{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T15:02:22Z","timestamp":1777993342542,"version":"3.51.4"},"reference-count":33,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: For patients with obstructive jaundice and who are indicated for pancreaticoduodenectomy (PD) or biliary intervention, either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and drainage (PTCD) may be indicated preoperatively. However, the possibility of procedure-related postoperative biliary tract infection (BTI) should be a concern. We tried to evaluate the impact of ERCP and PTCD on postoperative BTI. Methods: Patients diagnosed from June 2013 to March 2022 with periampullary lesions and with PD indicated were enrolled in this cohort. Patients without intraoperative bile culture and non-neoplastic lesions were excluded. Clinical information, including demographic and laboratory data, pathologic diagnosis, results of microbiologic tests, and relevant infectious outcomes, was extracted from medical records for analysis. Results: One-hundred-and-sixty-four patients from the cohort (164\/689) underwent preoperative biliary intervention, either ERCP (n = 125) or PTCD (n = 39). The positive yield of intraoperative biliary culture was significantly higher in patients who underwent ERCP than in PTCD (90.4% vs. 41.0%, p &lt; 0.001). Although there was no significance, a trend of higher postoperative BTI (13.8% vs. 2.7%) and BTI-related septic shock (5 vs. 0, 4.0% vs. 0%) in the ERCP group was noticed. While the risk factors for postoperative BTI have not been confirmed, a trend suggesting a higher incidence of BTI associated with ERCP procedures was observed, with a borderline p-value (p = 0.05, regarding ERCP biopsy). Conclusions: ERCP in patients undergoing PD increases the positive yield of intraoperative biliary culture. PTCD may be the favorable option if preoperative biliary intervention is indicated.<\/jats:p>","DOI":"10.3390\/jcm13144150","type":"journal-article","created":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T11:31:57Z","timestamp":1721129517000},"page":"4150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Clinical Impact of Different Types of Preoperative Biliary Intervention on Postoperative Biliary Tract Infection of Patients Undergoing Pancreaticoduodenectomy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9197-8439","authenticated-orcid":false,"given":"Min-Jung","family":"Wu","sequence":"first","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yung-Yuan","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9136-7224","authenticated-orcid":false,"given":"Yu-Liang","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9360-908X","authenticated-orcid":false,"given":"Hao-Wei","family":"Kou","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Yi","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-Te","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ta-Sen","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8927-2384","authenticated-orcid":false,"given":"Tsann-Long","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Yin","family":"Jan","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chi-Huan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nai-Jen","family":"Liu","sequence":"additional","affiliation":[{"name":"Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1514-3015","authenticated-orcid":false,"given":"Shang-Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Nan","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/den.12394","article-title":"Preoperative Biliary Drainage","volume":"27","author":"Saxena","year":"2015","journal-title":"Dig. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/MCG.0b013e3181ce5b36","article-title":"Effect of Preoperative Biliary Drainage on Coagulation and Fibrinolysis in Severe Obstructive Cholestasis","volume":"44","author":"Kloek","year":"2010","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_3","first-page":"1305","article-title":"Preoperative Biliary Drainage for Cancer of the Head of the Pancreas","volume":"52","author":"Rauws","year":"2010","journal-title":"Gastroenterol. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.hpb.2022.01.006","article-title":"Is Preoperative Biliary Stenting Associated with Increased Rate of Postoperative Complications for Patients Undergoing Pancreatoduodenectomy? A Review of National Surgical Quality Improvement Program Data","volume":"24","author":"Olecki","year":"2022","journal-title":"HPB"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.hpb.2021.08.942","article-title":"Impact of Preoperative Biliary Drainage on 30 Day Outcomes of Patients Undergoing Pancreaticoduodenectomy for Malignancy","volume":"24","author":"Werba","year":"2022","journal-title":"HPB"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1111\/den.13221","article-title":"Impact of Preoperative Biliary Drainage on Postoperative Outcome after Pancreaticoduodenectomy: An Analysis of 1500 Consecutive Cases","volume":"30","author":"Marchegiani","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1002\/jhbp.811","article-title":"A Multicenter Prospective Randomized Controlled Trial for Preoperative Biliary Drainage with Uncovered Metal versus Plastic Stents for Resectable Periampullary Cancer","volume":"27","author":"Cho","year":"2020","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1177\/0003134820971618","article-title":"When Is It Safe to Proceed with Pancreaticoduodenectomy Without Biliary Decompression?","volume":"87","author":"Mosquera","year":"2021","journal-title":"Am. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S1091-255X(99)80103-6","article-title":"Preoperative Biliary Drainage: Impact on Intraoperative Bile Cultures and Infectious Morbidity and Mortality after Pancreaticoduodenectomy","volume":"3","author":"Povoski","year":"1999","journal-title":"J. Gastrointest. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/S1091-255X(00)80074-8","article-title":"Do Preoperative Biliary Stents Increase Postpancreaticoduodenectomy Complications?","volume":"4","author":"Sohn","year":"2000","journal-title":"J. Gastrointest. