Acute Cholangitis in Patients With Severe Comorbidities: is Ercp Safe and Effective?

Aims Acute gallstone cholangitis (AGC) is a heterogeneous clinical entity. Patients with severe disease usually require urgent biliary decompression. Endoscopic retrograde cholangiopancreatography (ERCP) in patients with severe comorbidities is a significant challenge for endoscopists, however evidence about its safety and efficacy is still controversial.

Aims To determine the safety and efficacy of ERCP in patients with AGC and severe comorbidities.

Methods Retrospective review of AGC admissions who underwent ERCP, from January 2015 to December 2019. We defined patients with a Charlson Comorbidity Index score(CCIs)>3 as having severe comorbid status. Efficacy was evaluated through biliary cannulation success and complete stone clearance, and safety through registration of post-ERCP and anaesthesia-related complications.

Results 189 patients were included (108 with and 81 without severe comorbid status). There was a male preponderance (53 %) and the average age was 74.1±13.2 years. The proportion of severe disease (severe: 26 % vs. non-severe 19 %;p=0.130) and average timing of ERCP (4.14±2.61 vs. 3.62±2,31 days; p=0.187) were independent of comorbid status.

Technical success was similar in both groups with biliary cannulation possible in 182 patients and a successful stone extraction achieved in 175, in one session. Also, adverse events related to ERCP and anaesthesia were independent of CCIs, with a rate of 4.2 % (2 pancreatitis and 6 haemorrhages) and 4.7 %, respectively. Patients with CCIs>3 underwent ERCP under general anaesthesia more frequently (6.9 % vs. 1.1 %;p=0.015). The length of hospital stay of patients with severe comorbidities was significantly higher (9.44±3.01 vs. 7.46±5.33 days,p=0.02), however the proportion of intensive care admissions was comparable (4.3 % vs. 3.2 %,p=0.986). Procedure-related mortality was zero, but overall intrahospital mortality was significantly higher in patients with CCIs>3 (4.7 % vs. 0 % p=0.049).

Conclusions Our results show that ERCP can be safely and efficaciously performed on patients with severe comorbidities, although mortality should be taken into consideration when selecting therapeutic options.

Citation Sequeira C, Costa Santos I, Coelho M et al. eP367 ACUTE CHOLANGITIS IN PATIENTS WITH SEVERE COMORBIDITIES: IS ERCP SAFE AND EFFECTIVE? Endoscopy 2021; 53: S216.

Publication History

Article published online:
19 March 2021