Zhou Y, Zhang YQ, Huang SJ, Liang Y, Liang X, Wali M, Feng YD. Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity score-matched analysis. World J Gastroenterol 2024; 30(15): 2118-2127 [PMID: 38681983 DOI: 10.3748/wjg.v30.i15.2118]
Corresponding Author of This Article
Ya-Dong Feng, MD, PhD, Chief Doctor, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu Province, China. drfengyd@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 21, 2024; 30(15): 2118-2127 Published online Apr 21, 2024. doi: 10.3748/wjg.v30.i15.2118
Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity score-matched analysis
Yang Zhou, Yin-Qiu Zhang, Shuai-Jing Huang, Yan Liang, Xiao Liang, Masoom Wali, Ya-Dong Feng
Yang Zhou, Shuai-Jing Huang, Yan Liang, Xiao Liang, Masoom Wali, Ya-Dong Feng, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Yin-Qiu Zhang, Department of Gastroenterology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, Jiangsu Province, China
Co-first authors: Yang Zhou and Ying-Qiu Zhang.
Author contributions: Zhou Y wrote the manuscript; Feng YD was responsible for the case design; Zhang YQ and Huang SJ collected the data and analyzed the data; Liang Y and Wali M revised the manuscript; and all the authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was conducted at Zhongda Hospital Affiliated with Southeast University. The study was approved by the Ethics Committee (2019ZDSYLL094-P01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data are available upon request to the corresponding author (email: drfengyd@126.com).
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Dong Feng, MD, PhD, Chief Doctor, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu Province, China. drfengyd@126.com
Received: January 18, 2024 Peer-review started: January 18, 2024 First decision: February 9, 2024 Revised: February 19, 2024 Accepted: March 27, 2024 Article in press: March 27, 2024 Published online: April 21, 2024 Processing time: 91 Days and 23.8 Hours
Abstract
BACKGROUND
During emergency endoscopic retrograde cholangiopancreatography (ERCP), the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis (AC) due to choledocholithiasis are unclear.
AIM
To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.
METHODS
We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023. The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later, employing a propensity score (PS) framework. Our primary outcomes were intensive care unit (ICU) admission rates, ICU length of stay, and duration of antibiotic use.
RESULTS
In total, we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention: The urgent group (≤ 24 h, n = 102) and the elective group (> 24 h, n = 152). Ninety-three pairs of patients with similar characteristics were selected by PS matching. The urgent ERCP group had more ICU admissions (34.4% vs 21.5%, P = 0.05), shorter ICU stays (3 d vs 9 d, P < 0.001), fewer antibiotic use (6 d vs 9 d, P < 0.001), and shorter hospital stays (9 d vs 18.5 d, P < 0.001). There were no significant differences observed in adverse events, in-hospital mortality, recurrent cholangitis occurrence, 30-d readmission rate or 30-d mortality.
CONCLUSION
Urgent one-stage ERCP provides the advantages of a shorter ICU stay, a shorter duration of antibiotic use, and a shorter hospital stay.
Core Tip: We investigated the safety and feasibility of one-stage endoscopic treatment for moderate to severe acute cholangitis. Our study found that patients who underwent endoscopic retrograde cholangiopancreatography within 24 h had a shorter intensive care unit stay, a shorter duration of antibiotic use, and a shorter hospital stay.
