Skip to main content
SpringerLink
Log in

The efficacy and safety of one-stage endoscopic treatment for ascending acute cholangitis caused by choledocholithiasis with severe comorbidities

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Emergency endoscopic retrograde cholangiopancreatography (ERCP) for ascending acute cholangitis in patients with severe comorbidities is challenging. Here, we evaluated the efficacy and safety of one-stage ERCP in such patients by performing a retrospective study.

Methods

We included all patients with ascending acute cholangitis and undergoing ERCP between January 2017 and March 2019. In total, we recruited 212 patients: 74 and 138 with and without severe comorbidities, respectively. We collected and analyzed data related to basal characteristics, ERCP, and clinical outcomes.

Results

Elderly age (76.20 ± 9.99 years vs. 66.52 ± 8.16 years, P = 0.000), higher levels of leukocyte count (15.86 ± 2.47 × 109/ml vs. 13.49 ± 1.65 × 109/ml, P = 0.000), and serum bilirubin (3.11 ± 1.29 mg/dl vs. 1.94 ± 0.90 mg/dl, P = 0.000) were present in patients with severe comorbidities. A significantly higher proportion of these patients were severe cases (32.4% vs. 6.5%, P = 0.000), American Society of Anesthesiologists (ASA) stage V status (37.8% vs. 10.1%, P = 0.000) and had undergone general anesthesia (56.8% vs. 18.8%, P = 0.000). Successful biliary cannulation and complete stone clearance in one session were achieved in 207 and 202 patients, respectively. Mean length of hospital stay was 8.02 ± 2.71 days. Forty-three patients required ICU stay with the mean length of 3.26 ± 3.51 days. In-hospital mortality occurred in seven patients; all these patients had severe comorbidities. ERCP details, including urgent and early ERCP, biliary cannulation, complete stone clearance in one session, stent insertion, and complications were not significantly different between the two groups. Patients with severe comorbidities had a longer in-hospital stay (9.39 ± 3.15 days vs. 7.29 ± 2.11 days, P = 0.000), a higher proportion of ICU admission (45.9% vs. 6.5%, P = 0.000), and a longer ICU stay length (4.88 ± 4.37 days vs. 1.44 ± 0.52 days, P = 0.000). Our data also revealed that early diagnosis is an important predictor associated with clinical outcomes.

Conclusions

One-stage ERCP is safe and effective for ascending acute cholangitis caused by choledocholithiasis. Early diagnosis is a significant predictor of clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kiriyama S, Kozaka K, Takada T et al (2018) Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 25:17–30

    Article  Google Scholar 

  2. Lee JG (2009) Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol 6:533–541

    Article  Google Scholar 

  3. James PD, Kaplan GG, Myers RP et al (2014) Decreasing mortality from acute biliary diseases that require endoscopic retrograde cholangiopancreatography: a nationwide cohort study. Clin Gastroenterol Hepatol 12:1151–1159

    Article  Google Scholar 

  4. Yun DY, Han J, Oh JS et al (2014) Is endoscopic retrograde cholangiopancreatography safe in patients 90 years of age and older? Gut Liver 8:552–556

    Article  Google Scholar 

  5. Lee F, Ohanian E, Rheem J et al (2015) Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalized patients with acute cholangitis. Aliment Pharmacol Ther 42:212–220

    Article  CAS  Google Scholar 

  6. Tohda G, Ohtani M, Dochin M (2016) Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol 22:8382–8388

    Article  Google Scholar 

  7. Galeazzi M, Mazzola P, Valcarcel B et al (2018) Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians’ point of view. BMC Gastroenterol 18:38

    Article  Google Scholar 

  8. Park CS, Jeong HS, Kim KB et al (2016) Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients. Hepatobiliary Pancreat Dis Int 15:619–625

    Article  Google Scholar 

  9. Itoi T, Tsuyuguchi T, Takada T et al (2013) TG13 indications and techniques for biliary drainage in acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 20:71–80

    Article  Google Scholar 

  10. Cotton PB, Lehman G, Vennes J et al (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393

    Article  CAS  Google Scholar 

  11. Rex DK, Deenadayalu VP, Eid E et al (2009) Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology 137:1229–1237

    Article  Google Scholar 

  12. Schneider J, Hapfelmeier A, Thöres S et al (2016) Mortality risk for acute cholangitis (MAC): a risk prediction model for in-hospital mortality in patients with acute cholangitis. BMC Gastroenterol 16:15

