROUND

There is no universal consensus on the optimal timing of cholecystectomy following endoscopic retrograde cholangio-pancreatography (ERCP). This study aims to evaluate the effect of time delay and post-ERCP complications on cholecystectomy outcomes.

MATERIALS AND METHODS

All patients who underwent pre-op ERCP for concurrent cholelithiasis and choledocholithiasis between January 2009 and August 2019 at University Hospitals Plymouth, UK, were included. Patients who underwent single-stage cholecystectomy and common bile duct exploration were excluded from the study. Based on the delay to cholecystectomy, the patients were divided into early (within 2 weeks), intermediate (2-6 weeks) and late (> 6 weeks) groups. The operative outcomes between the three groups were compared.

RESULTS

We included 444 patients in the study, with 62 (14%), 90 (20%) and 292 (66%) patients in the early, intermediate and late groups, respectively. The median duration from ERCP to cholecystectomy was 75 days. There was no statistically significant difference in the conversion-to-open rate, bile leak rate or retained stones between the three groups. The median post-operative hospital stay (PHS) was 2, 2 and 1 day (P = 0.005) in the early, intermediate and late groups, respectively. The readmission rate was significantly more in the delayed group (3.2%, 11.1% and 13.7%; P = 0.05). Patients who suffered post-ERCP complications had a significantly longer PHS (4 vs 1 day, P = 0.001) and had higher conversion-to-open rate (16 vs 4.5%, P = 0.04).

CONCLUSION

Delayed cholecystectomy following ERCP is not associated with worse peri-operative outcomes and can facilitate more day-case surgery. However, early cholecystectomy can significantly reduce readmissions with gallstone-related symptoms and its associated hospital stay. Post-ERCP complications lead to a difficult cholecystectomy.

Outcomes of same admission cholecystectomy and endoscopic retrograde cholangiopancreatography for common bile duct stones: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study

BACKGROUND

The optimal timing for cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stones is unknown. We hypothesized that a delay between procedures would correlate with more biliary complications and longer hospitalizations.

METHODS

We prospectively identified patients who underwent same admission cholecystectomy after ERCP for CBD stones from 2016 to 2019 at 12 US medical centers. The cohort was stratified by time between ERCP and cholecystectomy: ≤24 hours (immediate), >24 to ≤72 hours (early), and >72 hours (late). Primary outcomes included operative duration, postoperative length of stay, (LOS), and hospital LOS. Secondary outcomes included rates of open conversion, CBD explorations, biliary complications, and in-hospital complications.

RESULTS

For the 349 patients comprising the study cohort, 33.8% (n = 118) were categorized as immediate, 50.4% (n = 176) as early, and 15.8% (n = 55) as late. Rates of CBD explorations were lower in the immediate group compared with the late group (0.9% vs. 9.1%, p = 0.01). Rates of open conversion were lower in the immediate group compared with the early group (0.9% vs. 10.8%, p < 0.01) and in the immediate group compared with the late group (0.9% vs. 10.9%, p < 0.001). On a mixed-model regression analysis, an immediate cholecystectomy was associated with a significant reduction in postoperative LOS (β = 0.79; 95% confidence interval, 0.65-0.96; p = 0.02) and hospital LOS (β = 0.68; 95% confidence interval, 0.62-0.75; p < 0.0001).

CONCLUSION

An immediate cholecystectomy following ERCP correlates with a shorter postoperative LOS and hospital LOS. Rates of CBD explorations and conversion to open appear more common after 24 hours.

LEVEL OF EVIDENCE

Therapeutic, level III.

The pre-operative predictive model for difficult elective laparoscopic cholecystectomy: A modification

BACKGROUND

Although LC is a common operation, difficult cases are still challenging. Several studies have identified factors for the difficulty and conversion. Many scoring systems have been established for pre-operative prediction. This study aimed to investigate significant factors and validity of Randhawa's model in our setting.

METHODS

This prospective study enrolled LC patients in Hepato-Pancreato-Biliary Surgery unit between March 2018 and October 2019. The difficulty of operation was categorized into 3 groups by intra-operative grading scale. Multivariate analysis was performed to define significant factors of very-difficult and converted cases. The difficulty predicted by Randhawa's model were compared with actual outcome. Area under ROC curve was calculated.

RESULTS

Among 152 patients, difficult and very-difficult groups were 59.2% and 15.1%, respectively. Sixteen cases needed conversion. Four factors (cholecystitis, ERCP, thickened wall, contracted gallbladder) for very-difficult group and 3 factors (obesity, biliary inflammation or procedure, contracted gallbladder) for conversion were significant. After some modification of Randhawa's model, the modified scoring system provided better prediction in terms of higher correlation coefficient (0.41 vs 0.35) and higher AUROC curve (0.82 vs 0.75) than original model.

DISCUSSION

Randhawa's model was feasible for pre-operative preparation. The modification of this model provided better prediction on difficult cases.

