Emergency digital cholangioscope-assisted one-stage bedside endoscopic stone removal combined with biliary drainage for severe acute cholangitis in intensive care unit: experience from a tertiary Chinese academic hospital

Abstract

Background and Aim: To date, Optimal endoscopic management of severe acute cholangitis (SAC) caused by choledocholithiasis remains controversial. The aim of our study was to assess the safety and efficacy of digital cholangioscope-assisted one-stage bedside endoscopic stone removal combined with biliary drainage for patients with SAC in intensive care unit (ICU). Methods: Patients admitted to the ICU for SAC caused by choledocholithiasis were prospectively included. Initial ICU treatment, including fluid resuscitation, antibiotics and organ support, was administered to improve the patient's conditions, followed by emergency digital cholangioscope-assisted emergency stone removal and biliary drainage at the ICU bedside. Data on treatment effectiveness, procedural complications, mortality, length of hospital stay, and follow-up were collected and analyzed. Results: From June 2020 to February 2022, twenty patients (8 men and 12 women; mean age, 74.8 ± 12.5 years) were enrolled into the study. Mean APACHE II and SOFA scores at ICU admission were 26.4 ± 6.5 and 12.5 ±3.2, respectively. Besides initial ICU treatment, all patients underwent sucessesfully cholangioscope-assisted one-stage stone removal and biliary drainage within 24 hours of admission, with a mean time of 7.2 ± 4.9 hours. The mean APACHE II and SOFA scores on days 1, 3, and 7 after endoscopic intervention were 21.7 ± 6.5 and 10.6 ±2.9, 17.2 ± 6.8 and 8.4 ±3.0, and 12.7 ± 7.7 and 5.4 ±3.7, respectively (P＜0.001, respectively). Only one adverse event (mild pancreatitis) was reported. The mean antibiotic therapy duration was 12.1 ± 4.4 days. The mean duration of ICU and hospital stay were 9.7 ± 5.0 days and 12.8 ± 4.5 days, respectively. The overall in-hospital mortality was 15% (3/20). During 6 months of follow-up, 2 patients died (one from pneumonia and one from myocardial infarction), and 15 patients remained alive without recurrence of cholangitis and no residual biliary stones were detected on imaging. Conclusion: This study provides evidence for the feasibility and efficacy of emergency cholangioscope-assisted bedside stone removal combined with biliary drainage in patients with SAC in ICU.