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ERCP within 6 or 12 h for acute cholangitis: a propensity score-matched analysis

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Abstract

Background

The optimal timing of biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute cholangitis remains controversial. The aim of our study was to determine if ERCP performed within 6 or 12 h of presentation was associated with improved clinical outcomes.

Methods

Medical records for all patients with acute cholangitis who underwent ERCP at our institution between 2009 and 2018 were reviewed. Outcomes were compared between those who underwent ERCP within or after 12 h using propensity score framework. Our primary outcome was length of hospitalization. Secondary outcomes included in-hospital mortality, adverse events, ERCP failure, length of ICU stay, organ failure, recurrent cholangitis, and 30-day readmission. In secondary analysis, outcomes for ERCP done within or after 6 h were also compared.

Results

During study period, 487 patients with cholangitis were identified, of whom 147 had ERCP within 12 h of presentation. Using propensity score matching, we selected 145 pairs of patients with similar characteristics. Length of hospitalization was similar between ERCP within or after 12 h (135.9 vs 122.1 h, p 0.094). No difference was noted in mortality, ERCP failure, adverse events, need and length of ICU stay, and recurrent cholangitis. However, 30-day readmission rates were lower when ERCP within 12 h (7.6 vs 15.2, p 0.042). No significant difference was noted in aforementioned outcomes between ERCP performed within or after 6 h.

Conclusions

ERCP performed within 6 h or 12 h of presentation was not associated with superior clinical outcomes, however, may result in reduced re-hospitalization.

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Authors and Affiliations

  1. Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb-Rose 101, Boston, MA, 02215, USA

    Aymeric Becq, Madhuri Chandnani, Anthony Bartley, Mohammad Bilal, Shishira Bharadwaj, Jonah Cohen, Moamen Gabr, Tyler M. Berzin, Douglas K. Pleskow & Mandeep S. Sawhney

  2. Harvard Medical School, Boston, MA, USA

    Aymeric Becq, Madhuri Chandnani, Anthony Bartley, Mohammad Bilal, Shishira Bharadwaj, Jonah Cohen, Moamen Gabr, Tyler M. Berzin, Douglas K. Pleskow & Mandeep S. Sawhney

  3. Gastroenterology Department, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy, France

    Alexandre Nuzzo

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  1. Aymeric Becq
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Contributions

AB, AB, MC, SB, JC, MG, TB, DP and MS: Conception and study design, data collection, drafting and revising of the manuscript. AN: Analysis.

Corresponding author

Correspondence to Mandeep S. Sawhney.

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Disclosures

Drs Aymeric Becq, Madhuri Chandnani, Anthony Bartley, Alexandre Nuzzo, Mohammad Bilal, Shishira Bharadwaj, Jonah Cohen, Moamen Gabr, Tyler M. Berzin, Douglas K. Pleskow and Mandeep S. Sawhney have no conflicts of interest or financial ties to disclose.

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464_2021_8523_MOESM1_ESM.png

Supplemental figure 1: Dot plots of standardized mean differences before and after propensity-score matching (propensity matched population). Supplementary file1 (PNG 45 KB)

Supplemental figure 2: Propensity score distributions across treatment groups. Supplementary file2 (PNG 15 KB)

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Becq, A., Chandnani, M., Bartley, A. et al. ERCP within 6 or 12 h for acute cholangitis: a propensity score-matched analysis. Surg Endosc 36, 2418–2429 (2022). https://doi.org/10.1007/s00464-021-08523-w

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  • DOI: https://doi.org/10.1007/s00464-021-08523-w

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