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Validation of Tokyo guidelines 2018 for safety and mortality benefit from urgent ERCP in acute cholangitis across

Umer Farooq1, Amlish B Gondal2, Diana Franco1

  • 1Department of Internal Medicine, Loyola Medicine, MacNeal Hospital, Berwyn, Illinois, USA.

Journal of Hepato-Biliary-Pancreatic Sciences
|November 18, 2022
PubMed

Insights

Urgent endoscopic retrograde cholangiopancreatography (ERCP) reduces mortality in acute cholangitis (AC) patients across all age groups. This study confirms the safety of urgent ERCP, supporting its use per Tokyo Guidelines regardless of patient age.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Procedures

Background:

  • The 2018 Tokyo Guidelines (TG18) advocate for urgent biliary drainage in acute cholangitis (AC) based on disease severity.
  • Evaluating the age-specific safety and mortality benefits of urgent endoscopic retrograde cholangiopancreatography (ERCP) is crucial for clinical decision-making.

Purpose of the Study:

  • To assess the safety and mortality outcomes of urgent ERCP in adult patients with AC, stratified by age groups.
  • To determine if age influences the benefits and risks associated with urgent ERCP for AC.

Main Methods:

  • A retrospective analysis of adult AC patients from the National Inpatient Sample database using ICD-10 codes.
  • Patients were categorized by AC severity (severe vs. nonsevere) and age (18-64, 65-79, 80+).
  • Multivariate regression models were employed to analyze mortality and complication rates, with statistical significance set at p < 0.05.

Main Results:

  • Urgent ERCP within 24 hours significantly decreased mortality in all age groups for both severe and nonsevere AC.
  • Increased rates of post-sphincterotomy bleeding were observed in patients aged 80 and above.
  • Post-ERCP acute cholecystitis was more frequent in the 65-79 age group, while pancreatitis and perforation rates did not differ significantly across age groups.

Conclusions:

  • Urgent ERCP offers a mortality benefit for acute cholangitis patients across diverse age demographics.
  • The procedure demonstrates an acceptable safety profile in various age groups, supporting its guideline-recommended application.
  • Clinical practice should adhere to the TG18 recommendations for urgent ERCP in AC, irrespective of patient age.
Abstract

Keywords:
age groupscholangitiscomplicationsendoscopic retrograde cholangiopancreatographyhospital mortality

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