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Background <p>Clinical 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).</p> Methods <p>We 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.</p> Results <p>Of 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114&#xa0;d (<i>p</i> = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, <i>p</i> = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, <i>p</i> &lt; 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, <i>p</i> = 0.46). Infections occurred in 9.6 and 4.4% (<i>p</i> = 0.33). Independent infection predictors were dilated bile duct (protective; odds ratio: 0.26, <i>p</i> = 0.02) and prolonged procedures (odds ratio: 3.73, <i>p</i> = 0.03).</p> Conclusions <p>Pre-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.</p>

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Pre-Endoscopic Retrograde Cholangiopancreatography Cholangitis and Stent Outcomes in Malignant Distal Biliary Obstruction: A Multicenter Propensity Score-Matched Analysis

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  • 发表日期：

    2026年5月16日

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  • Fumitaka Niiya,
  • Tatsunori Satoh,
  • Yosuke Kobayashi,
  • Junichi Kaneko,
  • Kazuma Ishikawa,
  • Naoki Tamai,
  • Masataka Yamawaki,
  • Jun Noda,
  • Tetsushi Azami,
  • Yuichi Takano,
  • Masatsugu Nagahama

摘要

Background

Clinical 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).

Methods

We 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.

Results

Of 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).

Conclusions

Pre-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.