ArticleDigestive diseases and sciences2026
Pre-Endoscopic Retrograde Cholangiopancreatography Cholangitis and Stent Outcomes in Malignant Distal Biliary Obstruction: A Multicenter Propensity Score-Matched Analysis.
Article in Digestive diseases and sciences, 2026. 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
backgroundClinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis on time to recurrent biliary obstruction (TRBO) and early post-ERCP infection in patients with distal malignant biliary obstruction (DMBO).
methodsWe retrospectively reviewed consecutive patients with DMBO who underwent their first ERCP-guided stenting at five Japanese centers (January 2020-August 2024). Patients were classified by pre-ERCP cholangitis status and matched at a 2:1 ratio of noncholangitis to cholangitis using propensity scores (PSM). The primary outcome was TRBO; secondary outcomes were post-ERCP infection, clinical success, and RBO rates. TRBO was analyzed using Kaplan-Meier, log-rank, and multivariable Cox analyses; sensitivity analyses yielded concordant results.
resultsOf 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114 d (p = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, p = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, p < 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, p = 0.46). Infections occurred in 9.6 and 4.4% (p = 0.33). Independent infection predictors were dilated bile duct (protective; odds ratio: 0.26, p = 0.02) and prolonged procedures (odds ratio: 3.73, p = 0.03).
conclusionsPre-ERCP cholangitis did not reduce stent patency or increase early infection rates in patients with DMBO. TRBO-depended primarily on stent type; nondilated ducts and prolonged procedures were predictive of infection. These findings support possible internal drainage during index ERCP with contemporary periprocedural management.
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