The Clinical Impact of Different Types of Preoperative Biliary Intervention on Postoperative Biliary Tract Infection of Patients Undergoing Pancreaticoduodenectomy.

Simple Summary: Post-pancreaticoduodenectomy complications are still a major concern nowadays, and we focused on one of the most catastrophic conditions observed from clinical practice, the postoperative biliary infection, which may cause postoperative intensive care unit admission or mortality. Evaluating the impact on postoperative biliary tract infection from endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography and drainage before surgery is important to clinical circumstances. Biliary pathogens identified with a positive yield of intra-operative bile culture in patients undergoing pancreaticoduodenectomy were also investigated. The result showed that performing endoscopic retrograde cholangiopancreatography enhances the likelihood of achieving a positive yield from intraoperative biliary culture. Thus, PTCD emerges as a potentially favorable option for patients with obstructive jaundice and is indicated for pancreaticoduodenectomy. Background: For patients with obstructive jaundice and who are indicated for pancreaticoduodenectomy (PD) or biliary intervention, either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and drainage (PTCD) may be indicated preoperatively. However, the possibility of procedure-related postoperative biliary tract infection (BTI) should be a concern. We tried to evaluate the impact of ERCP and PTCD on postoperative BTI. Methods: Patients diagnosed from June 2013 to March 2022 with periampullary lesions and with PD indicated were enrolled in this cohort. Patients without intraoperative bile culture and non-neoplastic lesions were excluded. Clinical information, including demographic and laboratory data, pathologic diagnosis, results of microbiologic tests, and relevant infectious outcomes, was extracted from medical records for analysis. Results: One-hundred-and-sixty-four patients from the cohort (164/689) underwent preoperative biliary intervention, either ERCP (n = 125) or PTCD (n = 39). The positive yield of intraoperative biliary culture was significantly higher in patients who underwent ERCP than in PTCD (90.4% vs. 41.0%, p < 0.001). Although there was no significance, a trend of higher postoperative BTI (13.8% vs. 2.7%) and BTI-related septic shock (5 vs. 0, 4.0% vs. 0%) in the ERCP group was noticed. While the risk factors for postoperative BTI have not been confirmed, a trend suggesting a higher incidence of BTI associated with ERCP procedures was observed, with a borderline p-value (p = 0.05, regarding ERCP biopsy). Conclusions: ERCP in patients undergoing PD increases the positive yield of intraoperative biliary culture. PTCD may be the favorable option if preoperative biliary intervention is indicated. [ABSTRACT FROM AUTHOR]