Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٣٣
4- Cholangitis and cholecystitis:
Cholangitis (ascending bile duct infection) and cholecystitis
(gallbladder infection if the gallbladder is still in sito) are potential
complications or sequelae of ERCP and/or sphincterotomy that are
sometimes difficult to distinguish from each other on clinical grounds
(Cotton et al., 1991).
Cholangitis:
The rate of cholangitis is 1% or less. Risk factors include the use of
combined percutaneous-endoscopic procedures, stent placement in
malignant strictures, the presence of jaundice and incomplete or failed
biliary drainage (Loperfido et al., 1998).
Prevention:
• The principal recommendation regarding prevention of cholangitis is
obtaining successful and complete biliary drainage (Freeman, 2002).
• Acute cholangitis can readily be prevented by routine stenting when
immediate removal of CBD stones is not possible after ES (Tanaka,
2002).
• Whether or not prophylactic antibiotics should be given to patients for
ERCP is unclear. Several studies have shown that prophylactic
antibiotics can reduce the rate of bacteremia, but few studies have
shown a reduction in clinical sepsis following ERCP (Harris et al.,
1999).
Cholecystitis (if the gallbladder is still in situ):
Cholecystitis may occur after sphincterotomy, but it is sometimes
difficult to decide whether this is a complication of the ERCP or merely
the natural history of gallbladder stones (Silvis, 1991).