Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China.
Department of Gastroenterology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, Jiangsu Province, China.
World J Gastroenterol. 2024 Apr 21;30(15):2118-2127. doi: 10.3748/wjg.v30.i15.2118.
During emergency endoscopic retrograde cholangiopancreatography (ERCP), the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis (AC) due to choledocholithiasis are unclear.
To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.
We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023. The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later, employing a propensity score (PS) framework. Our primary outcomes were intensive care unit (ICU) admission rates, ICU length of stay, and duration of antibiotic use.
In total, we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention: The urgent group (≤ 24 h, = 102) and the elective group (> 24 h, = 152). Ninety-three pairs of patients with similar characteristics were selected by PS matching. The urgent ERCP group had more ICU admissions (34.4% 21.5%, = 0.05), shorter ICU stays (3 d 9 d, < 0.001), fewer antibiotic use (6 d 9 d, < 0.001), and shorter hospital stays (9 d 18.5 d, < 0.001). There were no significant differences observed in adverse events, in-hospital mortality, recurrent cholangitis occurrence, 30-d readmission rate or 30-d mortality.
Urgent one-stage ERCP provides the advantages of a shorter ICU stay, a shorter duration of antibiotic use, and a shorter hospital stay.
在紧急内镜逆行胰胆管造影（ERCP）中，对于胆石性急性胆管炎（AC）患者，行一期内镜治疗的安全性和可行性尚不清楚。
探讨一期内镜治疗中重度 AC 的安全性和可行性。
本研究纳入了 2019 年 1 月至 2023 年 7 月期间所有因胆总管结石而被诊断为中重度胆管炎的患者。采用倾向性评分（PS）框架，比较了在 24 小时内接受 ERCP 和 24 小时后接受 ERCP 的患者的结局。我们的主要结局是入住重症监护病房（ICU）的比例、ICU 住院时间和抗生素使用时间。
共纳入 254 例患者，根据入院至干预的时间分为两组：紧急组（≤24 小时，n=102）和择期组（>24 小时，n=152）。通过 PS 匹配，选择了 93 对具有相似特征的患者。急诊 ERCP 组 ICU 入住率较高（34.4% vs. 21.5%，=0.05），ICU 住院时间较短（3 天 vs. 9 天，<0.001），抗生素使用时间较短（6 天 vs. 9 天，<0.001），住院时间较短（9 天 vs. 18.5 天，<0.001）。两组不良事件、住院死亡率、复发性胆管炎发生率、30 天再入院率或 30 天死亡率无显著差异。
紧急一期 ERCP 可缩短 ICU 住院时间、抗生素使用时间和住院时间。
