Effect of Urgent ERCP on Clinical Outcomes in Acute Cholangitis With Concurrent Acute Gallstone Pancreatitis: A Propensity Score Matching Analysis.

BACKGROUND/PURPOSE: Current guidelines do not provide specific recommendations regarding the timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis (AC) concurrent with acute gallstone pancreatitis (AGP). This study evaluated the impact of ERCP timing on clinical outcomes.

METHODS

A total of 144 patients diagnosed with AC concurrent with AGP between March 2019 and February 2024 were included in the study. Patients were classified into two groups: urgent ERCP group (ERCP ≤ 24 h) and non-urgent ERCP group (ERCP 24-72 h). Clinical outcomes were compared using propensity score matching (PSM) analysis.

RESULTS

After PSM, two well-balanced groups of 55 patients were created. The median ERCP time was 18 (13-21) hours in the urgent group and 41 (36-54) hours in the non-urgent group. There was no significant difference in composite outcomes, including in-hospital mortality, prolonged hospital stay, severe pancreatitis, or late localized/systemic complications of pancreatitis [11 (20%) vs. 16 (29.1%); p = 0.268]. Additionally, no significant difference was observed between the groups regarding prolonged hospital stay (p = 0.506), ICU admission (p = 0.680), or in-hospital mortality (p = 0.161).

CONCLUSIONS

Urgent ERCP within 24 h does not significantly improve clinical outcomes compared to ERCP performed within 24-72 h in patients with AC and AGP.