Impact of timing of ERCP on long term outcomes of ERCP for acute cholangitis - A single center retrospective study

Nitin Jagtap; Digvijay Chavan; Hardik Rughwani; Sana Fathima Memon; Sundeep Lakhtakia; Shujaath Asif; Rakesh Kalapala; Mohan Ramchandani; D Nageshwar Reddy

doi:10.1016/j.dld.2024.08.037

Impact of timing of ERCP on long term outcomes of ERCP for acute cholangitis - A single center retrospective study

Dig Liver Dis. 2024 Dec;56(12):2149-2153. doi: 10.1016/j.dld.2024.08.037. Epub 2024 Sep 7.

Authors

Nitin Jagtap¹, Digvijay Chavan¹, Hardik Rughwani¹, Sana Fathima Memon¹, Sundeep Lakhtakia¹, Shujaath Asif¹, Rakesh Kalapala¹, Mohan Ramchandani¹, D Nageshwar Reddy²

Affiliations

¹ Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
² Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India. Electronic address: aigindia@yahoo.co.in.

PMID: 39245601
DOI: 10.1016/j.dld.2024.08.037

Abstract

Introduction: Acute cholangitis is a critical medical emergency. The association between the timing of ERCP and clinical outcomes of acute cholangitis is still debated. The current study aims to evaluate whether ERCP within 48 h (urgent) is associated with improved long term clinical outcomes.

Methods: This study is a single-center retrospective analysis of a prospectively maintained database. All patients admitted with acute cholangitis as per Tokyo guidelines at AIG Hospitals, Hyderabad between January 2022 to December 2022 were included. We evaluated the association between urgent ERCP and length of hospital stay, need for reintervention and readmissions, and mortality.

Results: A total of consecutive 301 patients underwent ERCP for acute cholangitis; of which 217 patients (31.3 % females; mean age 54.02 ± 14.9 years) underwent urgent ERCP. The remaining 84 (32.1 % females; mean age 56.56 ± 13.9 years) underwent routine ERCP. Fifty-eight (26.7 %) and 22 (26.2 %) patients with Grade III underwent urgent and routine ERCP respectively. The median (IQR) hospital stay for urgent ERCP was 8.00 (6.00 - 11.00) days and for routine ERCP was 11.00(8.00 - 15.00; p value 0.0001), with similar hospital stay post ERCP (p 0.26). There was no significant difference in mortality upto one year between patients who underwent urgent (22.1 %;48/217) or routine ERCP (31.0 %;26/84, p 0.135). The cox proportional hazard model showed that mortality is independently associated with older age (HR 1.034;95 %CI: 1.013 - 1.054; p 0.001) and malignancy (HR 8.64;95 %CI:4.728 - 15.790; p 0.0001). There was no significant difference between two groups in terms of need for reinterventions and readmissions.

Conclusions: Urgent ERCP for acute cholangitis is associated comparable overall mortality, need for reinterventions, and readmissions with decreased total length of hospital stay. There is an unmet need to confirm these findings by randomized controlled studies.

Keywords: Acute Cholangitis; Endoscopic retrograde cholangiopancreatography; Mortality; Re-interventions; Readmissions; Timing.

MeSH terms

Acute Disease
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde*
Cholangitis* / surgery
Female
Humans
Length of Stay* / statistics & numerical data
Male
Middle Aged
Patient Readmission / statistics & numerical data
Retrospective Studies
Time Factors
Time-to-Treatment / statistics & numerical data
Treatment Outcome