Hafif kolanjitli hastalarda erken ve elektif endoskopik retrograd kolanjiyopankreatografi sonuçlarının karşılaştırılması

Abstract

Amaçlar: Hafif kolanjitli hastalarda endoskopik retrograd kolanjiyopankretografinin (ERCP) optimal süresi ve ne zaman yapılması gerektiği belirsizdir. Bu çalışmanın amacı, erken ve elektif ERCP yapılan hafif kolanjitli hastaların sonuçlarını karşılaştırmaktır. Yöntemler: Bu çalışma, Tocyo 18 (TC18) kılavuzuna göre hafif kolanjitli hastalarda elektif (başvurudan ERCP'ye kadar geçen süre>72 saat) ve erken (başvurudan ERCP'ye kadar geçen süre≤72 saat) ERCP sonuçlarını karşılaştırmak için retrospektif bir çalışma olarak tasarlanmıştır. Çalışmaya, Şubat 2019 ile 2023 tarihleri arasında tek bir üçüncü basamak merkezin gastroenteroloji kliniğinde ERCP yapılan naif papilla ve hafif kolanjit hastaları dahil edilmiştir. Sonuçlar: Çalışmamıza toplam 432 hafif kolanjit hastası dahil edildi. Elektif ERCP grubunun ortalama yaşı ve ASA skoru diğer gruptan biraz daha yüksekti (sırasıyla, p=0.039 ve p=0.025). İki grup arasında teknik ve klinik başarı, mortalite, ERCP ile ilişkili advers olaylar, organ yetmezliği ve yoğun bakım ünitesine yatış açısından anlamlı bir fark bulunmadı. Hastanede kalış süresi (LHS) elektif grupta erken gruba kıyasla anlamlı olarak (p<0.001) daha yüksekti. Sonuç: Çalışmamız, optimal ERCP zamanı belirsiz olan hafif kolanjitli hastalarda, erken veya elektif dönemde ERCP'nin mortalite ve diğer olumsuz sonuçlar üzerinde anlamlı bir etkisi olmadığını, ancak erken dönemde ERCP'nin hastaların LHS süresini kısalttığını göstermiştir.

Keywords

• ERCP
• Hafif kolanjit
• mortalite
• pankreatit

Comparison of the results of early and elective endoscopic retrograde cholangiopancreatography in patients with mild cholangitis

Abstract

Aims: The optimal duration of endoscopic retrograde cholangiopancreatography (ERCP) in patients with mild cholangitis and when it should be performed is unclear. This study aimed to compare the results of patients with mild cholangitis who underwent early and elective ERCP. Methods: This study was designed as a retrospective study to compare the results of elective (time from admission to ERCP>72 h) and early (time from admission to ERCP≤72 h) ERCP in patients with mild cholangitis according to the Tocyo 18 (TC18) guideline. The study included patients with naive papillae and mild cholangitis who underwent ERCP between February 2019 and 2023 at a single tertiary center’s gastroenterology clinic. Results: A total of 432 mild cholangitis patients were included in our study. The mean age and ASA score of the elective ERCP group was slightly higher than the other group (respectively, p=0.039 and p=0.025). No significant difference was found between the two groups in terms of technical and clinical success, mortality, ERCP-related adverse events, organ failure and intensive care unit admission. Length of hospital stay (LHS) was significantly (p<0.001) higher in the elective group compared to the early group. Conclusion: Our study showed that in patients with mild cholangitis with uncertain optimal ERCP time, ERCP in the early or elective period had no significant effect on mortality and other adverse outcomes, but ERCP in the early period shortened the patients’ LHS duration.

Keywords

• ERCP
• mild cholangitis
• mortality
• pancreatitis

References

1. 1. Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin North Am. 2008;92(4):925-960. doi: 10.1016/j.mcna.2008.03.001
2. 2. Kimura Y, Takada T, Kawarada Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepato-Biliary-Pancreatic Surg. 2007;14(1):15-26. doi: 10.1007/s00534-006-1152-y.
3. 3. Tinusz B, Szapary L, Paladi B, et al. Short-course antibiotic treatment is not inferior to a long-course one in acute cholangitis: a systematic review. Digest Dis Sci. 2019;64(2):307-315. doi: 10.1007/s10620-018-5327-6
4. 4. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepato‐Biliary‐Pancreatic Sci. 2018;25(1):3-16. doi: 10.1002/jhbp.518
5. 5. Hou LA, Laine L, Motamedi N, Shakian A, Lane C, Buxbaum J. Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol. 2017;51(6):534-538. doi: 10.1097/MCG.0000000000000763
6. 6. Hakuta R, Hamada T, Nakai Y, et al. No association of timing of endoscopic biliary drainage with clinical outcomes in patients with non-severe acute cholangitis. Digest Dis Sci. 2018;63(7):1937-1945. doi: 10.1007/s10620-018-5058-8
7. 7. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepato‐Biliary‐Pancreatic Sci. 2018;25(1):31-40. doi: 10.1002/jhbp.509
8. 8. Sugiura R, Naruse H, Yamamoto Y, et al. Very urgent endoscopic retrograde cholangiopancreatography is associated with early discharge in patients with non-severe acute cholangitis. Rev Esp Enferm Dig. 2022;114(3):133-139. doi: 10.17235/reed.2021.7995/2021

9. 9. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepato‐Biliary‐Pancreatic Sci. 2018;25(1):17-30. doi: 10.1002/jhbp.512
10. 10. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288-1294. doi: 10.1016/j.jclinepi.2004.03.012
11. 11. Owens WD, Felts JA, Spitznagel Jr EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiol. 1978;49(4):239-243. doi: 10.1097/00000542-197810000-00003
12. 12. Cotton P, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383-393. doi: 10.1016/s0016-5107(91)70740-2
13. 13. Lee F, Ohanian E, Rheem J, Laine L, Che K, Kim JJ. Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis. Alimentary Pharmacol Therapeut. 2015;42(2):212-220. doi: 10.1111/apt.13253
14. 14. Huang YC, Whu CH, Lee MH, et al. Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity. World J Gastroenterol. 2022;28(38):5602. doi: 10.3748/wjg.v28.i38.5602
15. 15. Buxbaum JL, Buitrago C, Lee A, et al. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021;94(2):207-221. doi: 10.1016/j.gie.2020.12.032
16. 16. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endosc. 2019;51(05):472-491. doi: 10.1055/a-0862-0346
17. 17. Du L, Cen M, Zheng X, et al. Timing of performing endoscopic retrograde cholangiopancreatography and inpatient mortality in acute cholangitis: a systematic review and meta-analysis. Clin Translat Gastroenterol. 2020;11(3):e00158. doi: 10.14309/ctg.0000000000000158
18. 18. Iqbal U, Khara HS, Hu Y, et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2020;91(4):753-760. doi: 10.1016/j.gie.2019. 09.040
19. 19. Lyu Y, Wang B, Ye S, Cheng Y. Impact of the Timing of endoscopic retrograde cholangiopancreatography for the treatment of acute cholangitis: a meta-analysis and systematic review. Surgic Laparosc Endosc Percutaneous Techn. 2022;32(6):764. doi: 10.1097/SLE.0000000000001110