Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity

作     者：Yao-Chi Huang Chi-Huan Wu Mu Hsien Lee Sheng Fu Wang Yung-Kuan Tsou Cheng-Hui Lin Kai-Feng Sung Nai-Jen Liu 

作者机构：Department of MedicineCollege of MedicineChang Gung UniversityTaoyuan 333Taiwan Department of Gastroenterology and HepatologyChang Gung Memorial HospitalTaoyuan 333Taiwan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2022年第28卷第38期

页      面：5602-5613页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：This study was reviewed and approved by the Ethics Committee of the Chang Gung Memorial Hospital(IRB No.202200881B0) 

主　　题：Acute cholangitis Endoscopic retrograde cholangiopancreatography severity Timing Thirtyday mortality Length of hospital stay 

摘      要：BACKGROUND The optimal timing of endoscopic retrograde cholangiopancreatography(ERCP)in acute cholangitis(AC) is uncertain,especially in patients with AC of varying *** To report whether the timing of ERCP is associated with outcomes in AC patients with different *** According to the 2018 Tokyo guidelines,683 patients who met the definite diagnostic criteria for AC were retrospectively *** results were first compared between patients receiving ERCP ≤ 24 h and24 h and then between patients receiving ERCP ≤ 48 h and48 *** analyses were performed in patients with grade Ⅰ,Ⅱ or Ⅲ *** primary outcome was 30-d *** outcomes were intensive care unit(ICU) admission rate,length of hospital stay(LOHS) and 30-d readmission *** Taking 24 h as the critical value,compared with ERCP24 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 significantly shorter(median,6 d vs 7 d).Stratified by the severity of AC,higher ICU admission was only observed in grade Ⅲ AC and shorter LOHS was only observed in grade Ⅰ and Ⅱ *** were no significant differences in 30-d mortality between groups,either in the overall population or in patients with grade Ⅰ,Ⅱ or Ⅲ *** 48 h as the critical value,compared with ERCP48 h,the proportion of choledocholithiasis as the cause of AC was significantly higher in the ERCP ≤ 48 h group(81.5% vs 68.3%).The ERCP ≤ 48 h group had significantly lower 30-d mortality(0 vs 1.9%) and shorter LOHS(6 d vs 8 d).Stratified by AC severity,lower 30-d mortality(0 vs 6.1%) and higher ICU admission rates(22.2% vs 10.2%) were only observed in grade Ⅲ AC,and shorter LOHS was only observed in grade I and Ⅱ *** the multivariate analysis,cardi