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ERCP within 6 or 12 h for acute cholangitis: a propensity score-matched analysis.
Aymeric Becq1,2, Madhuri Chandnani1,2, Anthony Bartley1,2
1Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb-Rose 101, Boston, MA, 02215, USA.
Surgical Endoscopy
|May 12, 2021
Summary
Performing endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis within 12 hours did not improve most outcomes but did reduce 30-day readmissions. Early ERCP for cholangitis may lower re-hospitalization rates.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Acute cholangitis management requires timely biliary drainage.
- The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis is debated.
Purpose of the Study:
- To evaluate if ERCP within 6 or 12 hours of presentation improves clinical outcomes in acute cholangitis patients.
- To compare outcomes between early (<6h or <12h) and delayed ERCP.
Main Methods:
- Retrospective review of 487 acute cholangitis patients undergoing ERCP (2009-2018).
- Propensity score matching compared outcomes for ERCP within vs. after 12 hours.
- Secondary analysis compared ERCP within vs. after 6 hours.
Main Results:
- No significant differences in hospitalization length, mortality, adverse events, or ICU stay between early (<12h) and delayed ERCP.
- 30-day readmission rates were significantly lower for ERCP within 12 hours (7.6% vs 15.2%, p=0.042).
- No significant outcome differences were observed when comparing ERCP within vs. after 6 hours.
Conclusions:
- ERCP within 6 or 12 hours of presentation for acute cholangitis was not associated with improved primary clinical outcomes.
- Early ERCP (within 12 hours) may be associated with reduced 30-day re-hospitalization rates.
