Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction – a prospective, randomized controlled study. (June 2013)

• Record Type: Journal Article
• Authors: Zhang, Rongchun; Zhao, Lina; Liu, Zhiguo; Wang, Biaoluo; Hui, Na; Wang, Xiangping; Huang, Rui; Luo, Hui; Fan, Daiming; Pan, Yanglin; Guo, Xuegang
• Is Part Of: Scandinavian journal of gastroenterology. Volume 48:Number 6(2013)
• Page Start: 758
• Page End: 763
• Publication Date: 2013-06
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2013.779745
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background: </italic> </bold>Air cholangiogram has been used in patients with malignant hilar obstruction to reduce cholangitis after endoscopic retrograde cholangiopancreatography (ERCP). However, it still remains unclear whether CO<sub>2</sub> could be used as an alternative for air cholangiography in such patients. <bold><italic>Objective: </italic></bold>To investigate the effect of CO<sub>2</sub> cholangiogram on post-ERCP complications. <bold><italic>Design: </italic></bold>Prospective, randomized controlled study. <bold><italic>Setting: </italic></bold>Tertiary care referral center. <bold><italic>Patients: </italic></bold>36 patients with Bismuth type II, III or IV were randomized into CO<sub>2</sub> group or iodine contrast group (control group). <bold><italic>Intervention: </italic></bold>Cholangiography was performed by injection of either CO<sub>2</sub> or iodine contrast through a sphincterotome. One or two metal stents were placed. <bold><italic>Main outcome measures: </italic></bold>Post-ERCP complications, length of hospital stay after ERCP, 1-month and 1-year mortality. <bold><italic>Result: </italic></bold>There was no significant difference in age, gender, symptoms, liver function tests, type of tumor origin and Bismuth type between patients in CO<sub>2</sub> and contrast groups (<italic>p</italic> > 0.05). Compared with one-stent placement, more volume of CO<sub>2</sub> and longer operation time were observed when performing two-stent placement (both <italic>p</italic> < 0.05). The rate of cholangitis in CO<sub>2</sub> group was significantly lower than that in control group (5.6% vs. 33.3%, <italic>p</italic> = 0.04). After ERCP, mean hospital stay time was shorter in CO<sub>2</sub> group compared with control (<italic>p</italic> < 0.05). The difference of 1-month and 1-year mortality between two groups was not significant (both <italic>p</italic> > 0.05). <bold><italic>Conclusion: </italic></bold>CO<sub>2</sub> cholangiogram could be a safe method to visualize intrahepatic bile duct with low incidence of post-ERCP cholangitis, which could be considered for the patients with malignant hilar obstruction.</p> </abstract>