Sugiura Ryo, Naruse Hirohito, Yamamoto Yoshiya, Hatanaka Kazuteru, Kinoshita Kenji, Abiko Satoshi, Miyamoto Shuichi, Suzuki Kazuharu, Higashino Masayuki, Kohya Risako, Sakamoto Naoya
Gastroenterology and Hepatology, Hakodate Municipal Hospital, Japan.
Gastroenterology and Hepatology, Hakodate Municipal Hospital.
Rev Esp Enferm Dig. 2022 Mar;114(3):133-139. doi: 10.17235/reed.2021.7995/2021.
endoscopic retrograde cholangiopancreatography (ERCP) is a first-line procedure for biliary drainage in patients with acute cholangitis, and there are no studies focused on very urgent ERCP within several hours of hospital arrival. This study aimed to elucidate the use of very urgent ERCP for non-severe acute cholangitis.
this retrospective observational study included patients with non-severe acute cholangitis who underwent ERCP between April 2011 and June 2020 in our institution. Patients were stratified into three groups based on time to ERCP after hospital arrival: very urgent (≤ 3 hours), urgent (3-24 hours) and elective (> 24 hours). The primary outcome was length of hospital stay (LOS).
the study cohort included 291 patients, 168 males (57.7 %), with a median age of 76 (interquartile range, 70-83) years. In all, 47, 196 and 48 patients underwent very urgent, urgent and elective ERCP, respectively. Median LOS in the very urgent, urgent, and elective groups was 12, 14, and 15 days, respectively (Kaplan-Meier method). A shorter LOS was associated with earlier ERCP (log-rank trend test, p = 0.04). The rates of readmission within 30 days of discharge and of adverse events were not significantly different among the three groups. By multivariate analysis, very urgent ERCP was associated with a significantly earlier discharge than urgent and elective ERCP (HR, 0.71, p = 0.04 and HR, 0.47, p < 0.01, respectively). In addition, age ≥ 75 years, pancreatitis, albumin ≤ 2.8 g/dL and two or more ERCP procedures were associated with a significantly longer LOS (HRs < 1, p < 0.05).
very urgent ERCP for non-severe acute cholangitis was associated with early discharge.
内镜逆行胰胆管造影术（ERCP）是急性胆管炎患者胆道引流的一线治疗方法，目前尚无针对患者入院数小时内进行极紧急ERCP的研究。本研究旨在阐明极紧急ERCP在非重度急性胆管炎中的应用情况。
这项回顾性观察性研究纳入了2011年4月至2020年6月在我院接受ERCP治疗的非重度急性胆管炎患者。根据入院后至ERCP的时间，将患者分为三组：极紧急组（≤3小时）、紧急组（3 - 24小时）和择期组（>24小时）。主要结局指标为住院时间（LOS）。
研究队列包括291例患者，其中男性168例（57.7%），中位年龄为76岁（四分位间距，70 - 83岁）。分别有47例、196例和48例患者接受了极紧急、紧急和择期ERCP。极紧急组、紧急组和择期组的中位住院时间分别为12天、14天和15天（Kaplan-Meier法）。住院时间缩短与更早进行ERCP相关（对数秩趋势检验，p = 0.04）。三组患者出院后30天内再入院率和不良事件发生率无显著差异。多因素分析显示，与紧急和择期ERCP相比，极紧急ERCP与出院时间显著提前相关（HR分别为0.71，p = 0.04和HR为0.47，p < 0.01）。此外，年龄≥75岁、胰腺炎、白蛋白≤2.8 g/dL以及进行两次或更多次ERCP手术与住院时间显著延长相关（HR < 1，p < 0.05）。
非重度急性胆管炎患者进行极紧急ERCP与早期出院相关。
