Escherichia coli Bacterobilia Is Associated with Severe Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Max Heckler, André L. Mihaljevic, Dominik Winter, Zhaoming Zhou, Bing Liu, Masayuki Tanaka, Ulrike Heger, Christoph W. Michalski, Markus W. Büchler, Thilo Hackert

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: The benefit of preoperative biliary stenting in the treatment of pancreatic ductal adenocarcinoma is controversially debated. Data from recent meta-analyses favor primary surgery for the majority of resectable pancreatic cancers. Regardless of this evidence, preoperative biliary stenting via endoscopy (EBS) is commonly performed, often before involvement of a surgeon. The goal of this study was to elucidate the association of bile duct stenting, microbiological dislocation of gut flora to the biliary compartment, and major postoperative complications. Methods: Patient data was derived from a prospectively maintained database including all pancreatic resections between January 2006 and December 2014. Patients receiving pancreaticoduodenectomy for malignant disease in the head of the pancreas with prior EBS were included. Microbiological data were obtained through conventional culture from intraoperative bile duct swabs. Results: Two hundred ninety-eight patients were enrolled in this study. Severe postoperative complications were associated with stent colonization: Postoperative pancreatic fistula type C occurred more frequently in E. coli–colonized patients (sample estimated odds ratio (OR) = 4.07), and the rate of lymphatic fistula was elevated in Enterococcus-colonized patients (OR = 3.25). Longer stenting duration (> 16 days) was associated with the prevalence of these bacteria. Conclusion: Major surgical complications following pancreaticoduodenectomy, including severe pancreatic fistula, are associated with bacterobilia after EBS. The indication for bile duct stenting should be evaluated in a multidisciplinary setting.

Original languageEnglish
Pages (from-to)1802-1808
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number8
Publication statusPublished - 2020 Aug 1
Externally publishedYes


  • Bile duct
  • E. coli
  • PDAC

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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