Validation of Tokyo guidelines 2018 for safety and mortality benefit from urgent ERCP in acute cholangitis across different age groups

Abstract

Background The 2018 Tokyo Guidelines (TG18) recommend urgent endoscopic biliary drainage based on acute cholangitis (AC) severity. Therefore, we evaluated the safety and mortality benefits of urgent endoscopic retrograde cholangiopancreatography (ERCP) in different age groups. Methods Using International Classification of Diseases‐10 (ICD‐10) codes, we sampled adult AC patients from National Inpatient Sample. TG18 definition of cholangitis severity was used to identify patients with severe and nonsevere (mild or moderate) AC. Age categories were 18–64, 65–79, and 80 and above. Multivariate linear or logistic regression was used as appropriate. We used Stata, version 14.2, to perform analyses considering two‐sided p < .05 as statistically significant. Results Among 137 100 patients, there were 93 365 (68.09%) patients with nonsevere cholangitis and 43 735 (31.91%) patients with severe cholangitis. Urgent ERCP (within 24 h) resulted in decreased mortality in all age groups for both severe and nonsevere AC. Post‐sphincterotomy bleeding was more common in patients ≥80 years of age, whereas post‐ERCP acute cholecystitis was more common in patients 65–79 years. The rates of post‐ERCP pancreatitis, bile duct perforation, and duodenal perforation did not differ among the age groups. In addition, there were no differences in the rate of sedation‐related complications between different age groups who underwent urgent ERCP. Conclusion This study demonstrates the mortality benefit from urgent ERCP for AC in different age groups and describes the safety of performing urgent ERCP in patients of various ages. Therefore, we recommend that urgent ERCP be performed according to the TG18 guidelines regardless of age.

Elevated plasma and bile levels of corisin, a microbiota-derived proapoptotic peptide, in patients with severe acute cholangitis

“…Acute cholangitis (AC) is a life-threatening condition that requires early diagnosis and treatment to prevent systemic complications and reduce mortality [ 1 , 47 ]. The Tokyo Guidelines, established by a panel of international experts, have improved diagnostic yield and facilitated decision-making in the early stages of the disease by recommending a combination of clinical, laboratory, and imaging findings [ 6 , 29 , 30 ]. However, there are still cases of AC that are difficult to diagnose and manage [ 13 , 48 ].…”

“…AC was diagnosed according to the diagnostic criteria of the 2018 Tokyo Guidelines. The Tokyo Guidelines provide criteria for diagnosing acute cholangitis based on clinical features, laboratory data, and imaging findings [ 6 , 29 , 30 ]. They also provide a severity grading system that classifies acute cholangitis into mild (grade 1), moderate (grade 2), and severe (grade 3) categories based on the presence or absence of organ dysfunction, cholangitis-related symptoms, and inflammatory response [ 6 , 29 , 30 ].…”

“…The Tokyo Guidelines provide criteria for diagnosing acute cholangitis based on clinical features, laboratory data, and imaging findings [ 6 , 29 , 30 ]. They also provide a severity grading system that classifies acute cholangitis into mild (grade 1), moderate (grade 2), and severe (grade 3) categories based on the presence or absence of organ dysfunction, cholangitis-related symptoms, and inflammatory response [ 6 , 29 , 30 ]. The inclusion criteria in the present study were suspicion of AC, obtention of written informed consent, and availability of ERCP study.…”

Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis

“…Complications related to cirrhosis, including portal gastropathy, esophageal varices, liver dysfunction, and coagulation impairment, further increase the risk of bleeding in these patients. 14 , 32 Previously performed studies documented different rates of post-ERCP bleeding. Navaneethan et al 7 analyzed the USA Nationwide inpatient sample database and reported that 2.1% of cirrhotic patients developed bleeding after ERCP.…”

Complex Intrahepatic Lithiasis: A Case Report of Combined Treatment With Surgical Exploration of the Bilioenteric Anastomosis and Laser Lithotripsy by Cholangioscopy

“…Five years later, she developed BEA stricture, and new intrahepatic calculi were formed, leading to recurrent pyogenic cholangitis and liver abscesses. Furthermore, the patient was subjected to five ERCPs and, finally, one percutaneous transhepatic drainage of the biliary tract in one episode of cholangitis Tokyo II [ 9 ]. The case was discussed in a multidisciplinary conference, and the patient was submitted to a surgical and endoscopic combined approach.…”