ArticleFrontiers in surgery2025
Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Biliary drainage is frequently used in patients with perihilar obstruction. This study was designed to compare the microbiological characteristics of patients whose biliary trees were either exposed or not exposed to duodenal fluid, depending on the drainage method used. Methods: The charts of 71 patients with perihilar obstruction (any etiology causing an obstruction parallel to that of a proximal cholangiocarcinoma according to the Bismuth-Corlette classification) were evaluated retrospectively. The contacted group comprised 20 patients who underwent either endoscopic stenting or percutaneous transhepatic biliary drainage (PTBD) with duodenal extension, while the non-contacted group consisted of 51 patients with either external PTBD or surgery upfront. Results: Positive bile culture results were identified in 19/20 (95%) vs. 17/51 (33%) patients ( Conclusions: The mode of the biliary drainage-duodenal vs. directly external-significantly modifies the microbiological characteristics of the patients with perihilar obstruction. Catheterization methods that entail continuous exposure of the biliary tree to duodenal fluid are associated with higher frequencies of bactibilia, presence of MDR and XDR bacteria in the bile, and intestinal colonization with CRE.
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