Pre-operative ERCP drainage of malignant obstructive jaundice: the effect on bile bacteriology.

Aims: It is unclear whether there is an improvement in surgical outcome for patients that undergo preoperative ERCP. We therefore sought to establish if the use of preoperative ERCP for biliary decompression is associated with an alteration in bile bacteriology and highlight the potential morbidity. Methods: A retrospective analysis was performed of 206 patients that had undergone HPB resection in our unit. The use of preoperative ERCP was established and a microbiological comparison made between those cases that underwent surgery alone and those that underwent preoperative ERCP with or without stent placement. Results: Of the 206 patients 89 had ERCP prior to surgery and 117 had surgery only. The incidence of bacteremia and fungaemia was significantly higher in the ERCP with stent group by comparison to those who had only surgery (P < 0.001). The most common organisms cultured for the all groups were coliforms and enterococcus, with an equal incidence of candida in those undergoing ERCP. Conclusion: ERCP for preoperative drainage of obstructed biliary systems is associated with a high incidence of bile bacteremia and fungal colonization. ERCP should be reserved for those patients with cholangitis preoperatively and should not be used routinely until thorough staging has been completed. [ABSTRACT FROM AUTHOR]