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/00000658-200107000-00008","article-title":"Effect of Preoperative Biliary Decompression on Pancreaticoduodenectomy-Associated Morbidity in 300 Consecutive Patients","volume":"234","author":"Pisters","year":"2001","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.amjsurg.2003.07.005","article-title":"V The Effect of Preoperative Biliary Stenting on Postoperative Complications after Pancreaticoduodenectomy","volume":"186","author":"Hodul","year":"2003","journal-title":"Am. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.surg.2007.04.022","article-title":"Correlation between Preoperative Biliary Drainage, Bile Duct Contamination, and Postoperative Outcomes for Pancreatic Surgery","volume":"142","author":"Limongelli","year":"2007","journal-title":"Surgery"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jhbp.322","article-title":"Preoperative Biliary Drainage Does Not Increase Major Complications in Pancreaticoduodenectomy: A Large Single Center Experience from the Massachusetts General Hospital","volume":"23","author":"Sahora","year":"2016","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.surg.2016.11.001","article-title":"Preoperative Biliary Stenting versus Operation First in Jaundiced Patients Due to Malignant Lesions in the Pancreatic Head: A Meta-Analysis of Current Literature","volume":"161","author":"Scheufele","year":"2017","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1245\/s10434-020-08645-w","article-title":"Impact of Qualitative and Quantitative Biliary Contamination Status on the Incidence of Postoperative Infection Complications in Patients Undergoing Pancreatoduodenectomy","volume":"28","author":"Suenaga","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e723","DOI":"10.1097\/MD.0000000000000723","article-title":"The Effects of Different Preoperative Biliary Drainage Methods on Complications Following Pancreaticoduodenectomy","volume":"94","author":"Huang","year":"2015","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/1457496914543975","article-title":"Preoperative Biliary Decompression Preceding Pancreaticoduodenectomy with Plastic or Self-Expandable Metallic Stent","volume":"104","author":"Udd","year":"2015","journal-title":"Scand. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: Diagnostic Criteria and Severity Grading of Acute Cholangitis (with Videos)","volume":"25","author":"Kiriyama","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.hpb.2015.10.012","article-title":"Early Biliary Complications Following Pancreaticoduodenectomy: Prevalence and Risk Factors","volume":"18","author":"Malgras","year":"2016","journal-title":"HPB"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/SLA.0b013e31823598fb","article-title":"A Prognostic Score to Predict Major Complications after Pancreaticoduodenectomy","volume":"254","author":"Braga","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijsu.2016.08.003","article-title":"Hepaticoplasty Prevents Cholangitis after Pancreaticoduodenectomy in Patients with Small Bile Ducts","volume":"35","author":"Hiyoshi","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kihara, Y., and Yokomizo, H. (2022). The Clinical Features of Late Postoperative Cholangitis Following Pancreaticoduodenectomy Brought on by Conditions Other than Cancer Recurrence: A Single-Center Retrospective Study. BMC Surg., 22.","DOI":"10.1186\/s12893-022-01752-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/jhbp.529","article-title":"Preoperative Biliary Drainage Adversely Affects Surgical Outcomes in Periampullary Cancer: A Retrospective and Propensity Score-Matched Analysis","volume":"25","author":"Lee","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/hpb.12170","article-title":"Treatment of Bacteriobilia Decreases Wound Infection Rates after Pancreaticoduodenectomy","volume":"16","author":"Mohammed","year":"2014","journal-title":"HPB"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.surg.2016.03.032","article-title":"Bacterobilia May Trigger the Development and Severity of Pancreatic Fistula after Pancreatoduodenectomy","volume":"160","author":"Ohgi","year":"2016","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s11605-021-05182-z","article-title":"Intraoperative Bile Culture in Pancreaticoduodenectomy: Teaching Old Dogma New Tricks","volume":"26","author":"Sutton","year":"2022","journal-title":"J. Gastrointest. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2951","DOI":"10.1007\/s00268-018-4546-5","article-title":"Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta-Analysis","volume":"42","author":"Hempel","year":"2018","journal-title":"World J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.hpb.2021.06.428","article-title":"The Association between Bacterobilia and the Risk of Postoperative Complications Following Pancreaticoduodenectomy","volume":"24","author":"Parapini","year":"2022","journal-title":"HPB"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.gassur.2005.08.011","article-title":"Influence of Bactibilia after Preoperative Biliary Stenting on Postoperative Infectious Complications","volume":"10","author":"Howard","year":"2006","journal-title":"J. Gastrointest. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/MPA.0000000000000265","article-title":"Preoperative Internal Biliary Drainage Increases the Risk of Bile Juice Infection and Pancreatic Fistula after Pancreatoduodenectomy: A Prospective Observational Study","volume":"44","author":"Fujii","year":"2015","journal-title":"Pancreas"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.surg.2022.11.021","article-title":"The Utility of Bile Juice Culture Analysis for the Management of Postoperative Infection after Pancreaticoduodenectomy","volume":"173","author":"Asukai","year":"2023","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.gie.2021.09.010","article-title":"Comparative Efficacy of Different Methods for Difficult Biliary Cannulation in ERCP: Systematic Review and Network Meta-Analysis","volume":"95","author":"Facciorusso","year":"2022","journal-title":"Gastrointest. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/14\/4150\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:17:35Z","timestamp":1760109455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/14\/4150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,16]]},"references-count":33,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["jcm13144150"],"URL":"https:\/\/doi.org\/10.3390\/jcm13144150","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,16]]}}}