CLINICAL IMPACT OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY TIMING IN ACUTE CHOLANGITIS

Aims:

Acute cholangitis is a life threatening disease that needs antibiotic therapy and biliary decompression. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line procedure used for biliary drainage. Our aim was to evaluate the clinical impact of ERCP timing in patients diagnosed with acute cholangitis.

Methods:

We included in this study, patients admitted with acute cholangitis from January 2016 to December 2016 at the Gastroenterolgy Departament of the Timis Emergency County Hospital, Romania. All patients underwent ERCP. Patients were divided in two groups according to their timing when the procedure was performed – in the first 48 hours and beyond 48 hours. We assessed their severity according to the 2018 Tokyo Guideline criteria and we analyzed the outcomes of mortality and length of hospital stay (LOHS).

Results:

A total of 72 patients was included in this study with a mean age of 64.6 ± 12.2 years. The female to male ratio was 0.9. Most patients had grade I (mild) severity of cholangitis 43/72 (59.7%). Grade II (moderate) severity of cholangitis was met in 16/72 (22.2%) patients and grade III (severe) in 13/72 (18.1%) patients. Analyzing the timing of ERCP, 39/72 (54.2%) patients underwent the procedure in less than 48 hours and 33/72 (45.8%) patients had their ERCP done in more than 48 hours. Delayed ERCP and a higher grade of severity was correlated with a longer hospital stay, a mean LOHS of 9 days. Early ERCP and mild grade of severity had a mean LOHS of 5 days. We found no differences in mortality associated with the timing of the procedure.

Conclusions:

ERCP needs to be performed as soon as possible. Delaying the procedure was not associated with an increased mortality rate, but significantly influenced the length of hospital stay.