Abstract
Background and study aims To assess the outcomes of urgent endoscopic retrograde cholangiopancreatography (ERCP)
performed with a single-use duodenoscope (SUD) in patients with moderate-to-severe
cholangitis.
Patients and methods Between 2021 and 2022 consecutive patients with moderate-to-severe cholangitis were
prospectively enrolled to undergo urgent ERCP with SUD. Technical success was defined
as the completion of the planned procedure with SUD. Multivariate analysis was used
to identify factors related to incidence of adverse events (AEs) and mortality.
Results Thirty-five consecutive patients (15 female, age 81.4±6.7 years) were enrolled. Twelve
(34.3%) had severe cholangitis; 26 (74.3%) had an American Society of Anesthesiologists
(ASA) score ≥3. Twenty-eight patients (80.0%) had a naïve papilla. Biliary sphincterotomy
and complete stone clearance were performed in 29 (82.9%) and 30 patients (85.7%),
respectively; in three cases (8.6%), concomitant endoscopic ultrasound-gallbladder
drainage was performed. Technical and clinical success rates were 100%. Thirty-day
and 3-month mortality were 2.9% and 14.3%, respectively. One patient had mild post-ERCP
pancreatitis and two had delayed bleeding. No patient or procedural variables were
related to AEs. ASA score 4 and leucopenia were related to 3-month mortality; on multivariate
analysis, leukopenia was the only variable independently related to 3-month mortality
(odds ratio 12.8; 95% confidence interval 1.03–157.2; P=0.03).
Conclusions The results of this “proof of concept” study suggest that SUD use could be considered
safe and effective for urgent ERCP for acute cholangitis. This approach abolishes
duodenoscope contamination from infected patients without impairing clinical outcomes.
Keywords
Stones - Cholangioscopy - Quality and logistical aspects - Hygiene
