Año 2022 / Volumen 114 / Número 3
Original
Very urgent endoscopic retrograde cholangiopancreatography is associated with early discharge in patients with non-severe acute cholangitis

133-139

DOI: 10.17235/reed.2021.7995/2021

Ryo Sugiura, Hirohito Naruse, Yoshiya Yamamoto, Kazuteru Hatanaka, Kenji Kinoshita, Satoshi Abiko, Shuichi Miyamoto, Kazuharu Suzuki, Masayuki Higashino, Risako Kohya, Naoya Sakamoto,

Resumen
Background: endoscopic retrograde cholangiopancreatography (ERCP) is a first-line procedure for biliary drainage in patients with acute cholangitis, and there are no studies focused on very urgent ERCP within several hours of hospital arrival. This study aimed to elucidate the use of very urgent ERCP for non-severe acute cholangitis. Methods: this retrospective observational study included patients with non-severe acute cholangitis who underwent ERCP between April 2011 and June 2020 in our institution. Patients were stratified into three groups based on time to ERCP after hospital arrival: very urgent (≤ 3 hours), urgent (3-24 hours) and elective (> 24 hours). The primary outcome was length of hospital stay (LOS). Results: the study cohort included 291 patients, 168 males (57.7 %), with a median age of 76 (interquartile range, 70-83) years. In all, 47, 196 and 48 patients underwent very urgent, urgent and elective ERCP, respectively. Median LOS in the very urgent, urgent, and elective groups was 12, 14, and 15 days, respectively (Kaplan-Meier method). A shorter LOS was associated with earlier ERCP (log-rank trend test, p = 0.04). The rates of readmission within 30 days of discharge and of adverse events were not significantly different among the three groups. By multivariate analysis, very urgent ERCP was associated with a significantly earlier discharge than urgent and elective ERCP (HR, 0.71, p = 0.04 and HR, 0.47, p < 0.01, respectively). In addition, age ≥ 75 years, pancreatitis, albumin ≤ 2.8 g/dL and two or more ERCP procedures were associated with a significantly longer LOS (HRs < 1, p < 0.05). Conclusions: very urgent ERCP for non-severe acute cholangitis was associated with early discharge.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Lee F, Ohanian E, Rheem J, et al. Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis. Aliment Pharmacol Ther 2015;42(2):212-20. DOI: 10.1111/apt.13253
2. Karvellas CJ, Abraldes JG, Zepeda-Gomez S, et al. The impact of delayed biliary decompression and anti-microbial therapy in 260 patients with cholangitis-associated septic shock. Aliment Pharmacol Ther 2016;44(7):755-66. DOI: 10.1111/apt.13764
3. Tsuchiya T, Sofuni A, Tsuji S, et al. Endoscopic management of acute cholangitis according to the TG13. Dig Endosc 2017;29(Suppl 2):94-9. DOI: 10.1111/den.12799
4. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018;25(1):17-30. DOI: 10.1002/jhbp.512
5. Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018;25(1):96-100. DOI: 10.1002/jhbp.519
6. Jang SE, Park SW, Lee BS, et al. Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP. Dig Dis Sci 2013;58(7):2082-7. DOI: 10.1007/s10620-013-2595-z
7. Hakuta R, Hamada T, Nakai Y, et al. No association of timing of endoscopic biliary drainage with clinical outcomes in patients with non-severe acute cholangitis. Dig Dis Sci 2018;63(7):1937-45. DOI: 10.1007/s10620-018-5058-8
8. Iqbal U, Khara HS, Hu Y, et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc 2020;91(4):753-60. DOI: 10.1016/j.gie.2019.09.040
9. Mulki R, Shah R, Qayed E. Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis. World J Gastrointest Endosc 2019;11(1):41-53. DOI: 10.4253/wjge.v11.i1.41
10. Eto K, Kawakami H, Haba S, et al. Single-stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non-randomized, open-label and exploratory clinical trial. J Hepatobiliary Pancreat Sci 2015;22(12):825-30. DOI: 10.1002/jhbp.296
11. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50(2):133-64. DOI: 10.1086/649554
12. Gomi H, Solomkin JS, Takada T, et al. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013;20(1):60-70. DOI: 10.1007/s00534-012-0572-0
13. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018;25(1):3-16. DOI: 10.1002/jhbp.518
14. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71(3):446-54. DOI: 10.1016/j.gie.2009.10.027
15. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013;48(3):452-8. DOI: 10.1038/bmt.2012.244
16. Park TY, Choi JS, Song TJ, et al. Early oral antibiotic switch compared with conventional intravenous antibiotic therapy for acute cholangitis with bacteremia. Dig Dis Sci 2014;59(11):2790-6. DOI: 10.1007/s10620-014-3233-0
17. Schwed AC, Boggs MM, Pham XD, et al. Association of admission laboratory values and the timing of endoscopic retrograde cholangiopancreatography with clinical outcomes in acute cholangitis. JAMA Surg 2016;151(11):1039-45. DOI: 10.1001/jamasurg.2016.2329
Artículos relacionados

Imagen en Patología Digestiva

Traumatic biliary fistula with bile duct disconnection

DOI: 10.17235/reed.2024.10096/2023

Carta

Hematoma post-endoscopic retrograde cholangiopancreatography

DOI: 10.17235/reed.2023.9670/2023

Imagen en Patología Digestiva

Colangiopatía post-COVID: hallazgos ultrasonográficos y de CPRE

DOI: 10.17235/reed.2022.9218/2022

Imagen en Patología Digestiva

Cholangiohydatidosis: an uncommon cause of acute cholangitis

DOI: 10.17235/reed.2020.7063/2020

Carta

Obstructive jaundice of a parasitic etiology

DOI: 10.17235/reed.2018.5827/2018

Carta

Estudio de masa pancreática: no todo es lo que parece

DOI: 10.17235/reed.2018.5527/2018

Instrucciones para citar
Sugiura R, Naruse H, Yamamoto Y, Hatanaka K, Kinoshita K, Abiko S, et all. Very urgent endoscopic retrograde cholangiopancreatography is associated with early discharge in patients with non-severe acute cholangitis. 7995/2021


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 1588 veces.
Este artículo ha sido descargado 149 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 23/03/2021

Aceptado: 03/05/2021

Prepublicado: 05/05/2021

Publicado: 07/03/2022

Tiempo de revisión del artículo: 38 días

Tiempo de prepublicación: 43 días

Tiempo de edición del artículo: 349 días


Compartir
Este artículo aun no tiene valoraciones.
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas