Khan Rishad, Marchena-Romero Kayley-Jasmin, Ismail Marwa F, Roberts Surain B, Gimpaya Nikko, Scaffidi Michael A, Sabrie Nasruddin, Khalaf Kareem, Mosko Jeffrey, James Paul, Forbes Nauzer, Razak Fahad, Verma Amol A, Grover Samir C
Department of Medicine, University of Toronto, Toronto, Canada.
GEMINI, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Canada.
Endosc Int Open. 2025 Jan 29;13:a24947333. doi: 10.1055/a-2494-7333. eCollection 2025.
Endoscopic retrograde cholangiopancreatography (ERCP) is important in acute cholangitis (AC) management but is not available at all hospitals. The association between on-site ERCP availability and cholangitis outcomes is unknown.
We included adults diagnosed with AC at 27 hospitals in Ontario through the GEMINI network. We collected data on demographics, clinical and laboratory values, and interventions. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, intensive care unit (ICU) admission, readmission rates, and requirement for percutaneous or surgical decompression. We used multivariable regression analyses to assess the impact of on-site ERCP availability on the primary and secondary outcomes with adjustment for relevant variables.
Our cohort included 4492 patients with a median age of 75. Patients at ERCP sites had higher unadjusted rates of undergoing ERCP (55.7% at ERCP sites, 40.8% at non-ERCP sites). Patients at ERCP sites compared with non-ERCP sites did not have significantly different in-hospital mortality (adjusted odds ratio [aOR] = 2.19, 95% confidence interval [CI] = 0.86-5.55). Compared with non-ERCP sites, patients at ERCP sites with underlying stricturing biliary disease or pancreaticobiliary malignancy (aOR = 1.94, 95% CI = 1.14-13.58) or severe cholangitis (aOR = 2.17, 95% CI = 1.17-4.02) had higher odds of in-hospital mortality. In a post-hoc propensity score-based analysis, there was no significant difference between patients at ERCP sites compared with those at non-ERCP sites for in-hospital mortality.
Patients at ERCP sites compared with non-ERCP sites did not have significantly different mortality. Subgroups of patients with underlying stricturing biliary disease or pancreaticobiliary malignancy and severe cholangitis, who have higher mortality at ERCP sites, warrant further study.
内镜逆行胰胆管造影术（ERCP）在急性胆管炎（AC）的治疗中具有重要作用，但并非所有医院都能开展此项检查。现场是否具备ERCP检查条件与胆管炎治疗效果之间的关联尚不清楚。
我们通过双子座网络纳入了安大略省27家医院中被诊断为AC的成年患者。我们收集了患者的人口统计学资料、临床和实验室检查结果以及干预措施等数据。主要结局指标是住院死亡率。次要结局指标包括住院时间、入住重症监护病房（ICU）情况、再入院率以及经皮或手术减压的需求。我们采用多变量回归分析来评估现场具备ERCP检查条件对主要和次要结局指标的影响，并对相关变量进行了校正。
我们的队列包括4492例患者，中位年龄为75岁。在有ERCP检查条件的医院就诊的患者接受ERCP检查的未校正率更高（有ERCP检查条件的医院为55.7%，无ERCP检查条件的医院为40.8%）。与无ERCP检查条件的医院相比，有ERCP检查条件的医院患者的住院死亡率无显著差异（校正比值比[aOR]=2.19，95%置信区间[CI]=0.86-5.55）。与无ERCP检查条件的医院相比，有ERCP检查条件的医院中患有潜在胆管狭窄性疾病或胰胆管恶性肿瘤（aOR=1.94，95%CI=1.14-13.58）或重症胆管炎（aOR=2.17，95%CI=1.17-4.02）的患者住院死亡几率更高。在一项基于倾向评分的事后分析中，有ERCP检查条件的医院患者与无ERCP检查条件的医院患者的住院死亡率无显著差异。
与无ERCP检查条件的医院相比，有ERCP检查条件医院的患者死亡率无显著差异。患有潜在胆管狭窄性疾病或胰胆管恶性肿瘤以及重症胆管炎的患者亚组在有ERCP检查条件的医院死亡率更高，值得进一步研究。
