{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:13:36Z","timestamp":1772165616060,"version":"3.50.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T00:00:00Z","timestamp":1592179200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T00:00:00Z","timestamp":1592179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO\n                      <jats:sub>2<\/jats:sub>\n                      for cholangiography in type IV hilar biliary lesions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922); group B, air (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918); group C, CO\n                      <jats:sub>2<\/jats:sub>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, there was no significant difference in terms of the patient\u2019s age, gender, symptoms and liver function tests among the three groups (\n                      <jats:italic>P\u2009&gt;<\/jats:italic>\n                      \u00a00.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7 and 27.8%,\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u00a00.05). The incidence of post-ERCP cholangitis was significantly higher in group A (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u00a00.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u00a00.05). However, there was no significant difference in the 30-day mortality rate among the three groups (\n                      <jats:italic>P\u2009&gt;<\/jats:italic>\n                      \u00a00.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      CO\n                      <jats:sub>2<\/jats:sub>\n                      or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-020-01341-9","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T08:02:55Z","timestamp":1592208175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3947-7706","authenticated-orcid":false,"given":"Wen-hui","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng-peng","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-ling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-hui","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-jing","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han-wei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"issue":"5","key":"1341_CR1","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1016\/j.gie.2019.12.023","volume":"91","author":"MX Xia","year":"2019","unstructured":"Xia MX, Cai XB, Pan YL, et al. Optimal stent placement strategy for malignant hilar biliary obstruction: a large multicenter parallel study. Gastrointest Endosc. 2019;91(5):1117\u201328.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"1341_CR2","first-page":"18","volume":"3","author":"KC Soares","year":"2014","unstructured":"Soares KC, Kamel I, Cosgrove DP, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr. 2014;3(1):18\u201334.","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"2","key":"1341_CR3","first-page":"170","volume":"140","author":"H Bismuth","year":"1975","unstructured":"Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obset. 1975;140(2):170\u20138.","journal-title":"Surg Gynecol Obset"},{"issue":"138","key":"1341_CR4","first-page":"417","volume":"62","author":"T Ishigaki","year":"2015","unstructured":"Ishigaki T, Sasaki T, Serikawa M, et al. Evaluation of antibiotic use to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis and cholangitis. Hepatogastroenterology. 2015;62(138):417\u201324.","journal-title":"Hepatogastroenterology"},{"issue":"3","key":"1341_CR5","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.giec.2011.04.004","volume":"21","author":"C Gerges","year":"2011","unstructured":"Gerges C, Schumacher B, Terheggen G, et al. Expandable metal stents for malignant hilar biliary obstruction. Gastrointest Endosc Clin N Am. 2011;21(3):481\u201397.","journal-title":"Gastrointest Endosc Clin N Am"},{"issue":"10","key":"1341_CR6","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.gie.2009.08.006","volume":"71","author":"P Chahal","year":"2010","unstructured":"Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. Gastrointest Endosc. 2010;71(10):195\u20139.","journal-title":"Gastrointest Endosc"},{"issue":"6","key":"1341_CR7","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1007\/s00423-009-0548-y","volume":"394","author":"F Pisello","year":"2009","unstructured":"Pisello F, Gaeraci G, Modica G, et al. Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique. Langenbeck's Arch Surg. 2009;394(6):1109\u201314.","journal-title":"Langenbeck's Arch Surg"},{"issue":"1","key":"1341_CR8","first-page":"88","volume":"9","author":"V Singh","year":"2010","unstructured":"Singh V, Singh G, Gupta V, et al. Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction. Hepatobiliary Pancreat Dis Int. 2010;9(1):88\u201392.","journal-title":"Hepatobiliary Pancreat Dis Int"},{"issue":"6","key":"1341_CR9","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s12664-014-0516-5","volume":"33","author":"R Sud","year":"2014","unstructured":"Sud R, Puri R, Choudhary NS, et al. Air cholangigram in not inferior to dye cholangiogram for malignant hilar biliary obstruction: a randomized study of efficacy and safety. Indian J Gastroenterol. 2014;33(6):537\u201342.","journal-title":"Indian J Gastroenterol"},{"key":"1341_CR10","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jclinane.2016.10.029","volume":"36","author":"S Trabanco","year":"2017","unstructured":"Trabanco S, Pardo S, Williams M, et al. Cerebral air embolism after ERCP. J Clin Anesth. 2017;36:133\u20135.","journal-title":"J Clin Anesth"},{"issue":"S 01","key":"1341_CR11","doi-asserted-by":"publisher","first-page":"E250","DOI":"10.1055\/s-0034-1365098","volume":"46","author":"C Duburque","year":"2014","unstructured":"Duburque C, Beaujard E, Landel JB, et al. Life-threatening air embolism during ERCP. Endoscopy. 2014;46(S 01):E250\u20131.","journal-title":"Endoscopy"},{"issue":"5","key":"1341_CR12","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1016\/j.gie.2009.03.028","volume":"70","author":"C Romberg","year":"2009","unstructured":"Romberg C. Systemic air embolism after ERCP: a case report and review of the literature (with video). Gastrointest Endosc. 2009;70(5):1043\u20135.","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"1341_CR13","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/PAP.0b013e3181aab793","volume":"16","author":"M Bisceglia","year":"2009","unstructured":"Bisceglia M, Simenone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography. Ade Anat Pathol. 