Incidence and outcomes in patients with acute cholangitis: a population-based study

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Gastroenterology

Background:

• Acute cholangitis (AC) is a serious biliary tract infection.
• The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in AC management remains debated.
• Early intervention versus delayed ERCP in AC requires further investigation.

Purpose of the Study:

• To compare outcomes between early (within 24 hours) and late ERCP in AC patients.
• To assess the impact of ERCP timing on hospital stay, severity, and mortality.
• To examine the overall prognosis of AC patients.

Main Methods:

• Prospective endoscopic database analysis (2010-2021).
• Inclusion of patients diagnosed with cholangitis (ICD-10 k83.0) or calculus of bile duct with cholangitis (ICD-10 k80.3).
• Verification of diagnosis and severity using Tokyo guidelines; sepsis analysis by Sepsis-3 criteria.

Main Results:

• 240 patients included; 25% underwent early ERCP.
• No significant difference in 30-day mortality between early (4.9%) and late (2.5%) ERCP groups.
• Early ERCP associated with more severe cholangitis (31% vs 18%) and sepsis (33% vs 19%), but shorter hospital stay (4 vs. 6 days).

Conclusions:

• ERCP timing significantly influences hospital stay duration in AC patients.
• Early ERCP (within 24 hours) leads to shorter hospitalizations despite presenting with more severe disease.
• The findings support considering early ERCP in AC management to optimize resource utilization.