Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

Abstract

AIMTo assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample.METHODSWe used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day (days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure, acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with in-hospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex, severe disease and comorbidities.RESULTSFour thousand five hundred and seventy patients satisfied the inclusion criteria; with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs 2.4%, adjusted odds ratio (aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality (1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions (9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group (6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group ($21459 vs $16939, P < 0.0001).CONCLUSIONEarly ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP.

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

“…Percutaneous drainage, performed in 2% of cases, is a technique recently introduced to our center. Early biliary drainage is associated with less intrahospital mortality, 30-day mortality, and hospital costs, particularly within 48 hours of admission and regardless of severity [ 18 , 19 ]. Procalcitonin has been proposed by some authors as a predictive indicator of severity and therefore of urgent biliary decompression [ 20 ], but this needs to be validated by more well-designed studies.…”

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

“…Endoscopic retrograde cholangiopancreatography (ERCP) is the choice of biliary drainage which should be performed early for moderate and severe cases, according to the severity grading of the updated Tokyo Guidelines of 2018 [ 3 ]. Moreover, recent studies show early ERCP (within 48 h of admission) in all grading of cholangitis is associated with shorter hospital stays, decrease costs and lower mortality rate [ [4] , [5] , [6] , [7] , [8] ].…”

Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

“…This can be life-threatening without timely intervention, such as biliary drainage and adequate antibiotics [1][2][3][4][5]. Early endoscopic retrograde cholangiopancreatography (ERCP) done within 48 h in patients with moderate-to-severe cholangitis is known to reduce the duration of hospitalization, mortality rates, and adverse events, such as multiple organ failure [3][4][5][6][7]. The most common cause of obstruction is choledocholithiasis, which accounts for about half of the cases [7][8][9].…”

“…Early endoscopic retrograde cholangiopancreatography (ERCP) done within 48 h in patients with moderate-to-severe cholangitis is known to reduce the duration of hospitalization, mortality rates, and adverse events, such as multiple organ failure [3][4][5][6][7]. The most common cause of obstruction is choledocholithiasis, which accounts for about half of the cases [7][8][9]. Malignant biliary obstruction (MBO), such as pancreatic cancer, cholangiocarcinoma, or metastatic cancer, constitutes 10-30% of cholangitis cases [3,5,[7][8][9].…”