Background and Aims
Acute cholangitis is characterized by abdominal pain, fever, and jaundice. Most patients
respond to medical management with intravenous hydration and antibiotics. About 20%
to 30% require biliary drainage, and ERCP is the procedure of choice. We conducted
a systematic review and meta-analysis to evaluate the impact of emergent biliary drainage
on patient outcomes.
Methods
A comprehensive literature review was conducted by searching the Embase and PubMed
databases from inception to April 2019 to identify all studies that evaluated the
impact of timing of ERCP on patient outcomes. Our primary outcome was in-hospital
mortality (IHM), and secondary outcomes were length of stay (LOS), organ failure,
and 30-day mortality. Fixed and random effects models were used to generate pooled
measures of IHM, 30-day mortality, and LOS.
Results
Nine observational studies involving 7534 patients were included in the primary meta-analysis.
IHM was significantly lower in patients who underwent emergent biliary drainage within
48 hours (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.28-0.98). As a sensitivity
analysis, we pooled the data from 2 population registry studies of 81,893 patients,
which yielded consistent results for the main outcomes. LOS was also significantly
lower in patients who underwent ERCP within 48 hours with a mean difference of 5.56
days (95% CI, 1.59-9.53). Patients who underwent emergent ERCP also had lower odds
of 30-day mortality (OR, 0.39; 95% CI, 0.14-1.08) and organ failure (OR, 0.69; 95%
CI, 0.33-1.46).
Conclusions
Our study reveals that performing emergent ERCP within 48 hours in patients with acute
cholangitis is associated with lower IHM, 30-day mortality, organ failure, and shorter
LOS.
Abbreviations:
AC (acute cholangitis), CI (confidence interval), IHM (in-hospital mortality), LOS (length of stay), MD (mean difference), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 16, 2019
Accepted:
September 27,
2019
Received:
December 14,
2018
Footnotes
DISCLOUSRE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 943.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
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- ERCP for acute cholangitis: timing is everythingGastrointestinal EndoscopyVol. 91Issue 4
- PreviewSince first described by Jean-Martin Charcot, French neurologist and Professor of Anatomical Pathology in Hôpital Salpêtrière in Paris, in the late 1800s, acute cholangitis remains well recognized by its eponymous sine qua non of fever, abdominal pain, and jaundice caused by biliary stasis and bacteriobilia.1 However, although the clinical manifestations still define the illness in most patients, the management of cholangitis has radically evolved from a disease treated primarily by surgery in the 19th century to one in which today, ERCP is widely accepted as the treatment of choice in establishing biliary drainage and often removing the cause.
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