Management of complicated gallstones in the elderly: comparing surgical and non-surgical treatment options

Objective

The aim of this study was to evaluate the differences in clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP), ERCP followed by cholecystectomy (EC) and percutaneous aspiration (PA) in the elderly population with choledocholithiasis.

Methods

We included a total of 43 338 elderly patients aged 60 years or older and 45 295 patients younger than 60 years for comparison in our study. Data were obtained from the Nationwide Inpatient Sample (Healthcare Utilization Project) for years 2001–14 by identifying patients who were admitted for gallstone complications based on the ICD 9 diagnostic code. Multiple logistic regression was used to calculate the odds of in-hospital mortality and to detect statistical differences among the treatment groups, age groups and between male and female patients. Univariate ordinary linear regression was used to compare the length of hospital stay and readmission frequency among the different age groups.

Results

The age of the patient affected mortality and the length of hospital stay after any type of procedure of gallstones removal. In a manner independent of the patient’s age, PA was associated with the highest risk of death and length of stay, while the EC was characterized by lowest mortality and ERCP by the shortest length of stay. Neither age of the patient nor the type of procedure affected the likelihood of readmission. The odds of death and the probability of readmission were not affected by patient sex. However, in patients aged between 60 and 79 years, the female gender predicted a shorter duration of stay in the hospital.

Conclusions

A patient’s age negatively affects the treatment outcomes of cholelithiasis with associated complications. The EC procedure appears to be the method of choice for the management of complicated gallstones in patients of all ages.

In-hospital Pediatric Endoscopic Retrograde Cholangiopancreatography Is Associated With Shorter Hospitalization for Children With Choledocholithiasis

OBJECTIVES

Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists.

METHODS

Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables.

RESULTS

One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004).

CONCLUSIONS

Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.

Predictive Factors for Long Operative Duration in Patients Undergoing Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Combined Choledochocystolithiasis

PURPOSE

Choledochocystolithiasis and its associated complications such as cholangitis and pancreatitis are managed by endoscopic retrograde cholangiography (ERC), with endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). However, affected patients present with complex conditions linked to operative difficulties in performing LC. The aim of this study was to elucidate the predictive factors for a prolonged LC procedure following ERC for treating patients with choledochocystolithiasis.

MATERIALS AND METHODS

The medical records of 109 patients who underwent LC after ERC for choledochocystolithiasis from September 2012 to August 2014 were evaluated retrospectively. The cases were divided into long and short operative duration groups using a cutoff operative time of 90 minutes. We used univariate and multivariate analyses to investigate predictive factors associated with long operative duration according to clinical variables, ERC-related factors, and peak serum levels of laboratory test values between the initial presentation and LC (intervening period).

RESULTS

Seventeen patients needed >90 min to complete LC. The presence of acute cholecystitis, placement of percutaneous transhepatic gallbladder drainage, higher peak serum white blood cell count and levels of C-reactive protein (CRP), and lower peak serum levels of lipase during the intervening period were associated with prolonged operative duration. Multivariate analysis showed that the independent predictive factors for long operative duration were the presence of acute cholecystitis (hazard ratio, 5.418; P=0.016) and higher peak levels of CRP (hazard ratio, 1.077; P=0.022).

CONCLUSION

When patients with choledochocystolithiasis are scheduled for LC after ERC, the presence of acute cholecystitis and high CRP levels during the intervening period could predict a protracted operation.

Surgery Reduces Risk of Complications Even in High-Risk Veterans After Endoscopic Therapy for Biliary Stone Disease

BACKGROUND

In otherwise healthy patients, randomized trials have shown reduced mortality with cholecystectomy (CCY) when compared to non-operative management after endoscopic retrograde cholangiopancreatography (ERCP) for biliary stone disease. These findings may not apply to veterans with multiple comorbidities, who have an increased risk of postoperative complications.

AIMS

Our study assessed the benefit of CCY among veterans with multiple comorbidities.

METHODS

Medical records of patients undergoing ERCP for biliary stone-related diseases from July 2008 to December 2016 were reviewed. Among patients who did not undergo CCY, risk of postoperative complications or death with CCY was estimated using the American College of Surgeons National Surgery Quality Improvement Program risk calculator. Charlson comorbidity index (CCI) and American Society of Anesthesiologists classification system (ASA) were used to assess patient's functional status. The primary outcome was incidence of recurrent biliary events or death with non-operative management, compared to estimated risk of serious postoperative complications or death with CCY.

RESULTS

A total of 152 patients met inclusion criteria, 81 of whom did not undergo CCY. Patients managed non-operatively were older and less medically fit than patients who underwent CCY. Biliary complications recurred in 23 patients managed non-operatively, including 3 deaths due to cholangitis. Among patients with CCI ≥ 3 and ASA ≥ 3 who were managed non-operatively (n = 43), the risk of serious biliary events was significantly higher than estimated risk of serious postoperative complications with laparoscopic CCY (26 vs 5%, p < 0.001).

