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acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

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World Journal of Clinical Cases 2023年第29期11卷 6984-6994页

作者： Yung-Kuan Tsou Yi-Tse Su Cheng-Hui Lin Nai-Jen Liu Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333TaiwanChina

BACKGROUND Whether clinical outcomes of acute cholangitis(AC)vary by etiology is *** To compare outcomes in AC caused by malignant biliary obstruction(MBO)and common bile duct stones(CBDS).METHODS This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)due to AC caused by MBO(MBO group,n=56)and CBDS(CBDS group,n=460).Clinical and laboratory parameters were compared between the *** score matching(PSM)created 55 matched *** used in the PSM analysis were age,sex,time to ERCP,and technical success of *** primary outcome comparison was 30-d *** secondary outcome comparisons were intensive care unit(ICU)admission rate,length of hospital stay(LOHS),and 30-d readmission *** Compared with the CBDS group,the MBO group had significantly lower body temperature,percentage of abnormal white blood cell counts,and serum levels of aspartate aminotransferase,alanine aminotransferase,and *** temperature,percent abnormal white blood cell count,and serum aspartate aminotransferase levels remained significantly lower in the MBO group in the PSM *** count,prothrombin time/international normalized ratio,and serum levels of alkaline phosphatase and total bilirubin were significantly higher in the MBO *** MBO group had a significantly higher percentage of severe AC(33.9%vs 22.0%,P=0.045)and received ERCP later(median,92.5 h vs 47.4 h,P<0.001).However,the two differences were not found in the PSM *** 30-d mortality(5.4%vs 0.7%,P=0.019),ICU admission rates(12.5%vs 4.8%,P=0.028),30-d readmission rates(23.2%vs 8.0%,P<0.001),and LOHS(median,16.5 d vs 7.0 d,P<0.001)were significantly higher or longer in the MBO ***,only LOHS remained significant in the PSM *** analysis revealed that time to ERCP and multiple organ dysfunction were independent factors associated with 30-d *** MBO patients underwent ERC

关键词： Malignant biliary obstruction Common bile duct stones Endoscopic retrograde cholangiopancreatography acute cholangitis Mortality Etiology

Red cell distribution width-to-albumin ratio is a simple promising prognostic marker in acute cholangitis requiring biliary drainage

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 487-494页

作者： Fatih Acehan Hüseyin Camli Cagdas Kalkan Mesut Tez Burak Furkan Demir Emin Altiparmak Ihsan Ates Department of Internal Medicine Ankara City HospitalAnkara 06800Türkiye Department of Gastroenterology Ankara City HospitalAnkara 06800Türkiye Department of General Surgery Ankara City HospitalAnkara 06800Türkiye

Background: It is crucial to assess the severity of acute cholangitis(AC). There are currently several prognostic markers. However, the accuracies of these markers are not satisfied. The present study aimed to investigate the predictive value of the red cell distribution width(RDW)-to-albumin ratio(RAR) for the prognosis of AC. Methods: We retrospectively evaluated consecutive patients diagnosed with AC between May 2019 and March 2022. RAR was calculated, and its predictive ability for in-hospital mortality, intensive care unit(ICU) admission, bacteremia, and the length of hospitalization were analyzed. Results: Out of 438 patients, 34(7.8%) died. Multivariate analysis showed that malignant etiology [odds ratio(OR) = 4.816, 95% confidence interval(CI): 1.936-11.980], creatinine(OR = 1.649, 95% CI: 1.095-2.484), and RAR(OR = 2.064, 95% CI: 1.494-2.851) were independent risk factors for mortality. When adjusted for relevant covariates, including age, sex, malignant etiology, Tokyo severity grading(TSG), Charlson comorbidity index, and creatinine, RAR significantly predicted mortality(adjusted OR = 1.833, 95% CI: 1.280-2.624). When the cut-off of RAR was set to 3.8, its sensitivity and specificity for mortality were 94.1% and 56.7%, respectively. Patients with an RAR of > 3.8 had a 20.9-fold(OR = 20.9, 95% CI: 4.9-88.6) greater risk of mortality than the remaining patients. The area under the curve value of RAR for mortality was 0.835(95% CI: 0.770-0.901), which was significantly higher than that of TSG and the other prognostic markers, such as C-reactive protein-to-albumin ratio, and procalcitonin-to-albumin ratio. Lastly, RAR was not inferior to TSG in predicting ICU admission, bacteremia, and the length of hospitalization. Conclusions: RAR successfully predicted the in-hospital mortality, ICU admission, bacteremia, and the length of hospitalization of patients with AC, especially in-hospital mortality. RAR is a promising marker that is more convenient than TSG and o

关键词： acute cholangitis Albumin Biliary drainage Mortality Red blood cell distribution width-to-albumin ratio

Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 619-625页

作者： Chan Sun Park Hee Seok Jeong Ki Bae Kim Joung-Ho Han Hee Bok Chae Sei Jin Youn Seon Mee Park Department of Internal Medicine Chungbuk National University College of Medicine

BACKGROUND： acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. METHODS： We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Patients＇ demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospectively obtained from medical records. Clinical parameters and outcomes were compared between elderly （75-80 years, n= 156） and very elderly （≥81 years, n=175） patients. We analyzed the effects of methods [none, endoscopic retrograde cholangio- pancreatography （ERCP）, percutaneous transhepatic biliary drainage, or failure] and timing （urgent or early） of biliary drainage on mortality and hospital stay in these patients. RESULTS： acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot＇s triad （4.2%） and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 （31.4%）, 175 （52.9%）, and 52 （15.7%）, respectively. Urgent bili-ary drainage （≤24 hours） was performed for 80.5% （247/307） of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of transient hiliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low （1.5%） and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis. CONCLUSIONS： The methods and timing used for biliary drainage and severity of cholangitis are the major determinants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for favorable

关键词： acute cholangitis biliary drainage prognosis elderly very elderly

Activation of TLR-4 and liver injury via NF-kappa B in rat with acute cholangitis

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 185-191页

作者： Yu, Hong Wu, Shuo-Dong China Med Univ Dept Biliary & Minimal Invas Surg 1 Shengjing Hosp Shenyang 110004 Peoples R China

BACKGROUND: Toll-like receptors (TLRs) are a family of type 1 transmembrane receptors, which can recognize different pathogen-associated molecular patterns. Among them, TLR-4 is specific to lipopolysaccharide. It transfers the infection signal into the cell and promotes the translocation of nuclear factor kappa B (NF-kappa B) to the nucleus and the subsequent transcriptional activation of genes encoding pro- and anti-inflammatory cytokines and chemokines. acute cholangitis (AC) is a common biliary tract infection in oriental countries, and often leads to liver injury. The activation of TLR-4 and its significance in liver injury in rats with AC remain unclear. METHODS: Rat models of AC (biliary tract obstruction+E. coli injection, n=36) and control models (biliary tract obstruction+saline, n=18) were made. Liver tissue injury was investigated by pathological examination. The levels of serum TNF-alpha and IL-10 were measured by enzyme-linked immunosorbent assay, and the expressions of TLR-4, NF-kappa B mRNAs and proteins in the liver were detected by RT-PCR, immunohistochemical staining and Western blotting, respectively. RESULTS: Severe liver tissue injury in rats with AC was evident as shown by pathological examination. TLR-4 and NF-kappa B were strongly expressed in the cytoplasm of hepatocytes in the AC group. They were negative or slightly positive in the control group. TLR-4 mRNA and protein in the liver of rats with AC increased 1 hour after biliary tract ligation and E. coli injection, and peaked at 6 hours after surgery. Twenty-four hours later, they began to decrease. The expression of TLR-4 was paralleled by that of NF-kappa B in the liver and TNF-alpha in serum. CONCLUSION: The higher expression of TLR-4 in the liver of rats with AC may be involved in liver injury through the activation of NF-kappa B and release of cytokines such as TNF-alpha.

关键词： acute cholangitis NF-kappa B toll-like receptor-4

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

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World Journal of Gastroenterology 2022年第38期28卷 5602-5613页

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 Department of Medicine College of MedicineChang Gung UniversityTaoyuan 333Taiwan Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333Taiwan

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 and>24 h and then between patients receiving ERCP ≤ 48 h and>48 *** 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 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 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 ERCP>48 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

关键词： acute cholangitis Endoscopic retrograde cholangiopancreatography severity Timing Thirtyday mortality Length of hospital stay

Short vs long-course antibiotic therapy in adults with acute cholangitis:A systematic review,meta-analysis,and evidence quality assessment

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World Journal of Gastroenterology 2023年第19期29卷 3027-3039页

作者： Karampet Kasparian Chrysanthos D Christou Konstantinos Petidis Michail Doumas Olga Giouleme Clinic of Oncology Gastroenterology and HematologyAlfried Krupp HospitalEssen 45131Germany Second Propedeutic Department of Internal Medicine Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

BACKGROUND acute cholangitis(AC)constitutes an infection with increased mortality rates in the *** to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced *** initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this ***,the optimal duration of the antibiotic treatment of AC is still *** To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with *** This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the *** study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and *** studies were included in the systematic review,and eight were eligible for *** to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 *** A total of 2763 patients were included in the systematic review,and 1313 were accounted for the *** mean age was 73.66±14.67 years,and the male and female ratio was 1:*** significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study *** Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of *** conclusions cannot be extracted concerning the hospitalization duration.

