Biomaterial Database

Recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy: incidence and risk factors. 2024

Anouk G Overdevest, and Jeska A Fritzsche, and Mark A D Smit, and Marc G Besselink, and Alessandro M Bonomi, and Olivier R Busch, and Freek Daams, and Otto M van Delden, and Geert Kazemier, and Jesse Langver, and Cyriel Y Ponsioen, and Rutger-Jan Swijnenburg, and Roy L J van Wanrooij, and Mattheus C B Wielenga, and Babs M Zonderhuis, and IJsbrand A J Zijlstra, and Joris I Erdmann, and Rogier P Voermans

Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands. Electronic address: a.overdevest@amsterdamumc.nl.

BACKGROUND Cholangitis is a well-known complication after hepaticojejunostomy (HJ), which is mainly caused by a stenotic anastomosis. However, the rate of cholangitis in patients with a non-stenotic (i.e. patent) HJ is unknown. We aimed to evaluate the incidence and risk factors of recurrent cholangitis in patients with a non-stenotic HJ. METHODS This single-center retrospective cohort study included all consecutive patients who had undergone hepatobiliary or pancreatic (HPB) surgery requiring HJ (2015-2022). Primary outcome was recurrent non-stenotic cholangitis, risk factors for recurrent non-stenotic cholangitis were identified using logistic regression. RESULTS Overall, 835 patients with a HJ were included of whom 31/698 (4.4%) patients developed recurrent cholangitis with a non-stenotic HJ during a median follow-up of 34 months (IQR 22-50) and 98/796 (12.3%) patients developed a symptomatic HJ stenosis. These 31 patients experienced 205 cholangitis episodes, median 7.0 (IQR 3.8-8.8) per patient, and 71/205 (34.6%) cholangitis episodes required hospitalization. Male sex (aOR 3.17 (95% CI: 1.34-7.49)) and benign disease (aOR 2.97, 95% CI 1.40-6.33) were identified as risk factors for recurrent cholangitis in non-stenotic HJ in both univariate and multivariable analysis. CONCLUSIONS This study shows that 4% of patients developed recurrent cholangitis without an underlying HJ stenosis.