Impact of endoscopic retrograde cholangiopancreatography (ERCP) timing on clinical outcomes in acute cholangitis associated with common bile duct stones

Tóm tắt

Objective: To evaluate the association between the timing of ERCP and clinical outcomes in patients with acute cholangitis (AC) of varying severities caused by common bile duct (CBD) stones patients. Subject and method: 227 acute cholangitis patients caused by CBD stones who underwent ERCP at the Department of Emergency Gastroenterology, 108 Military Central Hospital from February 2021 to April 2024 were retrospectively identified. Efficacy was compared between early ERCP (≤ 24 hours) and delayed ERCP (> 24hours) group concerning clinical characteristics, length of hospital stays (LOHS), and mortality rate. Result:  The patient cohort was stratified by severity: 43.6% Grade III AC, 39.2% Grade II, and 17.2% Grade I. ERCP ≤ 24h was performed in 44.1% of cases. The early ERCP group exhibited significantly lower platelet counts and prothrombin levels, and higher INR compared to the delayed group. LOHS was significantly longest in the severe AC group (8.28 ± 6.30 days) compared to the moderate and mild groups (p=0.017), demonstrating direct proportionality to disease severity. Furthermore, the complete stone removal rate was significantly lower in the severe AC group (34.3%) compared to Grade I (71.0%) and Grade II (60.6%) groups (p<0.001). Crucially, early ERCP significantly reduced the median LOHS compared to the delayed group 5 days vs. 7 days, (p=0.003), although the difference in overall mortality rate (4.0% vs. 3.15%) was not statistically significant (p>0.05). Conclusion: Severe acute cholangitis is directly proportional to the LOHS and increases the risk of mortality. Early ERCP demonstrated a significant reduction in the progression of organ failure and shortened the LOHS, with no statistically significant change in mortality.