Abstract
Purpose
We retrospectively assessed post-EST complications and examined whether combination therapy comprising endoscopic biliary drainage (EBD) plus endoscopic sphincterotomy (EST) as the initial treatment is safe in patients with acute cholangitis due to choledocholithiasis.
Methods
Among the 363 consecutive patients with acute cholangitis due to choledocholithiasis who were treated in our hospital between December 1992 and December 2006, the subjects comprised 127 patients with moderate acute cholangitis for whom EBD and EST were carried out. Factors influencing risk factors for post-EST pancreatitis, hemorrhage and hospitalization were determined by multivariate analysis.
Results
Multivariate analysis revealed that only precut sphincterotomy (PST) was a significant risk factor for post-EST pancreatitis, and the incidence of pancreatitis in patients who underwent PST was significantly higher than that in those who did not (P = 0.041). Only age was a significant risk factor for post-EST hemorrhage, and younger patients were likely to experience hemorrhage after EST (P = 0.021). Total bilirubin and the timing of EST were significant factors associated with hospitalization. Hospitalization in patients who underwent EBD plus EST as the initial treatment (emergency EST) was significantly shorter than that in those who palliatively underwent EST after EBD (elective EST; 11.8 vs. 16.2 days, P = 0.001).
Conclusions
Combination therapy comprising EBD plus EST as the initial treatment for patients with moderate acute cholangitis due to choledocholithiasis was safe and did not prolong the period of hospitalization.
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References
Sugiyama M, Atomi Y. Treatment of acute cholangitis due to choledocholithiasis in elderly and younger patients. Arch Surg. 1997;132:1129–33.
Hui CK, Lai KC, Yuen MF, Matthew NG, Chan CK, Wayne HU, et al. Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis? Gastrointest Endosc. 2003;58:500–4.
Sharma BC, Kumar R, Agarwal N, Sarin SK. Endoscopic biliary drainage by nasobiliary drain or by stent placement in patients with acute cholangitis. Endoscopy. 2005;37:439–43.
Kawai K, Akasaka Y, Murakami K, Tada M, Kohli Y, Nakajima M. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974;20:148–51.
Komatsu Y, Kawabe T, Toda N, Ohashi M, Isayama M, Tateishi K, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases. Endoscopy. 1998;30:12–7.
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18.
Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreas Surg. 2007;14:1–10.
Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreas Surg. 2007;14:27–34.
Ikeda S, Tanaka M, Itoh H, Tamura R. A newly devised cutting probe for endoscopic sphincterotomy of the ampulla of Vater. Endoscopy. 1977;9:238–41.
Ueki T, Otani K, Kawamoto K, Shimizu A, Fujimura N, Sakaguchi S, et al. Comparison between ulinastatin and gabexate mesylate for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective, randomized trial. J Gastroenterol. 2007;42:161–7.
Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreas Surg. 2007;14:52–8.
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–93.
Sugiyama M, Atomi Y. The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. Am J Gastroenterol. 1998;93:2065–8.
Smithline A, Silverman W, Rogers D, Nisi R, Wiersema M, Jamidar P, et al. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients. Gastrointest Endosc. 1993;39:652–7.
Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003;57:291–4.
Sofuni A, Maguchi H, Itoi T, Katanuma A, Hisai H, Niido T, et al. Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent. Clin Gastroenterol Hepatol. 2007;5:1339–46.
Deans GT, Sedman P, Martin DF, Royston CMS, Leow CK, Thomas WES, et al. Are complications of endoscopic sphincterotomy age related? GUT. 1997;41:545–8.
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The English used in this manuscript was revised by Miss K. Miller (Royal English Language Centre, Fukuoka, Japan).
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Ueki, T., Otani, K., Fujimura, N. et al. Comparison between emergency and elective endoscopic sphincterotomy in patients with acute cholangitis due to choledocholithiasis: is emergency endoscopic sphincterotomy safe?. J Gastroenterol 44, 1080–1088 (2009). https://doi.org/10.1007/s00535-009-0100-4
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DOI: https://doi.org/10.1007/s00535-009-0100-4