2009;16(4):255\u201362.","journal-title":"Ade Anat Pathol"},{"issue":"5","key":"1341_CR14","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/j.gie.2016.01.046","volume":"83","author":"SK Lo","year":"2016","unstructured":"ASGE Technology Committee, Lo SK, Fujii-Lau LL, et al. The use of carbon dioxide in gastrointestinal endoscopy. Gastrointest Endosc. 2016;83(5):857\u201365.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"1341_CR15","first-page":"16","volume":"46","author":"H Farnik","year":"2014","unstructured":"Farnik H, Weigt J, Malfertheiner P, et al. A multicenter study on the role of direct retrograde cholangioscopy in patients with inconclusive endoscopic retrograde cholangiography. Endoscopy. 2014;46(1):16\u201321.","journal-title":"Endoscopy."},{"issue":"1","key":"1341_CR16","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s11605-014-2610-5","volume":"19","author":"AM Sharata","year":"2015","unstructured":"Sharata AM, Dunst CM, Pescarus R, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19(1):161\u201370.","journal-title":"J Gastrointest Surg"},{"issue":"11","key":"1341_CR17","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1055\/s-0042-110397","volume":"48","author":"XC Zhang","year":"2016","unstructured":"Zhang XC, Li QL, Xu MD, et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy. 2016;48(11):967\u201378.","journal-title":"Endoscopy."},{"issue":"6","key":"1341_CR18","doi-asserted-by":"publisher","first-page":"758","DOI":"10.3109\/00365521.2013.779745","volume":"48","author":"R Zhang","year":"2013","unstructured":"Zhang R, Zhao L, Liu Z, et al. Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction- a prospective, randomized controlled study. Scand J Gastroenterol. 2013;48(6):758\u201363.","journal-title":"Scand J Gastroenterol"},{"issue":"3","key":"1341_CR19","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.urology.2009.04.064","volume":"75","author":"JY Hong","year":"2010","unstructured":"Hong JY, Kim WO, Kil HK. Detection of subclinical CO2 embolism by transesophageal echocardiography during laparoscopic radican prostatectomy. Urology. 2010;75(3):581\u20134.","journal-title":"Urology."},{"issue":"Suppl 1","key":"1341_CR20","first-page":"E215","volume":"48","author":"H Kondo","year":"2016","unstructured":"Kondo H, Naitoh I, Nakazawa T, et al. Development of fatal systemic gas embolism during direct peroral cholangioscopy under dioxide insufflations. Endoscopy. 2016;48(Suppl 1):E215\u20136.","journal-title":"Endoscopy."},{"issue":"3","key":"1341_CR21","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S0016-5107(91)70740-2","volume":"37","author":"PB Cotton","year":"1991","unstructured":"Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383\u201393.","journal-title":"Gastrointest Endosc"},{"issue":"6","key":"1341_CR22","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1136\/gut.32.6.685","volume":"32","author":"AA Polydorou","year":"1991","unstructured":"Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut. 1991;32(6):685\u20139.","journal-title":"Gut."},{"issue":"5","key":"1341_CR23","first-page":"218","volume":"21","author":"J Figueras","year":"1998","unstructured":"Figueras J, Llad\u00f3-Garriga L, Lama C, et al. Resection as elective treatment of hilar cholangiocarcinoma (Klatskin tumor). Gastroenterol Hepatol. 1998;21(5):218\u201323.","journal-title":"Gastroenterol Hepatol"},{"issue":"2","key":"1341_CR24","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1177\/1756283X15618132","volume":"9","author":"JM Lee","year":"2016","unstructured":"Lee JM, Lee SH, Jang DK, et al. Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction. Ther Adv Gastroenterol. 2016;9(2):189\u201398.","journal-title":"Ther Adv Gastroenterol"},{"issue":"29","key":"1341_CR25","doi-asserted-by":"publisher","first-page":"3973","DOI":"10.3748\/wjg.v13.i29.3973","volume":"13","author":"GD De Palma","year":"2007","unstructured":"De Palma GD, Lombardi G, Rega M, et al. Contrast-free endoscopic stent insertion in malignant biliary obstruction. World J Gastroenterol. 2007;13(29):3973\u20136.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"1341_CR26","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.gie.2010.02.042","volume":"72","author":"R Sud","year":"2010","unstructured":"Sud R, Puri R, Hussain S, et al. Air cholangiogram: a new technique for biliary imaging during ERCP. Gastrointest Endosc. 2010;72(1):204\u20138.","journal-title":"Gastrointest Endosc"},{"issue":"6","key":"1341_CR27","doi-asserted-by":"publisher","first-page":"27502","DOI":"10.18632\/oncotarget.15492","volume":"8","author":"Y Hong","year":"2017","unstructured":"Hong Y, Xin Y, Yue F, et al. Randomized clinical trial comparing the effects of sevoflurane and propofol on carbon dioxide embolism during pneumoperitoneum in laparoscopic hepatectomy. Ontotarget. 2017;8(6):27502\u20139.","journal-title":"Ontotarget."},{"issue":"4","key":"1341_CR28","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/0016-5085(89)91639-9","volume":"96","author":"JF Dowsett","year":"1989","unstructured":"Dowsett JF, Vaira D, Hatfield AR, et al. Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology. 1989;96(4):1180\u20136.","journal-title":"Gastroenterology."}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01341-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-020-01341-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-020-01341-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T19:21:16Z","timestamp":1623698476000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-020-01341-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,15]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1341"],"URL":"https:\/\/doi.org\/10.1186\/s12876-020-01341-9","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.2.22553\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.22553\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.22553\/v4","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.22553\/v3","asserted-by":"object"}]},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,15]]},"assertion":[{"value":"15 January 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the \u201cHuman Ethics Committee of Beijing 302 hospital\u201d.Written informed consents were obtained from all of these individuals or guardian participants. The consent obtained from guardians was in writing and on behalf of any patients that were minors at the time of study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"NA","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors, WHZ, PPD, LL, YLW, WHL, JJH, JH and HWL have no conflicts of interest or financial ties to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"189"}}