Impact of Early Versus Late Approach on the Management of Acute Cholangitis in an Ecuadorian Level-4 Health Center

Abstract

Introduction: Acute cholangitis is a bile duct inflammation and infection resulting from complete or partial obstruction due to different etiologies, including gallstones, malignant occlusion, etc. Clinical presentation includes intermittent fever with chills, right upper quadrant pain, and jaundice. With advances in minimally invasive techniques such as endoscopic techniques, the prognosis has improved in the last 30 years with a current mortality of 2.7 to 10%. Objective: compare the impact of the early versus late approach in the management of acute cholangitis according to the TG in patients admitted to the General Surgery Department of Luis Vernaza Hospital during 2018 to 2020. Methodology: Observational, retrospective, comparative and analytical study. Data was obtained from electronic medical records, organized using Microsoft Excel ®, and analyzed using SPSS 25.0 ®. Chi-square or Fisher's test were applied to compare the clinical characteristics by type of approach or severity scale. Statistical significance was established for p- value <0.05. Results: Ninety-eight patients were included, female: 54.08%. Grade II (moderate) cholangitis was the most frequent (64.29%). The main approach for biliary drainage was endoscopic (ERCP) (57.14%). A late approach (> 48 hours since hospital admission) was seen in 69.4%. Mortality by type of approach presented significant differences (p = 0.029): 0% with early approach vs. 14.71% with the late approach. Discussion: Patients with acute cholangitis were mainly approached late for biliary decompression; a worrying fact since it demonstrates non- compliance of fundamental TG recommendations were early or urgent bile duct decompression is described as a mainstay in acute cholangitis. Conclusions: Hospital stay was directly proportional to the type of approach (early or late). Mortality was higher in patients who underwent a late approach, and directly proportional to the severity. An early approach should always be preferred.

Colecistectomía laparoscópica difícil: una revisión del estado del arte

“…Una lesión en la vesícula biliar puede llevar a la liberación de bilis en la cavidad abdominal, lo cual eleva la probabilidad de infección y complicaciones. Los cirujanos deben estar atentos y tomar medidas precautorias para evitar lesiones no deseadas en la vesícula biliar (Coello Vergara, 2022).…”