Urgent versus early ERCP in mild-to-moderate acute cholangitis: a randomised controlled trial

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Gastroenterology

Background:

• Optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in mild-to-moderate acute cholangitis is unclear.
• Acute cholangitis management requires timely intervention to prevent complications.

Purpose of the Study:

• To compare clinical outcomes of urgent ERCP (within 24 hours) versus early ERCP (within 24-48 hours) in acute cholangitis patients.
• To evaluate the impact of ERCP timing on mortality, organ failure, and adverse events.

Main Methods:

• Single-center, open-label, randomized controlled trial involving 304 patients.
• Primary outcome: 30-day mortality. Secondary outcomes: organ failure, in-hospital mortality, length of stay, reintervention, readmission, and post-ERCP adverse events.
• Patients were randomized to either urgent ERCP (n=152) or early ERCP (n=152).

Main Results:

• No significant difference in 30-day mortality (3.95% vs. 6.58%) or in-hospital mortality between urgent and early ERCP groups.
• Similar rates of organ failure at day 3 and day 30, reintervention, and readmission were observed.
• Post-ERCP adverse events were significantly higher in the urgent ERCP group (17.1%) compared to the early ERCP group (9.2%).

Conclusions:

• Urgent ERCP within 24 hours is not superior to early ERCP within 24-48 hours for mild-to-moderate acute cholangitis.
• Early ERCP may be preferable due to a lower rate of procedure-related adverse events.
• The findings suggest a need to reconsider the urgency of ERCP in selected cholangitis cases.