Cho Eunae, Park Se Woo, Lee Kyong Joo, Park Da Hae, Cha Hyewon, Koh Dong Hee, Lee Jin, Park Chan Hyuk
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea.
Therap Adv Gastroenterol. 2025 Aug 13;18:17562848251361694. doi: 10.1177/17562848251361694. eCollection 2025.
The feasibility of performing complete endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis during weekends or holidays remains controversial due to concerns over increased risks of adverse events (AEs) in off-hour procedures.
To evaluate whether weekend drainage-only ERCP affects the incidence of AEs compared to standard weekday ERCP, and to identify risk factors for post-ERCP pancreatitis (PEP).
Prospective observational study.
Patients with acute cholangitis, diagnosed based on the Tokyo Guidelines 2018 and naïve major papillae, were prospectively enrolled between 2018 and 2023. Patients were categorized into two groups: the "Weekend ERCP" group, in which initial biliary drainage was performed on weekends with subsequent therapeutic ERCP on weekdays, and the "Weekday ERCP" group, in which all procedures were completed during weekdays. The primary outcome was the incidence of PEP; secondary outcomes included overall AEs and risk factor analysis.
A total of 1772 patients were included (Weekend group: = 148; Weekday group: = 1624) in this study. The incidence of PEP was 4.1% in the Weekend group and 4.9% in the Weekday group ( = 0.810). Overall AEs occurred in 3.4% and 4.9% of patients, respectively ( = 0.540). Multivariable analysis identified age ⩽60 years, female sex, history of acute pancreatitis, difficult cannulation, and endoscopic papillary balloon dilation as independent risk factors for PEP. Timing of ERCP (weekend vs weekday) was not associated with increased risk of PEP.
Weekend ERCPs limited to drainage-only strategies are as safe as weekday procedures in terms of AE rates, effectively managing resources and providing timely biliary decompression for acute cholangitis emergencies, although they often require subsequent definitive interventions.
The International Clinical Trials Registry Platform (identifier KCT0005950; https://cris.nih.go.kr).
由于担心非工作时间进行内镜逆行胰胆管造影术（ERCP）会增加不良事件（AE）的风险，因此在周末或节假日进行急性胆管炎的完全ERCP的可行性仍存在争议。
评估与标准工作日ERCP相比，仅在周末进行引流的ERCP是否会影响AE的发生率，并确定ERCP后胰腺炎（PEP）的危险因素。
前瞻性观察研究。
根据《2018年东京指南》诊断为急性胆管炎且乳头未接受过治疗的患者于2018年至2023年被前瞻性纳入研究。患者分为两组：“周末ERCP”组，即在周末进行初始胆管引流，随后在工作日进行治疗性ERCP；“工作日ERCP”组，即所有操作均在工作日完成。主要结局是PEP的发生率；次要结局包括总体AE和危险因素分析。
本研究共纳入1772例患者（周末组：n = 148；工作日组：n = 1624）。周末组PEP的发生率为4.1%，工作日组为4.9%（P = 0.810）。总体AE分别发生在3.4%和4.9%的患者中（P = 0.540）。多变量分析确定年龄≤60岁、女性、急性胰腺炎病史、插管困难和内镜下乳头球囊扩张是PEP的独立危险因素。ERCP的时间（周末与工作日）与PEP风险增加无关。
仅限于引流策略的周末ERCP在AE发生率方面与工作日操作一样安全，能有效管理资源并为急性胆管炎紧急情况及时提供胆道减压，尽管它们通常需要后续的确定性干预。
国际临床试验注册平台（标识符KCT0005950；https://cris.nih.go.kr）
