Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2018 Jul;63(7):1937-1945. doi: 10.1007/s10620-018-5058-8. Epub 2018 Apr 16.
Biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for acute cholangitis. Despite the established effectiveness of urgent biliary drainage in patients with severe acute cholangitis, the indication of this procedure for non-severe acute cholangitis is controversial.
To assess the safety of elective drainage (≥ 12 h of admission) for non-severe acute cholangitis.
We retrospectively identified 461 patients with non-severe acute cholangitis who underwent endoscopic biliary drainage. Using linear regression models with adjustment for a variety of potential confounders, we compared elective versus urgent biliary drainage (< 12 h of admission) in terms of clinical outcomes. The primary outcome was the length of stay.
There were 98 and 201 patients who underwent elective and urgent biliary drainage, respectively. The median length of stay was 11 days in both groups (P = 0.52). The timing of ERCP was not associated with length of stay in the multivariable model (P = 0.52). Secondary outcomes including in-hospital mortality and recurrence of cholangitis were not different between the groups.
Elective biliary drainage was not associated with worse clinical outcomes of non-severe acute cholangitis as compared to urgent drainage. Further investigation is warranted to justify the elective drainage for non-severe cholangitis.
经内镜逆行胰胆管造影术（ERCP）胆道引流是急性胆管炎的一线治疗方法。尽管紧急胆道引流对重度急性胆管炎患者的有效性已得到证实，但对于非重度急性胆管炎患者，该手术的适应证仍存在争议。
评估非重度急性胆管炎患者进行择期引流（入院后 12 小时以上）的安全性。
我们回顾性地确定了 461 例接受内镜胆道引流的非重度急性胆管炎患者。使用线性回归模型，并调整了多种潜在混杂因素，我们比较了择期与紧急胆道引流（入院后 12 小时内）在临床结局方面的差异。主要结局是住院时间。
分别有 98 例和 201 例患者接受了择期和紧急胆道引流。两组的中位住院时间均为 11 天（P=0.52）。多变量模型中 ERCP 的时间与住院时间无关（P=0.52）。次要结局包括住院期间死亡率和胆管炎复发，两组之间无差异。
与紧急引流相比，择期胆道引流与非重度急性胆管炎的临床结局无差异。需要进一步的研究来证明非重度胆管炎患者的择期引流是合理的。