    Article  Google Scholar 

  13. Sobani ZA, Yunina D, Abbasi A et al (2018) Endoscopic Retrograde cholangiopancreatography in nonagenarian patients: Is it really safe? Clin Endosc 51:375–380

    Article  Google Scholar 

  14. Butte JM, Hameed M, Ball CG (2015) Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment. World J Emerg Surg 10:13

    Article  Google Scholar 

  15. Khashab MA, Tariq A, Tariq U et al (2012) Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol 10:1157–1161

    Article  Google Scholar 

  16. Eto K, Kawakami H, Haba S et al (2015) Single-stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non-randomized, open-label and exploratory clinical trial. J Hepatobiliary Pancreat Sci 22:825–830

    Article  Google Scholar 

  17. Sugiyama M, Atomi Y (1998) The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. Am J Gastroenterol 93:2065–2068

    Article  CAS  Google Scholar 

  18. Hui CK, Lai KC, Yuen MF et al (2003) Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis? Gastrointest Endosc 58:500–504

    Article  Google Scholar 

  19. Perini RF, Sadurski R, Cotton PB et al (2005) Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: Dose the newtechnology make the difference? Gastrointest Endosc 61:53–57

    Article  Google Scholar 

  20. Feng Y, Zhu H, Chen X et al (2012) Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol 47:655–663

    Article  Google Scholar 

  21. Jin PP, Cheng JF, Liu D et al (2014) Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: a meta-analysis. World J Gastroenterol 20:5548–5556

    Article  Google Scholar 

  22. Tsuchida K, Iwasaki M, Tsubouchi M et al (2015) Comparison of the usefulness of endoscopic papillary large-balloon dilation with endoscopic sphincterotomy for large and multiple common bile duct stones. BMC Gastroenterol 15:59

    Article  Google Scholar 

  23. Lee JC, Moon JH, Choi HJ et al (2014) Delayed endoscopic papillary large balloon dilation after sphincterotomy for removing large bile duct stones in patients with acute cholangitis. Dig Dis Sci 59:1302–1306

    Article  Google Scholar 

  24. Kim JH, Yang MJ, Hwang JC et al (2013) Endoscopic papillary large balloon dilation for the removal of bile duct stones. World J Gastroenterol 19:8580–8594

    Article  Google Scholar 

  25. Omar MA, Abdelshafy M, Ahmed MY et al (2017) Endoscopic papillary large balloon dilation versus endoscopic sphincterotomy for retrieval of large choledocholithiasis: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 27:704–709

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Xiaoping Zhang, Guiqin Li, Liang Pan, and Yue Chen have contributed equally to this work

Authors and Affiliations

  1. Department of Gastroenterology, Jintan People Hospital Afflilated with Jiangsu University, 16 Nanmen Road, Jintan, 213200, China

    Xiaoping Zhang, Liang Pan & Kai Zhao

  2. Department of Gastroenterology, Lianshui People Hospital, 6 Hongri Road, Lianshui, 223400, China

    Guiqin Li, Kun Zhou, Yajun Cheng & Aijun Zhou

  3. Department of Gastroenterology, Lishui People Hospital, 86 Chongwen Road, Nanjing, 211200, China

    Yue Chen

  4. Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China

    Ruihua Shi, Wei Xu & Yadong Feng

Authors
  1. Xiaoping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guiqin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yue Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruihua Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kun Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yajun Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yadong Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aijun Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kai Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yadong Feng, Aijun Zhou or Kai Zhao.

Ethics declarations

Disclosures

Xiaoping Zhang, Guiqin Li, Liang Pan, Yue Chen, Ruihua Shi, WeiXu, Kun Zhou, Yajun Cheng, Yadong Feng, Aijun Zhou, and Kai Zhao have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Li, G., Pan, L. et al. The efficacy and safety of one-stage endoscopic treatment for ascending acute cholangitis caused by choledocholithiasis with severe comorbidities. Surg Endosc 34, 3963–3970 (2020). https://doi.org/10.1007/s00464-019-07168-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07168-0

Keywords

Search

Navigation