The Clinical Presentations of Liver Abscess Development After Endoscopic Retrograde Cholangiopancreatography with Choledocholithiasis: A 17-Year Follow-Up

Abstract

Background

Endoscopic Retrograde Cholangiopancreatography (ERCP), used for choledocholithiasis treatment, carries a risk of pyogenic liver abscess (PLA) due to communication between the biliary system and bowel contents. However, limited data exists on this issue. This study aims to identify the risk factors pertaining to liver abscesses following ERCP lithotomy.

Methods

We conducted a retrospective case series across multiple centers to evaluate patients who developed PLA after ERCP for choledocholithiasis. Data was obtained from the Chung Gung Research Database (January 2001 to December 2018). Out of 220 enrolled patients, 195 were categorized in the endoscopic sphincterotomy (ES) group, while 25 were in the non-ES group for further analysis.

Results

The non-ES group had significantly higher total bilirubin levels compared to the ES group (4.3 ± 5.8 vs 1.9 ± 2.0, p<0.001). Abscess size, location, and distribution (single or multiple) were similar between the two groups. The most common pathogens were Klebsiella pneumoniae and Escherichia coli. Pseudomonas infection was significantly less prevalent in the ES group compared to the non-ES group (3.6% vs 16.7%, p=0.007). Patients with concurrent malignancies (HR: 9.529, 95% CI: 2.667–34.048, p=0.001), elevated total bilirubin levels (HR: 1.246, 95% CI: 1.062–1.461, p=0.007), multiple abscess lesions (HR: 5.146, 95% CI: 1.777–14.903, p=0.003), and growth of enterococcus pathogens (HR: 4.518, 95% CI: 1.290–15.823, p=0.001) faced a significantly higher risk of in-hospital mortality.

Conclusion

PLA incidence was higher in the ES group compared to the non-ES group following ERCP for choledocholithiasis. Attention should be given to significant risk factors, including concurrent malignancies, elevated total bilirubin levels, multiple abscess lesions, and growth of enterococcus pathogens, to reduce in-hospital mortality.

Keywords:

• endoscopic retrograde cholangiopancreatography
• pyogenic liver abscess
• risk factors

Acknowledgments

The authors appreciate Miss Yi-Hsuan Tsai in the Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital for the assistance with programming and analyses.

Disclosure

The authors declared that they have no conflicts of interest in this work. All authors have no commercial association, such as consultancies, stock ownership or other equity interests or patent-licensing arrangements.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.