Advertisement

Digestive Diseases and Sciences

, Volume 63, Issue 7, pp 1937–1945 | Cite as

No Association of Timing of Endoscopic Biliary Drainage with Clinical Outcomes in Patients with Non-severe Acute Cholangitis

  • Ryunosuke Hakuta
  • Tsuyoshi Hamada
  • Yousuke Nakai
  • Hirofumi Kogure
  • Rie Uchino
  • Naminatsu Takahara
  • Suguru Mizuno
  • Tatsunori Suzuki
  • Tatsuya Sato
  • Tsuyoshi Takeda
  • Kazunaga Ishigaki
  • Kei Saito
  • Tomotaka Saito
  • Minoru Tada
  • Hiroyuki Isayama
  • Kazuhiko Koike
Original Article

Abstract

Background

Biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for acute cholangitis. Despite the established effectiveness of urgent biliary drainage in patients with severe acute cholangitis, the indication of this procedure for non-severe acute cholangitis is controversial.

Aims

To assess the safety of elective drainage (≥ 12 h of admission) for non-severe acute cholangitis.

Methods

We retrospectively identified 461 patients with non-severe acute cholangitis who underwent endoscopic biliary drainage. Using linear regression models with adjustment for a variety of potential confounders, we compared elective versus urgent biliary drainage (< 12 h of admission) in terms of clinical outcomes. The primary outcome was the length of stay.

Results

There were 98 and 201 patients who underwent elective and urgent biliary drainage, respectively. The median length of stay was 11 days in both groups (P = 0.52). The timing of ERCP was not associated with length of stay in the multivariable model (P = 0.52). Secondary outcomes including in-hospital mortality and recurrence of cholangitis were not different between the groups.

Conclusions

Elective biliary drainage was not associated with worse clinical outcomes of non-severe acute cholangitis as compared to urgent drainage. Further investigation is warranted to justify the elective drainage for non-severe cholangitis.

Keywords

Drainage Cholangitis Endoscopic retrograde cholangiopancreatography Length of stay 

Notes

Author’s contribution

RH, TH, and YN contributed to conception and design of the study, analysis and interpretation of the data, and drafting of the article. HK, RU, NT, SM, TS, TS, TT, KI, KS, TS, MT, HI, YN, and KK contributed to critical revision of the article for important intellectual content. All authors contributed to the final approval of the article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2018_5058_MOESM1_ESM.docx (46 kb)
Supplementary material 1 (DOCX 45 kb)

