On-site ERCP availability and cholangitis outcomes: Retrospective cohort study

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Gastroenterology

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for managing acute cholangitis (AC).
• ERCP is not universally available in all healthcare facilities.
• The impact of on-site ERCP availability on AC patient outcomes remains unclear.

Purpose of the Study:

• To investigate the association between on-site ERCP availability and outcomes in adult patients with acute cholangitis.
• To assess the effect of ERCP availability on in-hospital mortality, length of stay, ICU admission, readmission rates, and need for decompression.

Main Methods:

• A cohort of 4492 adult AC patients from 27 Ontario hospitals was analyzed using the GEMINI network.
• Multivariable regression analyses were employed to evaluate the impact of on-site ERCP availability.
• Secondary analyses included propensity score-based methods to control for confounding factors.

Main Results:

• Patients treated at sites with on-site ERCP showed no significant difference in in-hospital mortality compared to those at sites without ERCP.
• Patients at ERCP sites with underlying stricturing biliary disease or pancreaticobiliary malignancy, or severe cholangitis, exhibited higher odds of in-hospital mortality.
• Post-hoc propensity score analysis confirmed no significant difference in mortality between the two groups.

Conclusions:

• On-site ERCP availability does not appear to significantly alter overall in-hospital mortality for acute cholangitis patients.
• Specific subgroups, including those with biliary strictures, malignancy, or severe cholangitis, warrant further investigation due to observed higher mortality at ERCP-equipped sites.