CONCLUSION

Our study suggests that non-operative management is associated with a higher risk of complications than laparoscopic CCY, even among veterans with significant comorbidities.

Impact of preoperative endoscopic cholangiography and biliary drainage in Ampulla of Vater cancer

BACKGROUND

Ampulla of Vater (AOV) carcinoma is a rare malignancy but has a relatively good prognosis. The aims of this study were to determine the clinicopathologic factors associated with survival and disease recurrence in patients with AOV cancer, focusing on the impact of preoperative endoscopic retrograde cholangiopancreatography (ERCP) and type of biliary drainage (endoscopic retrograde biliary drainage [ERBD] or percutaneous transhepatic biliary drainage [PTBD]).

METHODS

We retrospectively reviewed the medical records of 80 patients who underwent curative resection for AOV cancer at a single institution between 1995 and 2015. The clinicopathologic factors associated with survival and disease recurrence were analyzed using univariate and multivariable tests.

RESULTS

The 5-year disease-free and overall actuarial survival rates were 39.3% and 51.3%, respectively. Moderate or poor differentiation, preoperative ERCP, advanced T stage, lymph node metastases, advanced stage and lymphovascular invasion were associated with disease-free survival in univariate analyses. The prognosis was worse in patients who underwent ERBD than in patients who underwent PTBD or no biliary drainage. Multivariable analysis showed that advanced AJCC stage and preoperative ERCP were independent risk factors for recurrence. Patient who underwent preoperative ERCP had a significantly higher rate of early distant metastasis within 1 year, especially in patients with early stage AOV cancer.

CONCLUSIONS

Preoperative ERCP was an independent risk factor for postoperative recurrence in patients with AOV cancer, and is characterized by early distant metastasis in early stage cancer. Therefore, unnecessary ERCP should be avoided in patients with AOV cancer. If biliary drainage is necessary, PTBD may be preferred to ERBD in AOV cancer.

Optimal Timing for Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

Background and Aims:

Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is often used as definitive treatment for common bile duct stones. The aim of this study was to investigate the optimal time interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

Materials and Methods:

PubMed and Embase were searched for studies comparing different time delays between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Observational studies and randomized controlled trials were included. Primary outcome was conversion rate from laparoscopic to open cholecystectomy and secondary outcomes were complications, mortality, operating time, and length of stay.

Results:

A total of 14 studies with a total of 1930 patients were included. The pooled estimate revealed an increase from a 4.2% conversion rate when laparoscopic cholecystectomy was performed within 24 h of endoscopic retrograde cholangiopancreatography to 7.6% for 24–72 h delay to 12.3% when performed within 2 weeks, to 12.3% for 2–6 weeks, and to a 14% conversion rate when operation was delayed more than 6 weeks.

Conclusion:

According to this systematic review, it is preferable to perform cholecystectomy within 24 h of endoscopic retrograde cholangiopancreatography to reduce conversion rate. Early laparoscopic cholecystectomy does not increase mortality, perioperative complications, or length of stay and on the contrary it reduces the risk of reoccurrence and progression of disease in the delay between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

Risk factors for post-endoscopic sphincterotomy biliary tract infection in patients with choledocholithiasis

AIM

To identify the risk factors for post-endoscopic sphincterotomy (EST) biliary tract infection in patients with choledocholithiasis.

METHODS

From May 2012 to May 2015, 102 patients with choledocholithiasis were chosen as study subjects, and all patients were treated by EST. These patients were divided into an infection group and a control group. Pre-operative data, operative data, basic diseases and history were compared between the two groups to identify the risk factors for biliary tract infection after EST.

RESULTS

A total of 29 patients were diagnosed with biliary tract infection. Diameter of stones ≥ 25 mm (OR = 1.971, 95%CI: 0.975-3.489), biliary dilatation/stricture (OR = 2.971, 95%CI: 1.165-4.724), multiple ERCP (OR = 2.217, 95%CI: 1.019-4.876), lithotripsy (OR = 2.598, 95%CI: 1.147-4.790), operative time ≥ 60 min (OR = 2.087, 95%CI: 1.994-3.867), diabetes (OR = 2.176, 95%CI: 1.763-3.885), biliary operation (OR = 1.723, 95%CI: 1.357-3.109), ERCP history (OR = 2.089, 95%CI: 1.665-3.576) and biliary stent (OR = 2.219, 95%CI: 1.982-3.347) were risk factors for post-EST biliary tract infection. Usage of antibiotics was identified to be a protective factor for post-EST biliary tract infection (OR = 0.471, 95%CI: 0.231-0.796).

CONCLUSION

Post-EST biliary tract infection demonstrates significant relativity with multiple factors, while usage of antibiotics exerts a protective effect against the infection.