Ito T, Sai JK, Okubo H, Saito H, Ishii S, Kanazawa R, Tomishima K, Watanabe S, Shiina S. Safety of immediate endoscopic sphincterotomy in acute suppurative cholangitis caused by choledocholithiasis. World J Gastrointest Endosc 2016; 8(3): 180-185 [PMID: 26862368 DOI: 10.4253/wjge.v8.i3.180]
Corresponding Author of This Article
Jin Kan Sai, MD, Associate Professor, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. jinkans@juntendo.ac.jp
Research Domain of This Article
Allergy
Article-Type of This Article
Retrospective Cohort 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 Gastrointest Endosc. Feb 10, 2016; 8(3): 180-185 Published online Feb 10, 2016. doi: 10.4253/wjge.v8.i3.180
Safety of immediate endoscopic sphincterotomy in acute suppurative cholangitis caused by choledocholithiasis
Tomoyasu Ito, Jin Kan Sai, Hironao Okubo, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina
Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
Hironao Okubo, Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
Author contributions: Ito T and Sai JK contributed equally to this work; Ito T collected and analyzed the data, and drafted the manuscript; Sai JK provided analytical oversight and designed and supervised the study; Watanabe S and Shiina S revised the manuscript for the important intellectual content; Okubo H, Saito H, Ishii S, Kanazawa R and Tomishima K participated in collecting the data; all authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the Institutional Review Board of Juntendo University.
Informed consent statement: Written informed consent for the procedures and treatment was obtained from patients or their next of kin in accordance with normal clinical practice.
Conflict-of-interest statement: No conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at (jinkans@juntendo.ac.jp). Consent for data sharing was not obtained from the participants but the presented data are anonymized and risk of identification is low.
Open-Access: 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/
Correspondence to: Jin Kan Sai, MD, Associate Professor, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. jinkans@juntendo.ac.jp
Telephone: +81-3-58021061 Fax: +81-3-56845960
Received: July 23, 2015 Peer-review started: July 30, 2015 First decision: September 14, 2015 Revised: September 28, 2015 Accepted: October 20, 2015 Article in press: October 27, 2015 Published online: February 10, 2016 Processing time: 190 Days and 17.5 Hours
Abstract
AIM: To examine the safety of immediate endoscopic sphincterotomy (EST) in patients with acute suppurative cholangitis (ASC) caused by choledocholithiasis, as compared with elective EST.
METHODS: Patients with ASC due to choledocholithiasis were allocated to two groups: Those who underwent EST immediately and those who underwent EBD followed by EST 1 wk later because they were under anticoagulant therapy, had a coagulopathy (international normalized ratio > 1.3, partial thromboplastin time greater than twice that of control), or had a platelet count < 50000 × 103/μL. One of four trainees [200-400 cases of endoscopic retrograde cholangiopancreatography (ERCP)] supervised by a specialist (> 10000 cases of ERCP) performed the procedures. The success and complication rates associated with EST in each group were examined.
RESULTS: Of the 87 patients with ASC, 59 were in the immediate EST group and 28 in the elective EST group. EST was successful in all patients in both groups. There were no complications associated with EST in either group of patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liver enzymes just before EST were significantly higher in the immediate EST group than in the elective EST group.
CONCLUSION: Immediate EST can be as safe as elective EST for patients with ASC associated with choledocholithiasis provided they are not under anticoagulant therapy, or do not have a coagulopathy or a platelet count < 50000 × 103/μL. Moreover, the procedure was safely performed by a trainee under the supervision of an experienced specialist.
Core tip: Immediate endoscopic sphincterotomy (EST) can be as safe as elective EST for patients with acute suppurative cholangitis associated with choledocholithiasis, because there were no complications associated with EST in either group of patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liver enzymes just before EST were significantly higher in the immediate EST group (n = 59) than in the elective EST group (n = 28). Moreover, the procedure was safely performed by a trainee under the supervision of an experienced specialist.