关键词： acute cholangitis Antibiotic Short-course Long-course Antimicrobial Treatment duration

Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity scorematched analysis

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World Journal of Gastroenterology 2024年第15期30卷 2118-2127页

作者： Yang Zhou Yin-Qiu Zhang Shuai-Jing Huang Yan Liang Xiao Liang Masoom Wali Ya-Dong Feng Department of Gastroenterology Zhongda HospitalSchool of MedicineSoutheast UniversityNanjing 210009Jiangsu ProvinceChina Department of Gastroenterology BenQ Medical CenterThe Affiliated BenQ Hospital of Nanjing Medical UniversityNanjing 210019Jiangsu ProvinceChina

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 *** To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe *** We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July *** 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)*** primary outcomes were intensive care unit(ICU)admission rates,ICU length of stay,and duration of antibiotic *** 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 *** urgent ERCP group had more ICU admissions(34.4%vs 21.5%,P=0.05),shorter ICU stays(3 d vs 9 d,Pcholangitis occurrence,30-d readmission rate or 30-d *** Urgent one-stage ERCP provides the advantages of a shorter ICU stay,a shorter duration of antibiotic use,and a shorter hospital stay.

关键词： acute cholangitis Endoscopic retrograde cholangiopancreatography One-stage treatment Optimal time

Verification of the Tokyo guidelines for acute cholangitis secondary to benign and malignant biliary obstruction:experience from a Chinese tertiary hospital

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Hepatobiliary & Pancreatic Diseases International 2013年第4期12卷 400-407页

作者： Gang Sun Lu Han Yun-Sheng Yang En-Qiang Linghu Wen Li Feng-Chun Cai Jin-Yan Kong Xiang-Dong Wang Jiang-Yun Meng Hong Du Hong-Bin Wang Qi-Yang Huang Quratulain Hyder Xiu-Li Zhang Department of Gastroenterology and Hepatology Chinese PLA General Hospital Department of General Oncology Chinese PLA General Hospital Department of Gastroenterology Pakistan Institute of Medical SciencesG-8-3 Islamabad Pakistan

BACKGROUND: The lack of widely-accepted guidelines for acute cholangitis largely lags behind the progress in medical and surgical technology and science for the management of acute cholangitis. This study aimed to verify the Tokyo guidelines for the management of acute cholangitis and cholecystitis of 2007 edition (TG07) in patients with obstructive cholangitis due to benign and malignant diseases. METHODS: The patients were retrieved from our existing ERCP database. Final diagnosis of acute cholangitis was made by detecting purulent bile during biliary drainage. We examined and compared the guidelines concerning benign and malignant obstruction. RESULTS: In 120 patients in our study, 82 and 38 had benign and malignant biliary obstruction, respectively. Guidelines based diagnosis was made in 68 (82.9%), 36 (94.7%), and 104 (86.7%) patients with benign, malignant, and overall biliary obstruction, respectively, which were significantly higher than 44 (53.7%), 17 (44.7%), and 61 (50.8%) diagnosed by Charcot’s triad (Pacute cholangitis albeit with limited prognostic values. Intrahepatic obstruction and hypoalbuminemia are new predictors of poor prognosis and need further assessment.

关键词： acute cholangitis the Tokyo guidelines endoscopic biliary drainage diagnosis

Optimal timing of biliary drainage based on the severity of acute cholangitis:A single-center retrospective cohort study

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World Journal of Gastroenterology 2022年第29期28卷 3934-3945页

作者： Zhao-Qing Lu Han-Yu Zhang Chen-Fen Su Yue-Yan Xing Guo-Xing Wang Chun-Sheng Li Department of Emergency Medicine Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Emergency and Critical Care Center Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis(AC).Although early biliary drainage is recommended by the treatment guidelines for AC,the best time for performing this procedure is yet to be ***,since the clinical outcomes of patients with severe AC vary dramatically,screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade *** To investigate the optimal drainage timing for AC patients with each disease severity grade and organ *** In this retrospective monocenter cohort analysis,we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December *** characteristics including age and sex,clinical and laboratory characteristics,and imaging findings of each patient were obtained from electronic medical *** investigated the all-cause in-hospital mortality(IHM),hospital length of stay(LOS),and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors[age,white blood cell(WBC)count,total bilirubin,albumin,lactate,malignant obstruction,and Charlton comorbidity index(CCI)].RESULTS Biliary drainage within 24 or 48 h in Grade Ⅲ AC patients could dramatically decrease IHM(3.9%vs 9.0%,P=0.041;4%vs 9.9%,P=0.018,respectively),while increasing LOS and hospitalization *** logistic analysis revealed that neurological,respiratory,renal,and cardiovascular dysfunctions,hypoalbuminemia,and malignant obstruction were significantly associated with IHM(odds ratio=5.32,2.541,6.356,4.021,5.655,and 7.522;P<0.001,P=0.016,P<0.001,P=0.012,P<0.001,and P<0.001;respectively).Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neur

关键词： acute cholangitis Endoscopic retrograde cholangiopancreatography Mortality Biliary drainage Organ dysfunction