References

  1. 1.
    Kogure H, Tsujino T, Yamamoto K, et al. Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage. J Gastroenterol. 2011;46:1411–1417.CrossRefPubMedGoogle Scholar
  2. 2.
    van Santvoort HC, Besselink MG, de Vries AC, et al. Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study. Ann Surg. 2009;250:68–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Umefune G, Kogure H, Hamada T, et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study. J Gastroenterol. 2017;52:734–745.CrossRefPubMedGoogle Scholar
  4. 4.
    Salek J, Livote E, Sideridis K, et al. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol. 2009;43:171–175.CrossRefPubMedGoogle Scholar
  5. 5.
    Pang YY, Chung YA. Predictors for emergency biliary decompression in acute cholangitis. Eur J Gastroenterol Hepatol. 2006;18:727–731.CrossRefPubMedGoogle Scholar
  6. 6.
    Tsujino T, Sugita R, Yoshida H, et al. Risk factors for acute suppurative cholangitis caused by bile duct stones. Eur J Gastroenterol Hepatol. 2007;19:585–588.CrossRefPubMedGoogle Scholar
  7. 7.
    Ramchandani M, Pal P, Reddy DN. Endoscopic management of acute cholangitis as a result of common bile duct stones. Dig Endosc. 2017;29(Suppl 2):78–87.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsuchiya T, Sofuni A, Tsuji S, et al. Endoscopic management of acute cholangitis according to the TG13. Dig Endosc.. 2017;29(Suppl 2):94–99.CrossRefPubMedGoogle Scholar
  9. 9.
    Okamoto K, Takada T, Strasberg SM, et al. TG13 management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:55–59.CrossRefPubMedGoogle Scholar
  10. 10.
    Kiriyama S, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19:548–556.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Miura F, Takada T, Strasberg SM, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:47–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Miura F, Okamoto K, Tokyo Takada T, Takada T, Tokyo Guidelines, et al. Iinitial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;.  https://doi.org/10.1002/jhbp.509.Google Scholar
  13. 13.
    Navaneethan U, Gutierrez NG, Jegadeesan R, et al. Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis. Gastrointestl Endosc. 2013;78:81–90.CrossRefGoogle Scholar
  14. 14.
    Khashab MA, Tariq A, Tariq U, et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol. 2012;10:1157–1161.CrossRefPubMedGoogle Scholar
  15. 15.
    Lee F, Ohanian E, Rheem J, et al. Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis. Aliment Pharmacol Ther. 2015;42:212–220.CrossRefPubMedGoogle Scholar
  16. 16.
    Jang SE, Park SW, Lee BS, et al. Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP. Dig Dis Sci. 2013;58:2082–2087.CrossRefPubMedGoogle Scholar
  17. 17.
    Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol.. 2009;7:303–310.CrossRefPubMedGoogle Scholar
  18. 18.
    Palmer WL, Bottle A, Davie C, et al. Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care. Arch Neurol. 2012;69:1296–1302.CrossRefPubMedGoogle Scholar
  19. 19.
    Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenterol Hepatol. 2009; 7:296–302e291.Google Scholar
  20. 20.
    Gallerani M, Imberti D, Ageno W, et al. Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends. Thromb Haemost. 2011;106:83–89.CrossRefPubMedGoogle Scholar
  21. 21.
    Kostis WJDK, Marcella SW, Shao YH, et al. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007;356:1099–1109.CrossRefPubMedGoogle Scholar
  22. 22.
    Hamada T, Yasunaga H, Nakai Y, et al. No weekend effect on outcomes of severe acute pancreatitis in Japan: data from the diagnosis procedure combination database. J Gastroenterol. 2016;51:1063–1072.CrossRefPubMedGoogle Scholar
  23. 23.
    Inamdar S, Sejpal DV, Ullah M, et al. Weekend vs. weekday admissions for cholangitis requiring an ERCP: comparison of outcomes in a national cohort. Am J Gastroenterol. 2016;111:405–410.CrossRefPubMedGoogle Scholar
  24. 24.
    Tabibian JH, Yang JD, Baron TH, et al. Weekend admission for acute cholangitis does not adversely impact clinical or endoscopic outcomes. Dig Dis Sci. 2016;61:53–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Parikh ND, Issaka R, Lapin B, et al. Inpatient weekend ERCP is associated with a reduction in patient length of stay. Am J Gastroenterol. 2014;109:465–470.CrossRefPubMedGoogle Scholar
  26. 26.
    Hou LA, Laine L, Motamedi N, et al. Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol. 2017;51:534–538.CrossRefPubMedGoogle Scholar
  27. 27.
    Mok SR, Mannino CL, Malin J, et al. Does the urgency of endoscopic retrograde cholangiopancreatography (ercp)/percutaneous biliary drainage (pbd) impact mortality and disease related complications in ascending cholangitis? (deim-i study). J Interv Gastroenterol. 2012;2:161–167.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.CrossRefPubMedGoogle Scholar
  29. 29.
    Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–243.CrossRefPubMedGoogle Scholar
  30. 30.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMedGoogle Scholar
  31. 31.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–458.CrossRefPubMedGoogle Scholar
  32. 32.
    Tan M, Schaffalitzky de Muckadell OB, Laursen SB. Association between early ERCP and mortality in patients with acute cholangitis. Gastrointest Endosc. 2017;.  https://doi.org/10.1016/j.gie.2017.04.009.Google Scholar
  33. 33.
    Isayama H, Yasuda I, Tan D. Current strategies for endoscopic management of acute cholangitis. Dig Endosc. 2017;29(Suppl 2):70–77.CrossRefPubMedGoogle Scholar
  34. 34.
    Kiriyama S, Takada T, Hwang TL, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci. 2017;24:329–337.CrossRefPubMedGoogle Scholar
  35. 35.
    Kiriyama S, Kozaka K, Takada T, et al. Diagnostic and severity grading criteria for acute cholangitis in the Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017;.  https://doi.org/10.1002/jhbp.512.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ryunosuke Hakuta
    • 1
  • Tsuyoshi Hamada
    • 1
    • 2
  • Yousuke Nakai
    • 1
  • Hirofumi Kogure
    • 1
  • Rie Uchino
    • 1
  • Naminatsu Takahara
    • 1
  • Suguru Mizuno
    • 1
  • Tatsunori Suzuki
    • 1
  • Tatsuya Sato
    • 1
  • Tsuyoshi Takeda
    • 1
  • Kazunaga Ishigaki
    • 1
  • Kei Saito
    • 1
  • Tomotaka Saito
    • 1
  • Minoru Tada
    • 1
  • Hiroyuki Isayama
    • 1
    • 3
  • Kazuhiko Koike
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoBunkyo-kuJapan
  2. 2.Department of Oncologic PathologyDana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA
  3. 3.Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan

Personalised recommendations