Management of acute cholangitis and the impact of endoscopic sphincterotomy

Abstract

Ninety-four patients admitted to Leicester Hospitals with acute cholangitis since 1977 were reviewed to coincide with the availability of endoscopic sphincterotomy (ES). Thirty-four were men and sixty were women, their mean age was 69.7 years and the median hospital stay was 20 days. There were 15 deaths (16 per cent) by 30 days in patients with significantly lower initial serum albumin levels (P less than 0.005) and significantly higher serum urea levels (P less than 0.05) than survivors. Eighty-two patients had common bile duct (CBD) calculi of whom 71 underwent early decompression of the biliary tree either surgically (28) or by ES(43). Early surgical decompression was associated with a significantly higher 30 day mortality (6/28) than early ES (2/43) (P less than 0.02) despite the fact that patients undergoing early ES were significantly older (P less than 0.02) and had significantly more medical risk factors (P less than 0.05). Of the 43 patients undergoing early ES 7 had had a previous cholecystectomy, 13 underwent subsequent elective cholecystectomy with no mortality and the remaining 23 had the gallbladder left in situ because of advanced age (mean age 79 years) and frailty. Only 2 of the 23 have since required cholecystectomy. We suggest that patients with acute cholangitis who do not rapidly respond to conservative treatment should undergo early ES with early surgery reserved for those who do not improve following ES. Elective cholecystectomy following successful ES can often be avoided in the elderly and frail.

Treatment of hepatic hydatid disease complications using endoscopic retrograde cholangiopancreatography procedures

“…In terms of treatment for acute cholangitis caused by cho ledocholithiasis, ES is superior to emergency surgery. 11 The same may be expected for cholangitis caused by hydatid disease. However, to our knowledge, there are no published data to support the routine use of ERCP in the preoperative assessment of patients with hydatid disease without biliary …”

G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure

“…The most common risk factor for cholangitis is obstruction of the biliary tract through choledocholithiasis, then followed by benign biliary stenosis, stricture of a biliary anastomosis and recently increased the number of cholangitis due to unresectable malignancies that have become the most common cause of cholangitis after the choledocholithiasis [10].…”

Does the urgency of endoscopic retrograde cholangiopancreatography (ercp)/percutaneous biliary drainage (pbd) impact mortality and disease related complications in ascending cholangitis? (deim-i study)

“…[3][4][5][6]11,12 With a clear benefit of ERCP in ascending cholangitis, the Tokyo guidelines stated that ERCP should occur following conservative treatment for patients with moderate to severe ascending cholangitis, but may occur electively in subjects with mild disease. 7 Additional trials have investigated whether clinicians can predict which patients must undergo emergency versus elective ERCP, with some promising results.…”