Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

Park, Namyoung; Lee, Sang Hyub; Kim, Joo Seong; Huh, Gunn; Chun, Jung Won; Cho, In Rae; Paik, Woo Hyun; Ryu, Ji Kon; Kim, Yong Tae

doi:10.1186/s12876-021-01755-z

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…In the literature, few studies reported only MBO-associated AC[ 17 ], some gave an account of only CBDS-associated AC[ 11 , 18 ], and most reported mixed results for AC of different etiologies[ 3 , 13 - 15 ]. Although the etiology of AC varies, studies explicitly comparing the clinical presentations and outcomes of AC of distinct etiologies are rare.…”

Section: Discussionmentioning

confidence: 99%

“…In the overall population analysis, we found that MBO-associated AC had significantly higher 30-d mortality than CBDS-associated AC, which is consistent with previous studies[ 3 , 4 ]. Regardless of the etiology, time to ERCP has been reported to be a prognostic factor associated with 30-d mortality in AC patients[ 13 , 16 , 17 ]. In a study of distal MBO-associated AC, Park et al [ 17 ] reported that urgent ERCP (within 24 h of ED arrival) improved 30-d mortality in moderate-to-severe AC patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

Tsou,

Su,

Lin

et al. 2023

World J Clin Cases

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Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

Tsou,

Su,

Lin

et al. 2023

World J Clin Cases

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“…As to when is the optimal timing for ERCP for acute cholangitis, this is an important clinical issue. The results of the comparative studies regarding the timing of ERCP are summarized in Table 1 6–14 . The recommended optimal timing of drainage depends on the severity of cholangitis based on the severity grading criteria 15 .…”

Section: Ercp For Acute Cholangitismentioning

confidence: 99%

Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone‐induced acute cholangitis and pancreatitis

Mukai

Itoi

Tsuchiya

et al. 2022

Digestive Endoscopy

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Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.

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“…However, 30-d mortality in AC has been reported to range from 1% to 16% between studies, which may be one of the reasons leading to inconsistent conclusions about the optimal timing of ERCP[ 11 , 13 - 15 ]. Differences in mortality may be due to different patient populations in different studies, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, Tan et al [ 11 ] included 43% of MBO patients in their study and reported a 30-d mortality rate of 16%. However, Park et al [ 15 ] included only patients with AC associated with distal MBO and reported an overall 30-d mortality rate of 4.8%. Therefore, there may be some other factors associated with 30-d mortality between studies.…”

Section: Discussionmentioning

confidence: 99%

Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity

Huang¹,

Wu²,

Lee³

et al. 2022

World J Gastroenterol

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BACKGROUND The optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis (AC) is uncertain, especially in patients with AC of varying severity. AIM To report whether the timing of ERCP is associated with outcomes in AC patients with different severities. METHODS According to the 2018 Tokyo guidelines, 683 patients who met the definite diagnostic criteria for AC were retrospectively identified. The results were first compared between patients receiving ERCP ≤ 24 h and > 24 h and then between patients receiving ERCP ≤ 48 h and > 48 h. Subgroup analyses were performed in patients with grade I, II or III AC. The primary outcome was 30-d mortality. Secondary outcomes were intensive care unit (ICU) admission rate, length of hospital stay (LOHS) and 30-d readmission rate. RESULTS Taking 24 h as the critical value, compared with ERCP > 24 h, malignant biliary obstruction as a cause of AC was significantly less common in the ERCP ≤ 24 h group (5.2% vs 11.5%). The proportion of cardiovascular dysfunction (11.2% vs 2.6%), respiratory dysfunction (14.2% vs 5.3%), and ICU admission (11.2% vs 4%) in the ERCP ≤ 24 h group was significantly higher, while the LOHS was significantly shorter (median, 6 d vs 7 d). Stratified by the severity of AC, higher ICU admission was only observed in grade III AC and shorter LOHS was only observed in grade I and II AC. There were no significant differences in 30-d mortality between groups, either in the overall population or in patients with grade I, II or III AC. With 48 h as the critical value, compared with ERCP > 48 h, the proportion of choledocholithiasis as the cause of AC was significantly higher in the ERCP ≤ 48 h group (81.5% vs 68.3%). The ERCP ≤ 48 h group had significantly lower 30-d mortality (0 vs 1.9%) and shorter LOHS (6 d vs 8 d). Stratified by AC severity, lower 30-d mortality (0 vs 6.1%) and higher ICU admission rates (22.2% vs 10.2%) were only observed in grade III AC, and shorter LOHS was only observed in grade I and II AC. In the multivariate analysis, cardiovascular dysfunction and time to ERCP were two independent factors associated with 30-d mortality. CONCLUSION ERCP ≤ 48 h conferred a survival benefit in patients with grade III AC. Early ERCP shortened the LOHS in patients with grade I and II AC.

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Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

Cited by 9 publications

References 30 publications

Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone‐induced acute cholangitis and pancreatitis

Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity

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