Alessandro M Bonomi, Anouk G Overdevest, Jeska A Fritzsche, Olivier R Busch, Freek Daams, Geert Kazemier, Rutger-Jan Swijnenburg, Ulrich Beuers, Babs M Zonderhuis, Roy L J van Wanrooij, Joris I Erdmann, Rogier P Voermans, Marc G Besselink
{"title":"肝-胰-胆手术后非狭窄性肝空肠吻合术患者复发性胆管炎的 \"升级方法 \"疗效：单中心系列研究。","authors":"Alessandro M Bonomi, Anouk G Overdevest, Jeska A Fritzsche, Olivier R Busch, Freek Daams, Geert Kazemier, Rutger-Jan Swijnenburg, Ulrich Beuers, Babs M Zonderhuis, Roy L J van Wanrooij, Joris I Erdmann, Rogier P Voermans, Marc G Besselink","doi":"10.1016/j.hpb.2024.10.016","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcome of a 'step-up approach' for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series.\",\"authors\":\"Alessandro M Bonomi, Anouk G Overdevest, Jeska A Fritzsche, Olivier R Busch, Freek Daams, Geert Kazemier, Rutger-Jan Swijnenburg, Ulrich Beuers, Babs M Zonderhuis, Roy L J van Wanrooij, Joris I Erdmann, Rogier P Voermans, Marc G Besselink\",\"doi\":\"10.1016/j.hpb.2024.10.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":13229,\"journal\":{\"name\":\"Hpb\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hpb\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hpb.2024.10.016\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hpb.2024.10.016","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Outcome of a 'step-up approach' for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series.
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.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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