Emerging Endoscopic Retrograde Cholangiopancreatography in Severe Acute Cholangitis

Aims Acute cholangitis with organ failure has a mortality rate of around 100 % if rapid decompression of the bile duct does not occur. The aim of the present study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in emergent drainage at a tertiary referral center.

Methods Retrospective study including ERCP performed on an emergent basis (<48H of admission) due to acute cholangitis between 2014 and 2019. Recorded demographic characteristics of patients, severity of cholangitis, endoscopic findings and procedures performed as well as mortality at 30 days.

Results Included 109 procedures, successful catheterization in 96.3 %(105/109). The majority (53.3 %) were male, mean age 77.8±10.4 years, 88.6 % were elderly (> 65 years), 49.5 % being oldest-old(≥80 years), mean Charlson’s comorbidities index of 5.1 ± 1.9 and duration of hospitalization was 14.6±10 days. One third of the patients were transferred from other hospitals and 80 % required admission to intermediate/intensive care units (mean duration 5.4±3.6 days). Cholangitis severity (Tokyo classification) was moderate in 16.5 % and severe in 83.5 %. Half pd patients (51 %) had failure of at least one organ. Choledocholithiasis was the main etiology (73.3 %) and in 14.3 % of patients there was concomitant acute pancreatitis. Time from clinical worsening to ERCP: <24h - 75.9 %; 24-48h - 24.1 %. About 20 % of the ERCP was performed in operating room, the remaining in endoscopy unit. Endoscopic sphincterotomy (EET) in 54.3 %, placement of biliary stents in 82.9 % and pancreatic stents in 10.5 %. Findings: choledocholithiasis-70.5 %; pus-55.2 %; occluded biliary stents-10.5 %; biliary stenosis-9.5 %. Complications in 10.6 % (hemorrhage after EET with endoscopic hemostasis). Anesthetic complications in 3.8 %. Mortality of 5.8 % and 14.7 %, 48h and 30 days after ERCP, respectively, unrelated to the procedure.

Conclusions Emerging ERCP is an effective and safe procedure in situations of severe acute cholangitis, playing a key role in improving survival in patients who initially have a poor prognosis.

Citation Macedo C, Sant’anna M, Gomes D et al. eP371 EMERGING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN SEVERE ACUTE CHOLANGITIS. Endoscopy 2021; 53: S217.

Publication History

Article published online:
19 March 2021