Association between early ERCP and mortality in patients with acute cholangitis

Tan, Ming; Muckadell, Ove B. Schaffalitzky de; Laursen, Stig Borbjerg

doi:10.1016/j.gie.2017.04.009

Cited by 60 publications

(60 citation statements)

References 14 publications

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“…In the adult study from Denmark, patients who underwent ERCP within 24 hours had lower 30-day mortality 91 . A prospective study of 199 consecutive adult patients with cholangitis managed by ERCP showed that a delay of more than 48 hours was associated with a longer hospital stay and a delay of more than 72 hours was associated with other adverse outcomes 93 .…”

Section: (Adult Evidence Level: Grade 1/b Full Agreement)mentioning

confidence: 89%

“…A recent retrospective adult study from Denmark of 166 patients with acute cholangitis who underwent ERCP found that the presence of AP did not influence outcome independent of cholangitis 91 . Thus, studies on the timing of ERCP in adult patients with AP could be helpful in patients with biliary AP and cholangitis.…”

Section: (Adult Evidence Level: Grade 1/b Full Agreement)mentioning

confidence: 96%

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EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

et al. 2018

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Section: (Adult Evidence Level: Grade 1/b Full Agreement)mentioning

confidence: 89%

Section: (Adult Evidence Level: Grade 1/b Full Agreement)mentioning

confidence: 96%

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

et al. 2018

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is the choice of biliary drainage which should be performed early for moderate and severe cases, according to the severity grading of the updated Tokyo Guidelines of 2018 [ 3 ]. Moreover, recent studies show early ERCP (within 48 h of admission) in all grading of cholangitis is associated with shorter hospital stays, decrease costs and lower mortality rate [ [4] , [5] , [6] , [7] , [8] ].…”

Section: Introductionmentioning

confidence: 99%

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

Sanguanlosit

Viriyaroj

Yodying

et al. 2020

Annals of Medicine and Surgery

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Background The common bile duct (CBD) stones passage in patients with cholangitis was unclear. This study aimed to evaluate the effect on CBD stone sizes and predicting factors on spontaneous passage in patients with cholangitis. Method The medical records of cholangitis at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to December 2019 were retrospectively reviewed. Patients with acute cholangitis from CBD stones underwent ERCP in the same admission were enrolled. Result Of the 96 patients, The rate of spontaneous passage of CBD stones was 19.8%. By univariate analysis, factors significantly associated with a predictor of spontaneous CBD stone passage in patient with cholangitis were single CBD stone (p = 0.001), CBD stone diameter < 5 mm (p < 0.001), and clinical symptom improved before ERCP procedure (p = 0.004). Multivariate logistic regression analyses also revealed that these three factors were significantly associated with spontaneous passage. From ROC curve analysis, stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). Conclusions CBD stone diameter < 5 mm, single CBD stone and improved clinical symptom before ERCP procedure are key predictors of spontaneous CBD stone passage in cholangitis.

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“…Urgent endoscopic biliary drainage was reported to be important in the treatment of acute cholangitis in a study by Boender et al [14], in 1995, pointing out that adverse events due to persistent cholangitis became more frequent as the delay between onset and biliary drainage increased. This was later supported by Tan et al, in their large group study, which reported marginally significant improvement of 30day mortality in patients who underwent ERCP within 24 h after hospitalization [15]. Accordingly, we adopted the policy of urgent ERCP as early as possible after the patient was stabilized [16].…”

Section: Discussionmentioning

confidence: 72%

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

Çakır

Hut

Akturk

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a tool often used for treating and diagnosing pancreaticobiliary diseases. One of the important complications of ERCP is pancreatitis. Even though transient hyperamylasemia is a more common and benign situation, it must be distinguished from post-ERCP pancreatitis. Aim To define the risk factors associated with post-ERCP pancreatitis (PEP) and tried to identify a cutoff about laboratory findings for positive or negative prediction. Material and methods We reviewed the medical files of patients who underwent ERCP for choledocholithiasis in a retrospective cohort study. The primary outcome is the risk factors associated with PEP. Receiver operator characteristics analysis was carried out for determination of cut-offs for laboratory parameters. Results The presence of cholangitis (p = 0.018), Wirsung cannulation (p = 0.008), presence of abdominal pain at 12 th and 24 th h (p < 0.001), amylase level at 12 th h (p < 0.001), C-reactive protein (CRP) levels at 6 th and 12 th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6 th and 12 th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 10 3 had negative predictive values over 70% and 90% respectively. Conclusions Physical examination and inflammatory parameters are important in diagnosis of PEP. CRP and WBC have high negative predictivity and sensitivity. Amylase level increase was most apparent 12 h after ERCP and significantly higher (p < 0.001) for the development of PEP. The first abdominal pain evaluation is meaningful at the 12 th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation.

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Association between early ERCP and mortality in patients with acute cholangitis

Cited by 60 publications

References 14 publications

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.

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