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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acute cholangitis: current concepts.ANZ J Surg. 2017; 87: 554-559
- Acute cholangitis.Surg Clin North Am. 1990; 70: 1297-1312
- Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.J Hepatobiliary Pancreat Surg. 2007; 14: 15-26
- Diagnosis and management of acute cholangitis.Curr Gastroenterol Rep. 2011; 13: 166-172
- TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis.J Hepatobiliary Pancreat Sci. 2013; 20: 1-7
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151 (W64): 264-269
- Early biliary drainage is associated with favourable outcomes in critically-ill patients with acute cholangitis.Prz Gastroenterol. 2018; 13: 16-21
- Outcomes associated with timing of ERCP in acute cholangitis secondary to choledocholithiasis.J Clin Gastroenterol. 2018; 52: e97-e102
- Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis.J Clin Gastroenterol. 2017; 51: 534-538
- Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis.Aliment Pharmacol Ther. 2015; 42: 212-220
- Acute cholangitis: does the timing of ERCP alter outcomes?.JOP. 2016; 17: 504-509
- Sa1520 Early ERCP is safe and cost-effective in the treatment of mild to moderate acute cholangitis [abstract].Gastrointest Endosc. 2011; 73: AB195
- Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: a nationwide analysis.World J Gastrointest Endosc. 2019; 11: 41-53
- Association between early ERCP and mortality in patients with acute cholangitis.Gastrointest Endosc. 2018; 87: 185-192
- Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP.Dig Dis Sci. 2013; 58: 2082-2087
- Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients.Hepatobiliary Pancreat Dis Int. 2016; 15: 619-625
- Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study.J Hepatobiliary Pancreat Sci. 2017; 24: 329-337
- Effectiveness of ERCP in cholangitis: a community-based study.Gastrointest Endosc. 2000; 52: 484-489
- Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis.Clin Gastroenterol Hepatol. 2012; 10: 1157-1161
- Timing of ERCP and outcomes of patients with acute cholangitis and choledocholithiasis: a nationwide population based study [abstract].Gastrointest Endosc. 2015; 81: AB354
- Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis.Gastrointest Endosc. 2013; 78: 81-90
- Weekend vs. weekday admissions for cholangitis requiring an ERCP: comparison of outcomes in a national cohort.Am J Gastroenterol. 2016; 111: 405-410
- Weekend admission for acute cholangitis does not adversely impact clinical or endoscopic outcomes.Dig Dis Sci. 2016; 61: 53-61
- No association of timing of endoscopic biliary drainage with clinical outcomes in patients with non-severe acute cholangitis.Dig Dis Sci. 2018; 63: 1937-1945
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
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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.
- Full-Text
- Preview