Urgent ERCP reduces mortality in acute cholangitis due to common bile duct stones

Aims ERCP is the standard treatment for acute cholangitis.Urgent ERCP within 24 hours is suggested for moderate to severe acute cholangitis, but the impact on clinical outcomes remains to be explored.This study aimed to evaluate the clinical outcomes of patients undergoing urgent versus delayed ERCP in acute cholangitis due to common bile duct stones.

Methods A retrospective review of the ERCP database of patients diagnosed with acute cholangitis due to CBD stones undergoing ERCP from 2020 to 2023. The timing of urgent ERCP was defined as within 24 hours of ad-mission. In-hospital mortality, persistent organ failure at 72 h, length of stay, complete stone removal and complications were assessed.

Results 157 patients were recruited with a mean age of 66 years. 21.5% had severe cholangitis, 40.4% moderate and 38% mild. 45.7% underwent emergency ERCP. There were no differences in clinical features between the two groups, with the exception of underlying malignancy, which was more frequent in the late ERCP group (p=0.047). In-hospital mortality in the urgent ERCP group was significantly lower than in the late ERCP group (p=0.032). Subgroup analysis showed that urgent ERCP was associated with lower in-hospital mortality in severe cases (p=0.024), but not in mild or moderate severity cases. Length of stay was shorter in the urgent ERCP group than in the delayed ERCP group (p<0.01). Nevertheless, urgent ERCP did not alter the rates of persistent organ failure, complete stone removal, complications and readmissions between the two groups.

Conclusions urgent ERCP in acute cholangitis due to CBD stones reduced in-hospital mortality and length of stay.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024