Division of Gastroenterology, Department of Internal Medicine, Liver Research Institute, College of Medicine, Seoul National University Hospital, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
BMC Gastroenterol. 2021 Apr 17;21(1):175. doi: 10.1186/s12876-021-01755-z.
There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla.
A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP.
The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant.
In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.
对于因远端恶性胆道梗阻（MBO）引起的胆管炎患者，内镜逆行胰胆管造影（ERCP）的最佳时机仍缺乏研究。本研究旨在探讨伴有原发性 MBO 和未受累乳头的急性胆管炎患者行 ERCP 的最佳时机。
共纳入 421 例因远端 MBO 导致的急性胆管炎患者进行本研究。紧急 ERCP 定义为急诊室（ER）到达后 24 小时内进行的 ERCP，早期 ERCP 定义为 ER 到达后 24-48 小时内进行的 ERCP。根据 ERCP 的时机，我们评估了 30 天和 180 天的死亡率作为主要结局。
与早期和延迟 ERCP 组（4.3%和 13.5%）相比，紧急 ERCP 组的 30 天死亡率最低（2.2%）（P<0.001）。紧急 ERCP 组的 180 天死亡率最低，其次是早期 ERCP 组和延迟 ERCP 组（39.4%、44.8%、60.8%；P=0.006）。亚组分析显示，在原发性远端 MBO 组和中重度胆管炎组中，紧急 ERCP 均显著改善了 30 天和 180 天的死亡率。然而，在继发性 MBO 和轻度胆管炎组中，紧急、早期和延迟 ERCP 组之间的死亡率差异无统计学意义。
对于伴有远端 MBO 的急性胆管炎患者，紧急 ERCP 可能有助于改善预后，特别是对于原发性远端 MBO 或中重度胆管炎患者。
