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Identifying factors contributing to morbidity in recurrent cholangitis

Emanuel A Shapera, MD1, Matteusz Lapucha, MD1, Lauren Baumgarten, MD1, Steven Kaspick, MD1, Cyrus Rahnema, MD1, Matthew Johnson, MD, MMS, FACS2, Paul Nelson, MD, FACS1. 1Mountain View Hospital, 2Desert Surgical Associates

Introduction: Recurrent Cholangitis can be caused by parasitical, calculous or malignant disease. We sought to determine clinical factors associated with recurrent cholangitis in two Las Vegas community hospitals to aid providers in management of this disease.

Methods and Procedures: Retrospective, multi-center study. Over 4000 ERCPs were analyzed between 2010 and 2017. 24 patients were identified as having multiple (60) admissions for cholangitis per Tokyo criteria. Univariate and multivariate analysis was conducted.

Results: Patients with a significantly (p < 0.0001) higher albumin level on admission (3.7) were discharged home more often than patients discharged to a facility or hospice (2.7). On Multivariate analysis, non-home discharge was associated with lower albumin level at admission (p=0.0055) and greater maximum temperature prior to decompression (p=0.0354). Increased hospital stay was associated with lower albumin level at admission (p=0.0019).

A majority (31/60) of recurrent episodes involved stent placement, exchange or removal. 14 patients (58%) had either biliary malignancy, gallbladder or both. Blood cultures were drawn in 52% of all episodes and positive in 45%, E coli being the most common pathogen isolated. All patients had low HDL levels (6 – 36, mean 22).

Conclusions: High fevers and poor nutritional status was associated with increased length of hospital stay and fewer home discharges. Tumors, gallbladders and malfunctioning stents contribute substantially to morbidity. Close follow up for indicated gallbladder removal, stent management and nutritional optimization is critical to reduce the burden of this disease.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86736

Program Number: P096

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

101

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