Management for CBD Stone-Related Mild to Moderate Acute Cholangitis: Urgent Versus Elective ERCP

Abstract

This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.

Single‐stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non‐randomized, open‐label and exploratory clinical trial

“…The cure rate of cholangitis in the present study (90%) was lower than that reported in previous studies on two-stage treatment (92-94%) [5] or single-stage treatment (97.7-100%) [13]. However, the cure rate of cholangitis was 94% when alleviation of cholangitis was assessed at 7 days after treatment.…”

“…Therefore, these findings may not always be applicable to non-severe cases of cholangitis without coagulopathy. Jang et al compared urgent and elective single-stage treatment for CBD stonerelated cholangitis and found that the cholangitis alleviation rate within 7 days of treatment was 97.7-100% and that 12.7% of all cases had complications, including mostly post-ERCP pancreatitis and bleeding in three cases (1.4%) [13]. Additionally, their study demonstrated the efficacy and safety of single-stage treatment in non-severe cases of cholangitis; however, the study was a single-center retrospective case accumulation study.…”

“…Studies have reported that the incidence of hemorrhagic complications rises if ES is performed during the acute stage of cholangitis [5,6]. For non-severe cholangitis, the incidence of hemorrhagic complications following ES has been reported to be 1-8.8% [13,14], which is similar to that reported in general cholangitis (approximately 5%) [15]. A recent study reported a decrease in the incidence of post-ES bleeding from 5.5% to 1.2% with the use of microprocessor-controlled electrosurgery [16].…”

“…The exclusion criteria were as follows: (1) body temperature <37°C; (2) severe acute cholangitis according to the TG07 [8]; (3) malignant biliary stricture confirmed with ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT), or magnetic resonance cholangiopancreatography (MRCP); (4) coagulopathy (platelet count <50,000/μL or prothrombin time international normalized ratio >2.0); (5) age <20 years; (6) performance status >3, according to the Eastern Cooperative Oncology Group scale [9]; (7) mental disability; (8) contrast medium allergy; (9) severe cardiovascular or pulmonary disease; (10) history of ES or endoscopic papillary balloon dilation; (11) ampullary neoplasm; (12) active acute pancreatitis; (13) (Fig. 1).…”

Mortality Risk for Acute Cholangitis (MAC): A risk prediction model for in-hospital mortality in patients with acute cholangitis

“…Adequate management of acute cholangitis is essential for survival [21][22][23][24]. However, acute cholangitis manifests from a broad variety of causes and with varied severity.…”