Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5602
Peer-review started: June 27, 2022
First decision: August 1, 2022
Revised: August 12, 2022
Accepted: September 23, 2022
Article in press: September 23, 2022
Published online: October 14, 2022
The optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis (AC) is uncertain, especially in patients with AC of varying severity.
To report whether the timing of ERCP is associated with outcomes in AC patients with different severities.
According to the 2018 Tokyo guidelines, 683 patients who met the definite diagnostic criteria for AC were retrospectively identified. The results were first compared between patients receiving ERCP ≤ 24 h and > 24 h and then between patients receiving ERCP ≤ 48 h and > 48 h. Subgroup analyses were performed in patients with grade I, II or III AC. The primary outcome was 30-d mortality. Secondary outcomes were intensive care unit (ICU) admission rate, length of hospital stay (LOHS) and 30-d readmission rate.
Taking 24 h as the critical value, compared with ERCP > 24 h, malignant biliary obstruction as a cause of AC was significantly less common in the ERCP ≤ 24 h group (5.2% vs 11.5%). The proportion of cardiovascular dysfunction (11.2% vs 2.6%), respiratory dysfunction (14.2% vs 5.3%), and ICU admission (11.2% vs 4%) in the ERCP ≤ 24 h group was significantly higher, while the LOHS was sign
ERCP ≤ 48 h conferred a survival benefit in patients with grade III AC. Early ERCP shortened the LOHS in patients with grade I and II AC.
Core Tip: Compared with endoscopic retrograde cholangiopancreatography (ERCP) > 24 h, ERCP ≤ 24 h group had a significantly higher intensive care unit (ICU) admission rate and shorter length of hospital stay (LOHS). Subgroup analysis showed higher ICU admission rate was only in grade III acute cholangitis (AC); shorter LOHS was only in grade II and I AC. Compared with ERCP > 48 h, ERCP ≤ 48 h group had significantly lower 30-d mortality and shorter LOHS. Subgroup analysis revealed lower 30-d mortality was only in grade III AC; shorter LOHS was only in grade II and I AC. We concluded that ERCP ≤ 48 h conferred a survival benefit in grade III AC; early ERCP shortened LOHS in grade II and I AC.