Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis

World J Gastroenterol. 2014 Sep 14;20(34):12260-8. doi: 10.3748/wjg.v20.i34.12260.


Aim: To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis.

Methods: We performed a prospective study of 127 patients who underwent endoscopic retrograde cholangiopancreatography, for various biliary disorders, at 3 tertiary referral centers in Germany from July 2011 through July 2012 ( NCT01109550). Bile, buccal, and stool samples were collected. When indicated, endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal infections.

Results: Candida species were detected in 38 of the 127 bile samples (29.9%). By multivariate analysis patients' age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis (P < 0.05). Patients with immunosuppression (P = 0.058) and recent long-term antibiotic therapy (> 7 d) (P = 0.089) tend to be at risk for biliary candidiasis. One patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed histologically. Of Candida subspecies detected, 36.7% were azole-resistant, such as C glabrata. Eight patients received anti-mycotic therapy, based on our algorithm. Of these, 3 had cancer with biliary tract involvement, 2 had secondary sclerosing cholangitis, 1 had retroperitoneal fibrosis, and 5 had septicemia. In all patients contamination was ruled out by smears of the endoscope channel.

Conclusion: Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary disorders. Our suggested algorithm facilitates the further clinical management.

Keywords: Biliary candidiasis; Biliary obstruction; Cholangitis; Invasive fungal infection.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms*
  • Antifungal Agents / therapeutic use
  • Bacteriological Techniques
  • Bile / microbiology
  • Biopsy
  • Candida / drug effects
  • Candida / isolation & purification*
  • Candidiasis / diagnosis*
  • Candidiasis / drug therapy
  • Candidiasis / microbiology
  • Chi-Square Distribution
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholangitis / diagnosis*
  • Cholangitis / drug therapy
  • Cholangitis / microbiology
  • Cholestasis / diagnosis*
  • Cholestasis / drug therapy
  • Cholestasis / microbiology
  • Constriction, Pathologic
  • Critical Pathways
  • Feces / microbiology
  • Female
  • Germany
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Mouth Mucosa / microbiology
  • Multivariate Analysis
  • Predictive Value of Tests
  • Risk Factors
  • Tertiary Care Centers


  • Antifungal Agents

Associated data