Recurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography.

Endoscopic retrograde cholangiograms were studied in 52 patients with recurrent pyogenic cholangitis, a condition which is prevalent in Asia and in which there is a primary bacterial cholangitis. The earlier changes of recurrent pyogenic cholangitis were identified and found to be confined to the intrahepatic biliary tree. The left hepatic duct was more severely affected than the right hepatic duct and had a higher infestation by clonorchis. The severity of radiological changes correlated well with the duration of illness and the need for surgery. Gallstones were present in 34.2% of the patients and pancreatic ductal abnormality in 7.7%. The decision for surgery could be made early and accurately, and the type of surgery and the assignment of surgeons could be planned in advance--situations which conventional intravenous cholangiograms could not achieve. Cholangitis complicated endoscopic retrograde cholangiograms in 23.1% of the initial 26 patients without antibiotic cover but none of the subsequent 26 in whom this was used.