Effect of ERCP timing on length of hospitalization in patients with mild acute cholangitis with calculi

Öz

Background and Aims: While early endoscopic retrograde cholangiopancreatography is currently recommended in moderate to severe acute cholangitis, the optimal timing of endoscopic retrograde cholangiopancreatography in mild acute cholangitis is controversial. In our study, we examined the effect of endoscopic retrograde cholangiopancreatography time on hospital stay in mild calculous acute cholangitis, which is the most common cause of acute cholangitis. We also investigated the factors predicting prolonged hospitalization. Marerials and Methods: The study was conducted retrospectively, including 178 patients who presented with mild calculous acute cholangitis between February 2019 and April 2021. The patients included in the study were divided into two groups according to the endoscopic retrograde cholangiopancreatography timing; those performed in the first 72 hours were assigned as the early endoscopic retrograde cholangiopancreatography group, and those performed after 72 hours were assigned as the late endoscopic retrograde cholangiopancreatography group. Multivariate regression analysis was performed to find factors predicting prolonged hospitalization. Results: The median time from admission to endoscopic retrograde cholangiopancreatography was 41 (23-52) hours in the early endoscopic retrograde cholangiopancreatography group and 114 (94-137) hours in the late endoscopic retrograde cholangiopancreatography group. The hospital stay was shorter in the early endoscopic retrograde cholangiopancreatography group [6 (4-8) vs 9 (6-10), p < 0.001]. The late endoscopic retrograde cholangiopancreatography group had a higher proportion of patients with prolonged hospitalization [34 (38.2%) vs 13 (14.6%), p < 0.001]. There was no difference between the two groups in terms of bacteremia, intensive care hospitalization, mortality and endoscopic retrograde cholangiopancreatography complications. In multivariate analysis, age (OR: 1.032, 95% CI: 1.005-1.060), endoscopic retrograde cholangiopancreatography timing (OR: 1.545, 95% CI: 1.240-1.925), and total bilirubin (OR: 1.198, 95% CI: 1.075-1.336) were found to be independent risk factors predicting prolonged hospitalization. Conclusion: In patients with mild calculous acute cholangitis, delayed endoscopic retrograde cholangiopancreatography performed after 72 hours prolongs the length of hospital stay.

Anahtar Kelimeler

• Acute calculous cholangitis
• ERCP timing
• length of hospital stay

Taşlı hafif akut kolanjit hastalarında ERCP zamanının hastanede yatış süresine etkisi

Öz

Giriş ve Amaç: Günümüzde, orta ve şiddetli akut kolanjitte erken endoskopik retrograd kolanjiopankreatografi önerilmekte iken, hafif akut kolanjitte endoskopik retrograd kolanjiopankreatografi için en uygun zamanlama konusu tartışmalıdır. Çalışmamızda, akut kolanjitin en yaygın nedeni olan hafif taşlı akut kolanjitte endoskopik retrograd kolanjiopankreatografi zamanının hastanede yatış süresi üzerindeki etkisini inceledik. Ayrıca, uzun süreli hastane yatışını öngören faktörleri araştırdık. Gereç ve Yöntem: Çalışma, Şubat 2019 ile Nisan 2021 tarihleri arasında hafif taşlı akut kolanjit nedeniyle başvuran 178 hasta dahil edilerek retrospektif olarak gerçekleştirildi. Hastalar, endoskopik retrograd kolanjiopankreatografinin yapıldığı zamana göre iki gruba ayrıldı: İlk 72 saat içinde endoskopik retrograd kolanjiopankreatografi yapılanlar "erken endoskopik retrograd kolanjiopankreatografi grubu", 72 saatten sonra endoskopik retrograd kolanjiopankreatografi yapılanlar ise "geç endoskopik retrograd kolanjiopankreatografi grubu" olarak sınıflandırıldı. Uzun hastanede yatışı öngören faktörlerin belirlenmesi amacıyla çok değişkenli regresyon analizi yapıldı. Bulgular: Erken endoskopik retrograd kolanjiopankreatografi grubunda, kabul ile endoskopik retrograd kolanjiopankreatografi arasındaki medyan süre 41 (23-52) saat, geç endoskopik retrograd kolanjiopankreatografi grubunda ise 114 (94-137) saat olarak saptandı. Erken endoskopik retrograd kolanjiopankreatografi grubunda hastanede yatış süresi, geç endoskopik retrograd kolanjiopankreatografi grubuna kıyasla anlamlı derecede daha kısaydı [6 (4-8) gün vs 9 (6-10) gün, p < 0.001]. Geç endoskopik retrograd kolanjiopankreatografi grubunda daha yüksek oranda uzamış yatışa sahip hasta vardı [34 (%38.2) vs 13 (%14.6), p < 0.001]. Her iki grup arasında bakteriyemi, yoğun bakımda yatış, mortalite ve endoskopik retrograd kolanjiopankreatografi komplikasyonları açısından fark bulunmadı. Çok değişkenli analizde, yaş (OR: 1.032, %95 CI: 1.005-1.060), endoskopik retrograd kolanjiopankreatografi zamanı (OR: 1.545, %95 CI: 1.240-1.925) ve total bilirubin düzeyi (OR: 1.198, %95 CI: 1.075-1.336) uzun hastane yatışını öngören bağımsız risk faktörleri olarak tespit edildi. Sonuç: Hafif taşlı akut kolanjit hastalarında, 72 saatten sonra yapılan geç endoskopik retrograd kolanjiopankreatografi hastane yatış süresini uzatır.

Anahtar Kelimeler

• Akut taşlı kolanjit
• ERCP zamanı
• hastanede kalış süresi

Kaynakça

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