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Paola Di Carlo,1 Nicola Serra,2 Francesco D’Arpa,3 Antonino Agrusa,3 Gaspare Gulotta,3 Teresa Fasciana,1 Vito Rodolico,1 Anna Giammanco,1 Consolato Sergi4,51Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy; 2Statistic Unit, Department of Public Health, University of Naples ‘Federico II’, Naples, Italy; 3Department of General Surgery and Emergency, University of Palermo, Palermo, Italy; 4Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; 5Department of Laboratory Medicine and Pathology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, CanadaBackground: The gut microbiota play an essential role in protecting the host against pathogenic microorganisms by modulating immunity and regulating metabolic processes. In response to environmental factors, microbes can hugely alter their metabolism. These factors can substantially impact the host and have potential pathologic implications. Particularly pathogenic microorganisms colonizing pancreas and biliary tract tissues may be involved in chronic inflammation and cancer evolution.Purpose: To evaluate the effect of bile microbiota on survival in patients with pancreas and biliary tract disease (PBD).Patients and Methods: We investigated 152 Italian patients with cholelithiasis (CHL), cholangitis (CHA), cholangiocarcinoma (CCA), gallbladder carcinoma (GBC), pancreas head carcinoma (PHC), ampullary carcinoma (ACA), and chronic pancreatitis (CHP). Demographics, bile cultures, therapy, and survival rates were analyzed in cohorts (T1 death