Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP.

We reviewed the clinical presentation, cholangiographic features, and long-term outcomes in 41 patients with recurrent pyogenic cholangitis (RPC, "Oriental" cholangiohepatitis) who underwent ERCP at our institution, comparing patients who were initially managed with therapeutic ERCP, immediate hepatobiliary surgery, and no intervention. Patients undergoing only diagnostic ERCP had recurrent symptoms in 62% of cases, twice as often as patients managed initially by therapeutic ERCP or immediate surgery. These former patients required subsequent surgery more often than patients in the latter two groups. Outcomes for patients with diffuse biliary calculi were no different between patients managed by therapeutic ERCP or by immediate hepatobiliary surgery. In the 15 patients with only extrahepatic stones, 7/9 (71%) managed by therapeutic endoscopy and 7/8 (87.5%) managed by immediate hepatobiliary surgery were asymptomatic at almost two years mean follow-up (P > 0.05). Patients having undergone at least one definitive hepatobiliary surgery had fewer recurrences when managed by repeat surgery, although the difference was not statistically significant. Four of six (67%) patients with dominant strictures managed endoscopically are asymptomatic at mean follow-up of 15 months. Our study emphasizes the recurrent nature of symptoms in RPC and supports the primary role of therapeutic ERCP in managing these patients, especially those with extrahepatic stone disease alone.