Association between early ERCP and clinical outcomes in patients with acute cholangitis – a single center study

Aims Acute cholangitis (AC) is associated with high mortality of up to 10%. The association between timing of ERCP and mortality in patients with AC remains unclear. The aim of this study was to investigate whether early ERCP within 48 hours was associated with improved survival.

Methods This is single center retrospective analysis of prospectively maintained database. All patients who admitted with AC at our unit between January 2022 to September 2024 were included in study if they underwent ERCP. Patients satisfying diagnostic criteria of AC according to Tokyo Guidelines and stratified according to severity of AC. We evaluated association between ERCP within 48 hours and length of hospital stay, need for reintervention and re-admissions, mortality in- hospital and at 3 months follow

Results A total of 99 patients underwent ERCP during the study period; (31.3% females; mean age 54.02±14.9 years). 28 patients (29%) underwent ERCP within 48 hours from the time of hospitalization, and 71% patients underwent later ERCP. Patients undergoing ERCP within 48 hours were younger (medians: 65 vs 73 years; P=.01) and had a higher heart rate (medians: 95 vs 90 beats/minute; P=.02). Overall 30-day mortality was 16% (n=27). Mortality was 8% (n=2) among patients undergoing early ERCP and 19% (n=5) among patients undergoing later ERCP (P=.18). There was no statistically significant difference for overall mortality (6.45%vs7.14%, p 0.83); need for reinterventions (46.1% versus 54.8%, p 0.53) and readmissions (62.2% versus 58.33%; p 0.18).

Conclusions The current study indicates that ERCP within 48 hours for AC is associated with decreased length of hospital stay while overall mortality, need for reinterventions, readmissions are comparable. There is unmet need to confirm these findings by randomized controlled study.

Publication History

Article published online:
27 March 2025